The Utility of Hepatobiliary Scintigraphy Scans in the Tokyo Guidelines Era for Acute Cholecystitis

Area of Science:

• Medical Imaging
• Diagnostic Medicine
• Gastroenterology

Background:

• Hepatobiliary Scintigraphy (HIDA) is used for acute cholecystitis (AC) diagnosis but has limitations.
• The Tokyo Guidelines 2018 (TG18) provide criteria for AC diagnosis.
• There is a need to optimize the use of HIDA scans in AC evaluation.

Purpose of the Study:

• To develop a predictive model for HIDA scan results in patients with suspected AC.
• To identify patients with suspected AC for whom a HIDA scan may be unnecessary.
• To refine AC diagnosis based on TG18 criteria and clinical data.

Main Methods:

• Retrospective review of 235 patients undergoing HIDA scans for suspected AC.
• Logistic regression analysis incorporating TG18 criteria and patient characteristics.
• Development of a model to predict negative HIDA scan results.

Main Results:

• Male gender, age, RUQ tenderness, clinical Murphy's sign, suggestive ultrasound findings, gallbladder wall thickening, and distention were associated with positive HIDA results.
• The developed model predicted HIDA results with an area under the curve of 0.81.
• The model identified a subset of patients for whom HIDA scans might be unnecessary.

Conclusions:

• HIDA scans may be overutilized in the current era of TG18.
• An accurate and simple predictive model was developed based on TG18.
• This model can help identify patients with suspected AC who do not require a HIDA scan for diagnosis.