Is hepato-imino diacetic acid scan a better imaging modality than abdominal ultrasound for diagnosing acute cholecystitis?

• Published in: The American journal of surgery Vol. 210; no. 3; pp. 473 - 482
• Main Authors: Kaoutzanis, Christodoulos, M.D, Davies, Eric, M.D, Leichtle, Stefan W., M.D, Welch, Kathleen B., M.S., M.P.H, Winter, Suzanne, M.S, Lampman, Richard M., Ph.D, Franz, Michael G., M.D, Arneson, Wallace, M.D
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2015; Elsevier Limited
• Subjects: Abdomen; Abdominal ultrasound; Acids; Acute cholecystitis; Cholecystectomy; Cholecystitis, Acute - diagnostic imaging; Cholecystitis, Acute - surgery; Cholesterol; Confidence intervals; Emergency Service, Hospital; Female; Gallbladder; Gallbladder diseases; HIDA scan; Histology; Hospitals; Humans; Imino Acids; Laboratories; Male; Middle Aged; Negative predictive value; Pain; Positive predictive value; Predictive Value of Tests; Radionuclide Imaging; Retrospective Studies; Sensitivity and Specificity; Studies; Surgery; Time Factors; Ultrasonic imaging; Ultrasonography; Visualization; Positive predictive value; Acute cholecystitis; Sensitivity and Specificity; Abdominal ultrasound; Negative predictive value; HIDA scan
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2015.03.005

Abstract Background The role of hepato-imino diacetic acid scan (HIDA) in the diagnosis of acute cholecystitis remains controversial when compared with the more commonly used abdominal ultrasound (AUS). Methods The diagnostic imaging workup of 1,217 patients who presented to the emergency department at a single hospital with acute abdominal pain and suspicion of acute cholecystitis was reviewed to calculate the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of AUS and HIDA. Results In patients undergoing both imaging modalities, HIDA had significantly higher sensitivity (90.7% vs 64.0%, P < .001) and specificity (71.4% vs 58.4%, P = .005) than AUS for the diagnosis of acute cholecystitis. Additionally, PPV and NPV of HIDA (56.2% and 95.0%, respectively) were higher than PPV and NPV of AUS (38.4% and 80.0%, respectively) when both imaging modalities were used for the same patient. Conclusion In adults with acute abdominal pain, HIDA significantly increases the accuracy of the correct diagnosis.