Abdominal ultrasound versus hepato-imino diacetic acid scan in diagnosing acute cholecystitis—what is the real benefit?

Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos)

“…The use of US in acute cholecystitis has been well reported, and its ease of use and non‐invasive modality have been described in case series studies . However, the diagnostic yield described in those articles varies according to the device, assessment criteria, and diagnostic criteria used in each of the studies, all of which were of small numbers of patients in single institutions.…”

“…However, the diagnostic yield described in those articles varies according to the device, assessment criteria, and diagnostic criteria used in each of the studies, all of which were of small numbers of patients in single institutions. All studies that have compared the diagnostic yield of hepatobiliary scintigraphy (HIDA scanning) with that of US have found that the diagnostic yield is higher for HIDA scanning , but diagnostic imaging with US is nevertheless recommended in three newly proposed guidelines despite its limited diagnostic yield .…”

Is hepato-imino diacetic acid scan a better imaging modality than abdominal ultrasound for diagnosing acute cholecystitis?

“…15 Patients were considered to have acute cholecystitis on AUS if a diagnosis of ''acute cholecystitis'' or ''likely/ equivocal acute cholecystitis'' was given by a boardcertified, attending radiologist based on the constellation of AUS findings. Several specific AUS findings were also analyzed, including the presence of sonographic Murphy's sign, gallbladder wall thickening greater than 5 mm, presence of pericholecystic fluid, and presence of hydrops with increased transverse gallbladder diameter.…”

“…[12][13][14] To date, the majority of physicians continue to use AUS as the initial imaging modality when suspecting acute cholecystitis. 12,15 We previously described a lower sensitivity of AUS when compared with HIDA scan for the diagnosis of acute cholecystitis. 15 The aim of this study was to more definitively establish the diagnostic utility of the 2 imaging modalities by determining the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of AUS and HIDA scan in a high volume of cases that present to the emergency department with upper abdominal pain suspicious for acute cholecystitis.…”

“…12,15 We previously described a lower sensitivity of AUS when compared with HIDA scan for the diagnosis of acute cholecystitis. 15 The aim of this study was to more definitively establish the diagnostic utility of the 2 imaging modalities by determining the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of AUS and HIDA scan in a high volume of cases that present to the emergency department with upper abdominal pain suspicious for acute cholecystitis. We also evaluated specific combinations of findings present on ultrasound, and assessed the occurrence of these findings in cases with histologically proven disease.…”