Computed tomography versus ultrasound for the diagnosis of acute cholecystitis: a systematic review and meta-analysis

Objectives

Some patients undergo both computed tomography (CT) and ultrasound (US) sequentially as part of the same evaluation for acute cholecystitis (AC). Our goal was to perform a systematic review and meta-analysis comparing the diagnostic performance of US and CT in the diagnosis of AC.

Materials and methods

Databases were searched for relevant published studies through November 2023. The primary objective was to compare the head-to-head performance of US and CT using surgical intervention or clinical follow-up as the reference standard. For the secondary analysis, all individual US and CT studies were analyzed. The pooled sensitivities, specificities, and areas under the curve (AUCs) were determined along with 95% confidence intervals (CIs). The prevalence of imaging findings was also evaluated.

Results

Sixty-four studies met the inclusion criteria. In the primary analysis of head-to-head studies (n = 5), CT had a pooled sensitivity of 83.9% (95% CI, 78.4–88.2%) versus 79.0% (95% CI, 68.8–86.6%) of US (p = 0.44). The pooled specificity of CT was 94% (95% CI, 82.0–98.0%) versus 93.6% (95% CI, 79.4–98.2%) of US (p = 0.85). The concordance of positive or negative test between both modalities was 82.3% (95% CI, 72.1–89.4%). US and CT led to a positive change in management in only 4 to 8% of cases, respectively, when ordered sequentially after the other test.

Conclusion

The diagnostic performance of CT is comparable to US for the diagnosis of acute cholecystitis, with a high rate of concordance between the two modalities.

Clinical relevance statement

A subsequent US after a positive or negative CT for suspected acute cholecystitis may be unnecessary in most cases.

Key Points

When there is clinical suspicion of acute cholecystitis, patients will often undergo both CT and US.

CT has similar sensitivity and specificity compared to US for the diagnosis of acute cholecystitis.

The concordance rate between CT and US for the diagnosis of acute cholecystitis is 82.3%.

Graphical Abstract