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

Autor: Childs DD; Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA. dchilds@wakehealth.edu., Lalwani N; Department of Radiology, Virginia Commonwealth University Health, Richmond, VA, USA., Craven T; Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA., Arif H; Department of Medical Imaging, College of Medicine, The University of Arizona, Tucson, AZ, USA., Morgan M; Department of Radiology, University of Pennsylvania Health System, Philadelphia, PA, USA., Anderson M; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA., Fulcher A; Department of Radiology, Virginia Commonwealth University Health, Richmond, VA, USA.
Jazyk: angličtina
Zdroj: Abdominal radiology (New York) [Abdom Radiol (NY)] 2024 Feb; Vol. 49 (2), pp. 384-398. Date of Electronic Publication: 2023 Nov 20.
DOI: 10.1007/s00261-023-04059-w
Abstrakt: 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.
(© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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