title: Sonographic diagnosis of acute cholecystitis in patients with symptomatic gallstones.
abstract: OBJECTIVE
  The aim of the retrospective study was to assess the diagnostic ultrasound (US) criteria for acute cholecystitis in patients admitted for symptomatic gallbladder stones.
  
  
  METHODS
  The medical records of 186 patients who had undergone cholecystectomy within 24 hours after an US examination were reviewed. Acute cholecystitis was defined on the basis of pathology findings. The correlation between standardized US signs and final diagnosis of acute cholecystitis was assessed with univariate and multivariate analyses. The diagnostic values of US based on the correlated signs were then calculated.
  
  
  RESULTS
  The prevalence of acute cholecystitis was 52.7% (95% confidence interval [CI], 42.8-64.2). Three US signs were found to be predictive of acute cholecystitis: gallbladder distension, wall edema, and pericholecystic fluid collection. When none of the US signs were registered, sonography proved to have a 72.4% (95% CI, 59.1-83.3) negative predictive value. When registering two or three signs, sonography had positive predictive values of 78% (95% CI, 56.3-92.5) and 100% (95% CI, 58.9-100), respectively. With just one sign, the positive predictive value was 57.6% (95% CI, 47.2-67.4), and such a finding was furthermore observed in only 53.2% of the cases.
  
  
  CONCLUSIONS
  The sonografic diagnosis of acute cholecystitis may be achieved by registering only three standardized US signs. Nevertheless, in patients admitted for symptomatic gallstones, US is of some utility in less than half of those patients.
authors.affiliation: Department of Surgery, University Hospital of Verona, Piazzale A. Stefani 1, 37126, Verona, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Borzellino
authors.affiliation: Department of Radiology, University Hospital of Verona, Piazzale A. Stefani 1, 37126, Verona, Italy.
authors.forename: A P
authors.initials: AP
authors.lastname: Massimiliano Motton
authors.affiliation: Department of Surgery, University Hospital of Verona, Piazzale A. Stefani 1, 37126, Verona, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Minniti
authors.affiliation: Department of Radiology, University Hospital of Verona, Piazzale A. Stefani 1, 37126, Verona, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Montemezzi
authors.affiliation: Department of Pathology, University Hospital of Verona, Piazzale A. Stefani 1, 37126, Verona, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Tomezzoli
authors.affiliation: Department of Surgery, University Hospital of Verona, Piazzale A. Stefani 1, 37126, Verona, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Genna
mesh_terms: D000208:Acute Disease; D000368:Aged; D041881:Cholecystitis, Acute / Q000000981:diagnostic imaging*; D005260:Female; D005704:Gallbladder / Q000000981:diagnostic imaging; D042882:Gallstones / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000379:methods*
keywords: acute cholecystitis; diagnostic accuracy; gallstones; ultrasonography