title: Fluorodeoxyglucose positron emission tomography-computed tomography: a novel approach for the diagnosis of cholecystitis for equivocal diagnoses after ultrasound imaging.
abstract: Although hepatobiliary iminodiacetic acid (HIDA) scan is often used when the diagnosis of cholecystitis remains questionable after ultrasound, it carries a high false-positive rate and has other limitations. Fluorodeoxyglucose positron emission tomography-computed tomography (18FDG PET-CT) has recently gained enthusiasm for its ability to detect infection and inflammation. In this study, we evaluate the accuracy of 18FDG PET-CT in diagnosing cholecystitis. Nineteen patients with suspected cholecystitis (Group S) underwent PET-CT and 10 had positive PET-CT findings. Of these 10, nine underwent cholecystectomies, and pathology confirmed cholecystitis in all nine. One patient was managed nonoperatively as a result of multiple comorbidities. Of the nine patients with negative PET-CT, six were managed nonoperatively, safely discharged, and had no readmissions at 3-month follow-up. The other three patients with negative PET-CT underwent cholecystectomies, and two showed no cholecystitis on pathology. The third had mild to moderate cholecystitis with focal mucosal erosion/ulceration without gallbladder wall thickening on pathology. 18FDG PET-CT detected gallbladder inflammation in all but one patient with pathology-proven cholecystitis with a sensitivity and specificity of 0.90 and 1.00, respectively. 18FDG-PET-CT appears to be a promising, rapid, direct, and accurate test in diagnosing cholecystitis and could replace HIDA scan in cases that remain equivocal after ultrasound.
authors.affiliation: Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
authors.forename: Yosef
authors.initials: Y
authors.lastname: Nasseri
authors.forename: Ariel J
authors.initials: AJ
authors.lastname: Ourian
authors.forename: Alan
authors.initials: A
authors.lastname: Waxman
authors.forename: Alessandro
authors.initials: A
authors.lastname: D'Angolo
authors.forename: Louise E
authors.initials: LE
authors.lastname: Thomson
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Margulies
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002764:Cholecystitis / Q000000981:diagnostic imaging*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18