From the Guidelines
The initial diagnostic imaging for biliary colic is ultrasound (US).
Rationale
- US is suggested as the initial imaging modality for suspected acute cholecystitis or acute cholangitis in nonpregnant adults and children due to its reasonable accuracy, lower cost, and portability 1.
- The accuracy of US in diagnosing gallstones is high, with a reported accuracy of 96% for detection of gallstones 1.
- US is also useful in identifying other gallbladder abnormalities, such as gallbladder wall thickening, pericholecystic fluid, and intraluminal debris or membranes 1.
- Although US may have limitations, such as operator dependence and reduced accuracy in obese patients, its benefits outweigh these drawbacks 1.
- Other imaging modalities, such as CT, MRI/MRCP, and HIDA, may be used as subsequent imaging studies if additional evaluation is needed, but US remains the first choice for initial imaging 1.
- The use of US as the initial imaging technique is also recommended by the World Society of Emergency Surgery due to its cost-effectiveness, wide availability, reduced invasiveness, and good accuracy for gallstone disease 1.
Key Points
- US is the preferred initial imaging technique for suspected biliary colic.
- US has high accuracy for detecting gallstones.
- US can identify other gallbladder abnormalities.
- Other imaging modalities may be used as subsequent studies if needed.
From the Research
Initial Diagnostic Imaging for Biliary Colic
- The initial diagnostic imaging modality of choice for biliary colic is ultrasound 2, 3, 4, 5.
- Ultrasound is highly specific for choledocholithiasis and is a useful screening tool for biliary tract pathology 3, 5.
- Abdominal ultrasound is the test of choice in suspected biliary tract pathology, including biliary colic 5.
- Other imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI) may be used in specific situations, but are not routinely required for initial diagnosis 2, 3.
Rationale for Ultrasound as Initial Imaging Modality
- Ultrasound is non-invasive and highly sensitive for detecting gallbladder stones and other biliary tract abnormalities 4.
- Ultrasound is also useful for evaluating the main bile duct and intrahepatic bile ducts 4.
- The use of ultrasound as the initial imaging modality can help prevent misdiagnosis and guide further diagnostic and therapeutic studies 2, 3, 4, 5.