Does ultrasonography accurately diagnose acute cholecystitis? Improving diagnostic accuracy based on a review at a regional hospital

Abstract

Background: Acute cholecystitis is one of the most common diseases requiring emergency surgery. Ultrasonography is an accurate test for cholelithiasis but has a high falsenegative rate for acute cholecystitis. The Murphy sign and laboratory tests performed independently are also not particularly accurate. This study was designed to review the accuracy of ultrasonography for diagnosing acute cholecystitis in a regional hospital. Methods:We studied all emergency cholecystectomies performed over a 1-year period. All imaging studies were reviewed by a single radiologist, and all pathology was reviewed by a single pathologist. The reviewers were blinded to each other's results.Results: A total of 107 patients required an emergency cholecystectomy in the study period; 83 of them underwent ultrasonography. Interradiologist agreement was 92% for ultrasonography. For cholelithiasis, ultrasonography had 100% sensitivity, 18% specificity, 81% positive predictive value (PPV) and 100% negative predictive value (NPV). For acute cholecystitis, it had 54% sensitivity, 81% specificity, 85% PPV and 47% NPV. All patients had chronic cholecystitis and 67% had acute cholecystitis on histology. When combined with positive Murphy sign and elevated neutrophil count, an ultrasound showing cholelithiasis or acute cholecystitis yielded a sensitivity of 74%, specificity of 62%, PPV of 80% and NPV of 53% for the diagnosis of acute cholecystitis. Conclusion:Ultrasonography alone has a high rate of false-negative studies for acute cholecystitis. However, a higher rate of accurate diagnosis can be achieved using a triad of positive Murphy sign, elevated neutrophil count and an ultrasound showing cholelithiasis or cholecystitis.Contexte : La cholécystite aiguë est l'une des maladies les plus répandues exigeant une chirurgie d'urgence. L'échographie est un test précis pour le dépistage de la cholélithiase, mais elle s'accompagne d'un taux élevé de diagnostics faux-négatifs de cholécystite aiguë. Le signe de Murphy et les analyses de laboratoire effectuées indépendamment ne sont pas non plus particulièrement précis. Cette étude a été conçue pour vérifier la précision de l'échographie dans le diagnostic de la cholécystite aiguë dans un hôpital régional.Méthodes : Nous avons passé en revue toutes les cholécystectomies d'urgence effectuées sur une période d'un an. Toutes les épreuves d'imagerie ont été examinées par un seul radiologue et toutes les analyses d'anatomopathologie, par un seul anatomopathologiste. Les examinateurs n'étaient pas au courant de leurs conclusions respectives.Résultats : En tout, 107 patients ont eu besoin d'une cholécystectomie d'urgence au cours de la période de l'étude; 83 ont subi une échographie. La concordance d'opinion entre les radiologues a été de 92 % en ce qui concerne l'échographie. Pour la cholélithiase, l'échographie a présenté une sensibilité de 100 %, une spécificité de 18 %, une valeur prédictive positive (VPP) de 81 % et une valeur prédictive négative (VPN) de 100 %. En ce qui concerne la cholécystite aiguë...

The Role of Procalcitonin in Evaluation of the Severity of Acute Cholecystitis

“…Ultrasonographic imaging examination determines the diagnosis of cholelithiasis with almost 98% sensitivity. Its diagnostic value for AC patients was reported as 54%-90% in the literature [12,13]. Moreover, no correlation has been reported between USI findings and histopathological results for AC [7].…”

C-reactive protein has a better discriminative power than white cell count in the diagnosis of acute cholecystitis

“…Persistent abdominal pain has 80% sensitivity and 49% specificity (18). Murphy's sign has sensitivity of 68% and specificity of 45%, abdominal tenderness 91% and 20%, respectively (9,18).Temperature > 37.5 C has sensitivity of 3% and 100% specificity, WCC > 9.7 x 10^9/L 64% sensitivity and 47% specificity (9).…”

“…The diagnosis of AC based on right upper quadrant pain and tenderness, fever, Guidelines (TG07, TG13) and added to existing diagnostic criteria of AC ( Murphy's sign, right upper quadrant mass/pain/tenderness, fever, elevated white cell count , liver ultrasound , magnetic resonance imaging, computed tomography and Tc-HIDA scan) Creactive protein (CRP) (5,6). CRP is not used as a diagnostic bench mark for AC in the United States, Canada, Europe, India, Australia and New Zealand CRP (7)(8)(9)(10)(11). In this setting, reliance on an elevated WCC as a criterion of AC would misdiagnose this condition in neutropenic patients.…”

Results of emergency management of acute abdomen in adults based on clinical assessment and basic imaging investigations: are advanced imaging techniques always necessary for successful treatment?

“…8,13,14 In current study, almost 83 % cases of urolithiasis were diagnosed accurately by ultrasound examination of the abdomen as compared to 62 % diagnostic accuracy reported by Haroun AA et al 15 In this study, CECT helped in diagnosis and treatment of 9 patients. Four patients out of 5 suffering from intestinal obstruction were treated surgically and all 5 patients diagnosed as pancreatitis were managed conservatively bases on CECT scan reports.…”

“…Similar results have been reported in a study by Hwang H et al which correlates well with observations of the present study. 8 It was also observed that 1 out of 3 patients with acute abdomen was suffering from more serious conditions such as pancreatitis, intestinal obstruction with / without intestinal perforation.…”