How to image the gallbladder in suspected cholecystitis.

Area of Science:

• Radiology
• Gastroenterology
• Medical Imaging

Background:

• Oral cholecystography was historically the primary method for evaluating gallbladder function and anatomy.
• Significant advancements in medical imaging have led to the development of more sensitive and specific diagnostic tools.

Purpose of the Study:

• To outline the current landscape of gallbladder imaging modalities.
• To delineate the roles of various diagnostic tests in assessing gallbladder pathology based on suspected disease.

Main Methods:

• Review of current diagnostic techniques for gallbladder pathology.
• Comparison of ultrasonography, cholescintigraphy, and oral cholecystography.
• Discussion of decision-making criteria for test selection based on suspected gallbladder disease.

Main Results:

• Real-time ultrasonography and cholescintigraphy are the primary, highly sensitive, and specific tests for gallbladder pathology.
• Oral cholecystography, endoscopic retrograde pancreatography, and percutaneous gallbladder puncture are now supplementary tests.
• Ultrasonography is the preferred initial test for suspected chronic and acute cholecystitis, with cholescintigraphy used for resolving diagnostic uncertainty.

Conclusions:

• Modern imaging techniques have largely superseded oral cholecystography for routine gallbladder evaluation.
• Test selection for gallbladder disease is guided by the suspected condition and pre-test probability of disease.
• Ultrasonography and cholescintigraphy are crucial for accurate diagnosis and management of gallbladder disorders.