Can CT (Computed Tomography) angiography of the abdomen and pelvis detect cholecystitis?

From the Guidelines

Yes, CT angiography of the abdomen and pelvis can detect cholecystitis, though it is not the first-line imaging test for this condition.

Key Points to Consider

• CT angiography may show gallbladder wall thickening, pericholecystic fluid, gallbladder distention, and surrounding inflammatory changes that suggest cholecystitis, as noted in studies such as 1 and 1.
• It can also identify complications such as perforation, abscess formation, or gangrenous changes.
• However, ultrasound is typically the preferred initial imaging modality for suspected cholecystitis due to its high sensitivity, lack of radiation, lower cost, and widespread availability, as suggested by 1.
• Ultrasound can directly visualize gallstones, which are present in 90-95% of cholecystitis cases, and demonstrate the sonographic Murphy's sign.
• CT angiography becomes particularly valuable when ultrasound results are inconclusive, when there are concerns about complications, or when other intra-abdominal pathologies need to be excluded.
• In cases where cholecystitis is strongly suspected but ultrasound is negative or inconclusive, a hepatobiliary iminodiacetic acid (HIDA) scan offers the highest sensitivity and specificity for diagnosis by demonstrating cystic duct obstruction.

Recommendation Based on Latest Evidence

Given the latest guideline update from 1 in 2024, which suggests obtaining an abdominal CT scan as subsequent imaging to diagnose acute cholecystitis or acute cholangitis if initial US is equivocal/non-diagnostic and clinical suspicion persists, CT angiography of the abdomen and pelvis is a viable option for detecting cholecystitis, especially in scenarios where ultrasound is inconclusive. This approach aligns with prioritizing morbidity, mortality, and quality of life outcomes by ensuring accurate diagnosis and appropriate management of cholecystitis.

From the Research

CT Angiography of Abdomen and Pelvis for Detecting Cholecystitis

• CT angiography of the abdomen and pelvis can be used to detect cholecystitis, as it provides detailed images of the gallbladder and surrounding tissues 2, 3, 4.
• Studies have shown that CT scans are more sensitive than ultrasound for diagnosing acute cholecystitis, with a sensitivity of 92% compared to 79% for ultrasound 4.
• CT scans are also more efficient for diagnosing complicated cases of cholecystitis, such as hemorrhagic or gangrenous cholecystitis 3, 5.
• The use of CT angiography can help identify complications of cholecystitis, such as gallbladder perforation or emphysematous cholecystitis, which can guide surgical planning and management 5.
• However, it's worth noting that ultrasound is still a useful tool for evaluating gallstone disease and can be used in conjunction with CT scans for a more comprehensive diagnosis 2, 4.
• The choice of imaging modality may depend on the clinical presentation and suspicion of complications, as well as the availability of resources and expertise 3, 6.