From the Guidelines
Angiography is not a primary diagnostic tool for cholecystitis, and its use is generally limited to complicated cases with suspected vascular complications. The diagnosis of cholecystitis typically involves imaging modalities such as ultrasound, CT, and HIDA scans, which provide better diagnostic information for gallbladder inflammation 1.
Types of Angiograms
There are several types of angiograms that can be used in the diagnosis and treatment of cholecystitis, including:
- Conventional angiography: This involves injecting contrast material into the blood vessels to visualize them on an X-ray.
- CT angiography: This uses CT scans to visualize the blood vessels after contrast material has been injected.
- Magnetic resonance angiography (MRA): This uses MRI to visualize the blood vessels without the need for contrast material. However, these are not typically used as first-line diagnostic tools for cholecystitis.
Role of Angiography in Cholecystitis
Angiography may be used in certain situations, such as:
- Hemorrhagic cholecystitis: Angiography can be used to identify the source of bleeding and embolization can be performed to control it 1.
- Gallbladder ischemia: Angiography can be used to diagnose and treat ischemia of the gallbladder. In therapeutic settings, angiography can be used for transarterial embolization to control bleeding in hemorrhagic cholecystitis, particularly in patients who are poor surgical candidates 1.
Risks and Benefits
The risks of angiography include contrast-induced nephropathy, vascular injury, and allergic reactions to contrast material, which must be weighed against potential benefits in each individual case 1. It is essential to note that the most recent and highest quality study, published in 2024, supports the use of ultrasound and CT scans as the primary diagnostic tools for acute cholecystitis, with a sensitivity of 73% and specificity of 83% for ultrasound, and a sensitivity of 73% and specificity of 94% for CT 1.
From the Research
Angiography in Diagnosing and Treating Cholecystitis
There are no direct references to the use of angiograms in diagnosing and treating cholecystitis in the provided studies. However, the following information can be gathered regarding the diagnosis and treatment of cholecystitis:
- The diagnosis of acute cholecystitis typically involves ultrasonography, which has a sensitivity of approximately 81% and a specificity of approximately 83% 2.
- Hepatobiliary scintigraphy is considered the gold standard diagnostic test when an ultrasound result does not provide a definitive diagnosis 2.
- CT scans can also be used for the diagnosis of acute cholecystitis, especially for complicated cases, and can help decide on emergency treatment 3.
- The treatment of acute cholecystitis usually involves laparoscopic cholecystectomy, which is recommended to be performed within 72 hours of diagnosis 4, 2.
- Other treatment options, such as percutaneous cholecystostomy tube placement, can be used for patients with high perioperative risk or those who are severely ill 2.
Types of Angiograms
Although there is no direct evidence on the use of angiograms in diagnosing and treating cholecystitis, some types of angiograms that can be used in general medical practice include:
- CT angiogram
- MRI angiogram
- Digital subtraction angiogram
- Fluoroscopy-guided angiogram
These types of angiograms are typically used to visualize blood vessels and diagnose vascular conditions, but their use in cholecystitis is not mentioned in the provided studies.
Key Points
- Ultrasonography and hepatobiliary scintigraphy are commonly used for diagnosing acute cholecystitis.
- Laparoscopic cholecystectomy is the recommended treatment for acute cholecystitis.
- CT scans can be used for diagnosing complicated cases of acute cholecystitis.
- There is no direct evidence on the use of angiograms in diagnosing and treating cholecystitis in the provided studies.