Diagnostic performance of ultrasound in acute cholecystitis: a systematic review and meta-analysis

Sih-Shiang Huang; Kai-Wei Lin; Kao-Lang Liu; Yao-Ming Wu; Wan-Ching Lien; Hsiu-Po Wang

doi:10.1186/s13017-023-00524-5

Diagnostic performance of ultrasound in acute cholecystitis: a systematic review and meta-analysis

World J Emerg Surg. 2023 Nov 30;18(1):54. doi: 10.1186/s13017-023-00524-5.

Authors

Sih-Shiang Huang¹, Kai-Wei Lin¹, Kao-Lang Liu^{2

3}, Yao-Ming Wu⁴, Wan-Ching Lien^{5

6}, Hsiu-Po Wang⁷

Affiliations

¹ Department of Emergency Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, No.7, Chung-Shan South Road, Taipei, 100, Taiwan.
² Department of Medical Imaging, National Taiwan University Cancer Center, National Taiwan University Hospital, Taipei, Taiwan.
³ Department of Medical Imaging, College of Medicine, National Taiwan University, Taipei, Taiwan.
⁴ Department of Surgery, College of Medicine, National Taiwan University, Taipei, Taiwan.
⁵ Department of Emergency Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, No.7, Chung-Shan South Road, Taipei, 100, Taiwan. wanchinglien@ntu.edu.tw.
⁶ Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan. wanchinglien@ntu.edu.tw.
⁷ Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.

Abstract

Background: An updated overview of ultrasound (US) for diagnosis of acute cholecystitis (AC) remains lacking. This systematic review was conducted to evaluate the diagnostic performance of US for AC.

Methods: A systematic review was conducted following PRISMA guidelines. We meticulously screened articles from MEDLINE, Embase, and the Cochrane Library, spanning from inception to August 2023. We employed the search strategy combining the keywords "bedside US", "emergency US" or "point-of-care US" with "AC". Two reviewers independently screened the titles and abstracts of the retrieved articles to identify suitable studies. The inclusion criteria encompassed articles investigating the diagnostic performance of US for AC. Data regarding diagnostic performance, sonographers, and sonographic findings including the presence of gallstone, gallbladder (GB) wall thickness, peri-GB fluid, or sonographic Murphy sign were extracted, and a meta-analysis was executed. Case reports, editorials, and review articles were excluded, as well as studies focused on acalculous cholecystitis. The study quality was assessed with the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool.

Results: Forty studies with 8,652 patients were included. The majority of studies had a low risk of bias and applicability concerns. US had a pooled sensitivity of 71% (95% CI, 69-72%), a specificity of 85% (95% CI, 84-86%), and an accuracy of 0.83 (95% CI, 0.82-0.83) for the diagnosis of AC. The pooled sensitivity and specificity were 71% (95% CI, 67-74%) and 92% (95% CI, 90-93%) performed by emergency physicians (EPs), 79% (95% CI, 71-85%) and 76% (95% CI, 69-81%) performed by surgeons, and 68% (95% CI 66-71%) and 87% (95% CI, 86-88%) performed by radiologists, respectively. There were no statistically significant differences among the three groups.

Conclusion: US is a good imaging modality for the diagnosis of AC. EP-performed US has a similar diagnostic performance to radiologist-performed US. Further investigations would be needed to investigate the impact of US on expediting the management process and improving patient-centered outcomes.

Keywords: Acute cholecystitis; Emergency physician; Ultrasound.

Publication types

Meta-Analysis
Systematic Review
Review

MeSH terms

Cholecystitis, Acute* / diagnostic imaging
Humans
Sensitivity and Specificity
Ultrasonography / methods

Grants and funding

NSTC 112-2410-H-002 -171/National Science and Technology Council