title: Abdominal ultrasound versus hepato-imino diacetic acid scan in diagnosing acute cholecystitis--what is the real benefit?
abstract: BACKGROUND
  Acute cholecystitis is one of the most common surgical problems, yet substantial debate remains over the utility of simple examination, abdominal ultrasound (AUS), or advanced imaging such as hepato-imino diacetic acid (HIDA) scan to support the diagnosis.
  
  
  METHODS
  The preoperative diagnostic workup of patients who underwent cholecystectomy with histologically confirmed acute cholecystitis was reviewed to calculate the sensitivity of AUS, HIDA scan, or both. In addition, the sensitivity of the commonly described ultrasonographic findings was assessed.
  
  
  RESULTS
  From 2010 through 2012, 406 patients among 9087 reviewed charts presented to the emergency department with acute upper abdominal pain and met inclusion criteria. 32.5% (N = 132) of patients underwent AUS only, 11.3% (N = 46) underwent HIDA scan only, and 56.2% (N = 228) had both studies performed for workup. 52.7% (N = 214) of patients had histopathologically confirmed acute cholecystitis. The sensitivities of AUS, HIDA, and AUS combined with HIDA for acute cholecystitis were 73.3% (95% confidence interval [CI] = 66.3%-79.5%), 91.7% (95% CI = 86.2%-95.5%), and 97.7% (95% CI = 93.4%-99.5%), respectively. Although of limited sensitivity, AUS findings of sonographic Murphy sign, gallbladder distension, and gallbladder wall thickening were associated with a diagnosis of acute cholecystitis.
  
  
  CONCLUSIONS
  The sensitivity of AUS for diagnosing acute cholecystitis in patients with acute upper abdominal pain is limited. The addition of a HIDA scan in the diagnostic workup significantly improves sensitivity and can add valuable information in the appropriate clinical setting.
authors.affiliation: Department of Surgery, Saint Joseph Mercy Health System, Ann Arbor, Michigan. Electronic address: ckaoutzanis@gmail.com.
authors.forename: Christodoulos
authors.initials: C
authors.lastname: Kaoutzanis
authors.affiliation: Department of Surgery, Saint Joseph Mercy Health System, Ann Arbor, Michigan.
authors.forename: Eric
authors.initials: E
authors.lastname: Davies
authors.affiliation: Department of Surgery, Saint Joseph Mercy Health System, Ann Arbor, Michigan.
authors.forename: Stefan W
authors.initials: SW
authors.lastname: Leichtle
authors.affiliation: Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, Michigan.
authors.forename: Kathleen B
authors.initials: KB
authors.lastname: Welch
authors.affiliation: Department of Surgery, Saint Joseph Mercy Health System, Ann Arbor, Michigan.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Winter
authors.affiliation: Department of Surgery, Saint Joseph Mercy Health System, Ann Arbor, Michigan.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Lampman
authors.affiliation: Department of Surgery, Saint Joseph Mercy Health System, Ann Arbor, Michigan.
authors.forename: Wallace
authors.initials: W
authors.lastname: Arneson
mesh_terms: D000328:Adult; D000368:Aged; D002763:Cholecystectomy; D041881:Cholecystitis, Acute / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D006801:Humans; D007098:Imino Acids; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D014463:Ultrasonography
chemical_list: D007098:Imino Acids; C049470:lidofenin
keywords: Abdominal ultrasound; Acute cholecystitis; HIDA scan; Hepato-imino diacetic acid scan; Sensitivity