Ultrasonographic and spiral CT evaluation of simple and complicated acute cholecystitis: diagnostic protocol assessment based on personal experience and review of the literature

Autor: Gualdi Gf, S. Lanciotti, M. Coniglio, M. De Vargas Macciucca, M. L. De Cicco
Rok vydání: 2006
Předmět:
Adult
Male
medicine.medical_specialty
Biliary Tract Diseases
Cholecystography
medicine.medical_treatment
Gallstones
Sensitivity and Specificity
Predictive Value of Tests
Cholecystitis
Bile
Humans
Medicine
Cholecystectomy
Radiology
Nuclear Medicine and imaging
Aged
Retrospective Studies
Ultrasonography
Neuroradiology
Aged
80 and over
Protocol (science)
medicine.diagnostic_test
business.industry
Air
Gallbladder
Interventional radiology
Retrospective cohort study
General Medicine
Middle Aged
80 and over
acute disease
adult
aged
air
bile
biliary tract diseases
cholecystectomy
cholecystitis
cholecystography
dilatation
emergencies
female
gallbladder
gallstones
gases
humans
male
middle aged
pathologic
predictive value of tests
radiography/surgery/ultrasonography
radiography/ultrasonography
retrospective studies
sensitivity and specificity
spiral computed
tomography
ultrasonography
Predictive value of tests
Acute Disease
Female
Gases
Radiology
Tomography
Emergencies
business
Tomography
Spiral Computed
Dilatation
Pathologic
Zdroj: La radiologia medica. 111:167-180
ISSN: 1826-6983
0033-8362
Popis: The aim of this study was to identify and classify the ultrasonographic and computed tomography (CT) signs of simple and complicated acute cholecystitis and to define the correct diagnostic protocol.We retrospectively reviewed 35 patients (23 men and 12 women; mean age 66.6 years) presenting with acute cholecystitis who were assessed by emergency ultrasonography (US) (30/35 cases) and spiral CT (12/35 cases); all patients underwent emergency surgery. The US signs were analysed and classified as major criteria (wall thickening and stratification, distension, Murphy's sign), minor criteria (bile stones, sludge, and biliary tract dilatation), and complication signs (gas collections, aerobilia, fluid collection, difficult or missed identification of the gallbladder). Imaging results were compared with histological findings (gold standard), and accuracy, sensitivity, specificity, and positive and negative predictive values (PPVs and NPVs) were assessed for each modality. Concordance between the US and CT findings was also evaluated for cases undergoing both examinations; additional findings provided by one or the other modality were also assessed.US had an accuracy of 66.6%, a sensitivity of 37.5%, a specificity of 70%, a PPV of 100%, and an NPV of 58.3%. CT had 100% accuracy, sensitivity, and specificity. Concordance between US and CT was observed for diagnosis of complications, but CT provided additional findings in all cases. The majority of complicated cases undergoing US examination (68.7%) revealed more than two major criteria and one minor criterion or at least one sign of complication.If more than two major signs associated with one minor sign or at least one sign of complication are present at US, CT is mandatory to recognise and thoroughly evaluate the type of complication and indicate appropriate treatment.
Databáze: OpenAIRE
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