title: Computed Tomography Is More Sensitive than Ultrasound for the Diagnosis of Acute Cholecystitis.
abstract: BACKGROUND
  Ultrasound (US) is the first-line diagnostic study for evaluating gallstone disease and is considered the test of choice for diagnosing acute cholecystitis (AC). However, computed tomography (CT) is used widely for the evaluation of abdominal pain and is often obtained as a first abdominal imaging test, particularly in cases in which typical clinical signs of AC are absent or other possible diagnoses are being considered. We hypothesized that CT is more sensitive than US for diagnosing AC.
  
  
  METHODS
  A prospective registry of all urgent cholecystectomies performed by our acute care surgery service between June 2008 and January 2014 was searched for cases of AC. The final diagnosis was based on operative findings and pathology. Patients were classified into two groups according to pre-operative radiographic work-up: US only or CT and US. The US group was compared with the CT and US group with respect to clinical and demographic characteristics. For patients undergoing both tests the sensitivity of the two tests was compared.
  
  
  RESULTS
  One hundred one patients with AC underwent both US and CT. Computed tomography was more sensitive than US for the diagnosis of AC (92% versus 79%, p=0.015). Ultrasound was more sensitive than CT for identification of cholelithiasis (87% versus 60%, p<0.01). Patients undergoing both tests prior to surgery were more likely to be older, male, have medical comorbidities, and lack typical clinical signs of AC.
  
  
  CONCLUSIONS
  Computed tomography is more sensitive than US for the diagnosis of AC and is most often used in patients without typical clinical signs of AC.
authors.affiliation: Department of Surgery, Division of Trauma, Emergency Surgery and Critical Care, Massachusetts General Hospital and Harvard Medical School , Boston, Massachusetts.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Fagenholz
authors.affiliation: Department of Surgery, Division of Trauma, Emergency Surgery and Critical Care, Massachusetts General Hospital and Harvard Medical School , Boston, Massachusetts.
authors.forename: Eva
authors.initials: E
authors.lastname: Fuentes
authors.affiliation: Department of Surgery, Division of Trauma, Emergency Surgery and Critical Care, Massachusetts General Hospital and Harvard Medical School , Boston, Massachusetts.
authors.forename: Haytham
authors.initials: H
authors.lastname: Kaafarani
authors.affiliation: Department of Surgery, Division of Trauma, Emergency Surgery and Critical Care, Massachusetts General Hospital and Harvard Medical School , Boston, Massachusetts.
authors.forename: Catrina
authors.initials: C
authors.lastname: Cropano
authors.affiliation: Department of Surgery, Division of Trauma, Emergency Surgery and Critical Care, Massachusetts General Hospital and Harvard Medical School , Boston, Massachusetts.
authors.forename: David
authors.initials: D
authors.lastname: King
authors.affiliation: Department of Surgery, Division of Trauma, Emergency Surgery and Critical Care, Massachusetts General Hospital and Harvard Medical School , Boston, Massachusetts.
authors.forename: Marc
authors.initials: M
authors.lastname: de Moya
authors.affiliation: Department of Surgery, Division of Trauma, Emergency Surgery and Critical Care, Massachusetts General Hospital and Harvard Medical School , Boston, Massachusetts.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Butler
authors.affiliation: Department of Surgery, Division of Trauma, Emergency Surgery and Critical Care, Massachusetts General Hospital and Harvard Medical School , Boston, Massachusetts.
authors.forename: George
authors.initials: G
authors.lastname: Velmahos
authors.affiliation: Department of Surgery, Division of Trauma, Emergency Surgery and Critical Care, Massachusetts General Hospital and Harvard Medical School , Boston, Massachusetts.
authors.forename: Yuchiao
authors.initials: Y
authors.lastname: Chang
authors.affiliation: Department of Surgery, Division of Trauma, Emergency Surgery and Critical Care, Massachusetts General Hospital and Harvard Medical School , Boston, Massachusetts.
authors.forename: D Dante
authors.initials: DD
authors.lastname: Yeh
mesh_terms: D000328:Adult; D041881:Cholecystitis, Acute / Q000175:diagnosis*; D003955:Diagnostic Tests, Routine / Q000379:methods*; D005260:Female; D005704:Gallbladder / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011860:Radiography, Abdominal / Q000379:methods*; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014463:Ultrasonography / Q000379:methods*