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Ultrasound (US) and cholescintigraphy (e.g., hepatobiliary iminodiacetic acid [HIDA] scanning) are used widely to evaluate patients with suspected acute cholecystitis. Additionally, emergency department clinicians sometimes order computed tomography (CT) as the initial test, especially when they are considering both biliary and nonbiliary causes of abdominal pain.
To address the diagnostic accuracy of imaging tests for acute cholecystitis, researchers performed a meta-analysis of 57 studies with explicitly stated criteria for positive tests and with surgery and clinical follow-up as reference standards. Cholescintigraphy was evaluated in 40 studies, and US was evaluated in 26 studies; CT and magnetic resonance imaging were evaluated in only …