Prospective evaluation of 99mTc-IDA cholescintigraphy and gray-scale ultrasound in the diagnosis of acute cholecystitis.

Abstract

Prospective analysis of the efficacy of 99mTc-IDA cholescintigraphy and cholecystosonography showed that both are excellent techniques for assessing patients with suspected acute cholecystitis (accuracy 84.7% and 88.1% respectively). Consequently, the choice of tests selected to evaluate patients with suspected acute cholecystitis depends on several factors including; (a.) quality of equipment available; (b.) capability of the technologist performing the examination; (c.) relative experience of the physician supervising the examination; and (d.) willingness of the surgical consultant to accept a positive examination as sufficient evidence to perform emergency surgery. The authors feel that cholecystosonography should be used to assess the presence of acute cholecystitis in jaundiced patients because of its capability in the assessment of bile duct dilatation, and because of the lower reliability of cholescintigraphy when bile duct obstruction is possible (i.e., in jaundice). Ancillary findings in cholecystosonography and cholescintigraphy can aid in the differential diagnosis of acute right upper quandrant pain syndromes.

A Prospective Evaluation of Emergency Department Bedside Ultrasonography for the Detection of Acute Cholecystitis

“…Radiology ultrasonography has been shown to be accurate to diagnose cholelithiasis and acute cholecystitis in patients referred from the ED, 16,[21][22][23][24][25][26][27][28][29][30][31] but it is limited by its routine availability and portability. To facilitate throughput, rapidly narrow the differential diagnosis, and institute early treatment, emergency physicians are increasingly using bedside ultrasonography in the initial evaluation of patients with suspected cholecystitis.…”

Contribution of ultrasonography and cholescintigraphy to the diagnosis of acute acalculous cholecystitis in intensive care unit patients

“…Initial retrospective reports using cholescintigraphy claimed 98 % accuracy and 100 % specificity in symptomatic patients [21,25,26]. Some authors have supported cholescintigraphy as the procedure of choice for acute cholecystitis diagnosis [22,23,25].…”

“…Under the same conditions Araki [33] observed a correlation of 86 %. Some studies comparing US and cholescintigraphy have reached the opposite conclusion [2,9,25,26]. Other authors feel that cholescintigraphy should be the screening test of choice for patients with suspected acute cholecystitis.…”

Diagnosis ofacute cholecystitis using ultrasonography

“…US is one of the methods most frequently used in thediagnosis of acute cholecystitis; however, several studies have stressed the limitations of the method related to the operator's expertise, the ultrasound machines used and the possibility of performing the investigation at the bedside [19][20][21] . There are also studies proving the accuracy and advantages of US performed in emergency as compared to hepato- [22,23] or computer tomography [24] .Summers and Colab. studied a better accuracy of US performed in the emergency setting than that of the same method performed by radiologists for the identificationof surgical conditions such as acute cholecystitis [25] .The originality of the study resides in the correlation of the clinical and ultrasonographic aspects with intra-operatory findings, as well as in the analysis of sonographicrole in the diagnosis of different forms of cholecystitis.The incidence of acute cholecystitis was higher in female patients,andmost of the patient who complain of acute calculuscholecystitis created at age between (41-50) years old, The results of the present study confirm the variations in lithiasis incidence, as stated in the epidemiological literature [26,27] .…”