Table 3.

Imaging techniques for acute cholecystitis

Technique	Major findings	Notes
Abdominal ultrasonography	Enlarged gallbladder size	First choice
	Gallbladder wall thickening (>4mm) Incarcerated gallstone(s) Intraluminal debris echoes Pericholecystic fluid collection or abscess Positive “sonographic” Murphy sign Sonolucent “double wall sign”	Moderate sensitivity (88%90%) and specificity (80%) [63, 122-124]
Hepatobiliary scintigraphy (technetium iminodiacetic	Compound given intravenously and excreted by the liver Test is positive if the gallbladder is not visualized (i.e., cystic	Highest sensitivity and specificity (≈90-95%) [123]
acid or hydroxyiminodiacetic acid)	duct obstruction due to edema by acute cholecystitis) [63]	Not easily available
Computed Tomography (CT)	Gallbladder wall edema	High sensitivity 94%
	Pericholecystic fluid Other complications [125]	Low specificity 59% [123, 126]
Magnetic Resonance	Gallstones are likely passed in the common bile duct [127]	Moderate accuracy [123]
Cholangio-Pancreatography		Not easily available
(MRCP)		Under evaluation

Adapted from Portincasa P, Wang DQH. Gallstones. In: Podolsky KD, Camilleri M, Fitz JG, Kalloo AN, Shanahan F, Wang TC, eds. Yamada’s Textbook of Gastroenterology. 6th ed. Hoboken, New Jersey (USA): Wiley-Blackwell, 2015:1808-1834 [56].