Is HIDA Scan Necessary for Sonographically Suspicious Cholecystitis?

Background : Historically, abdominal ultrasound is the study of choice for diagnosing cholelithiasis, whereas HIDA scan is the study of choice for diagnosing acute cholecystitis. With improvements in ultrasound technology over the past two decades, we sought to reevaluate the clinical utility of HIDA scan over ultrasound alone in diagnosing cholecystitis. Methods : A retrospective review of 154 patients admitted to our emergency room with suspicion for cholecystitis who underwent abdominal sonography, HIDA scan, and proceeded to cholecystectomy on the same admission was conducted. Results of ultrasound and HIDA scan were compared to the final surgical pathology. Results : The two groups did not differ with respect to age or gender. HIDA scan had a greater sensitivity, specificity, and accuracy in diagnosing cholecystitis, but the positive predictive value of ultrasound and HIDA scan were similar. Conclusions : While HIDA scan may be the test of choice for diagnosing cholecystitis, it may be unnecessary in patients with sonographically suspicious cholecystitis, as these sonographic features, when present, are highly predictive of cholecystitis. doi: http://dx.doi.org/10.4021/jcs201w