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Abdominal Radiology

20-11-2023 | Cholecystitis | Special Section: Benign Biliary Disease

A meta-analysis of the performance of ultrasound, hepatobiliary scintigraphy, CT and MRI in the diagnosis of acute cholecystitis

Authors: David D. Childs, Neeraj Lalwani, Timothy Craven, Hina Arif, Mathew Morgan, Mark Anderson, Ann Fulcher

Published in: Abdominal Radiology

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Abstract

Purpose

To evaluate the recently reported relative diagnostic accuracy of US, CT, MRI, and cholescintigraphy for diagnosing acute cholecystitis.

Methods

2 radiologists independently performed systematic electronic searches for articles published between 2000 and 2021 and applied inclusion/exclusion criteria. 2 different radiologists extracted data from the articles and scored each with a methodological quality tool. Pooled estimates of sensitivity and specificity were calculated with a bivariate linear mixed model. A second analysis made head-to-head comparisons (US vs. CT, US vs. cholescintigraphy). Factors were also analyzed for potential confounding effects on diagnostic accuracy.

Results

Of 6121 initial titles, 22 were included. The prevalence of cholecystitis varied widely across studies (9.4–98%). Pooled sensitivity and specificity estimates were 69% (confidence limit [CL] 62–76%) and 79% (CL 71–86%) for US, 91% (CL 86–94%) and 63% (CL 51–74%) for cholescintigraphy, 78% (CL 69–84%) and 81% (CL 71–88%) for CT, and 91% (CL 78–97%) and 93% (CL 70–99%) for MRI. Regarding head-to-head comparisons, the sensitivity of CT (87.6%, CL 70–96%) was significantly higher than US (66.8%, CL 43–84%), while specificities (81.7% with CL 54–95% for US, 91.9% with CL 67–99% for CT) were similar. The sensitivity of cholescintigraphy (87.4%, CL 76–94%) was significantly greater than US (61.6%, CL 44–77%), while the specificity of US (82%, CL 65–92%) was significantly higher than cholescintigraphy (68%, CL 47–84%).

Conclusion

Recent data suggests that CT may have a higher sensitivity than US for diagnosing acute cholecystitis, with similar specificity. Cholescintigraphy remains a highly sensitive modality with lower specificity than previously reported. MRI remains under studied, but with promising results.
Appendix
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Metadata
Title
A meta-analysis of the performance of ultrasound, hepatobiliary scintigraphy, CT and MRI in the diagnosis of acute cholecystitis
Authors
David D. Childs
Neeraj Lalwani
Timothy Craven
Hina Arif
Mathew Morgan
Mark Anderson
Ann Fulcher
Publication date
20-11-2023
Publisher
Springer US
Published in
Abdominal Radiology
Print ISSN: 2366-004X
Electronic ISSN: 2366-0058
DOI
https://doi.org/10.1007/s00261-023-04059-w
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