title: Single-photon emission computed tomography/computed tomography as a problem-solving tool in patients with suspected acute cholecystitis.
abstract: OBJECTIVE
  The aim of this study was to evaluate our institutional experience with single-photon emission computed tomography/computed tomography (SPECT/CT) hepatobiliary imaging as a problem-solving tool in the workup of suspected acute cholecystitis.
  
  
  METHODS
  We queried our radiology information system database for cases in which SPECT/CT had been performed as part of the routine hepatobiliary technetium Tc 99m iminodiacetic acid studies done for the evaluation of acute cholecystitis. Fifty-three consecutive patients who had SPECT/CT after planar imaging were included. This cohort represents cases that were considered problematic by the initial interpreting physician on the basis of planar images. The planar and SPECT/CT images were retrospectively reviewed independently and separately by 2 experienced nuclear medicine specialists who evaluated the planar images for visualization of the gallbladder on a binary scale (yes or no) and rated their level of confidence on an ordinal scale(unsure, somewhat sure, and sure).
  
  
  RESULTS
  Single-photon emission CT/CT would have led to change in the management for interpreter 1 in a total of 23 cases (41%), with change from normal to abnormal scan findings (28%) and from abnormal to normal scan findings (13%). Similarly, SPECT/CT would have led to change in the management for interpreter 2 in a total of 23 cases (43%), with change from normal to abnormal scan findings (13%) and from abnormal to normal scan findings (30%).
  
  
  CONCLUSIONS
  Although planar hepatobiliary scanning is usually sensitive and specific, there are occasionally problematic cases. In our experience, we found that the addition of SPECT/CT improved the interobserver agreement and may change management in patients with superimposed bowel activity and/or unusual gallbladder anatomy that can confound the planar interpretation.
authors.affiliation: From the*Department of Radiology, Division of Nuclear Medicine, University of Michigan Health Systems, Ann Arbor; and †Division of Nuclear Medicine, Veterans Affairs Health System, Ann Arbor, MI.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Arabi
authors.forename: Richard K J
authors.initials: RK
authors.lastname: Brown
authors.forename: Ben A
authors.initials: BA
authors.lastname: Dwamena
authors.forename: Eric
authors.initials: E
authors.lastname: Jakubowski
authors.forename: Kyu
authors.initials: K
authors.lastname: Kim
authors.forename: Rolando
authors.initials: R
authors.lastname: Alvarez
authors.forename: Morand
authors.initials: M
authors.lastname: Piert
authors.forename: Kirk
authors.initials: K
authors.lastname: Frey
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D041881:Cholecystitis, Acute / Q000175:diagnosis* / Q000453:epidemiology*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D064847:Multimodal Imaging / Q000706:statistics & numerical data*; D015995:Prevalence; D011379:Prognosis; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D019784:Technetium Tc 99m Diethyl-iminodiacetic Acid; D015899:Tomography, Emission-Computed, Single-Photon / Q000706:statistics & numerical data*; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D019275:Radiopharmaceuticals; D019784:Technetium Tc 99m Diethyl-iminodiacetic Acid