Acute cholecystitis and acute cholangitis: the radiologist's role in diagnosis and management

Acute cholecystitis (AC) and acute cholangitis (ACh) are common biliary conditions that can range in clinical severity from mild discomfort to life-threatening complications. The Tokyo Guidelines (TG) recommend a diagnostic approach that integrates clinical signs, laboratory findings, and imaging features to improve diagnostic accuracy. However, diagnosis might be difficult given overlapping clinical symptoms and the different imaging presentations of different disorders. A coordinated multidisciplinary approach is necessary for effective management, in which radiologists are pivotal in both diagnosis and treatment. This review explores the imaging characteristics of AC and ACh across various modalities, including ultrasound (US), contrast-enhanced ultrasound (CEUS), computed tomography (CT), and magnetic resonance imaging (MRI). Furthermore, the article reviews severity staging and management strategies to enable radiologists to address the diverse clinical scenarios they are likely to face. Finally, the article highlights the importance of interventional radiology methods such biliary drainage and percutaneous cholecystostomy (PC), which are usually crucial in the treatment of high-risk or critically ill patients.