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

World Journal of Emergency Surgery volume 18, Article number: 54 (2023) Cite this article

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.

Introduction

Acute cholecystitis (AC) is one of the most common diseases in emergency departments (EDs), occurring in 3–10% of patients with acute abdominal pain [1]. It generally results from cystic duct obstruction by a gallstone, followed by inflammation of the gallbladder (GB) [2].

Diagnostic imaging modalities for AC include ultrasound (US), computed tomography (CT), or hepatobiliary iminodiacetic acid (HIDA) scan [3]. A 2012 meta-analysis reported that the HIDA scan had the highest diagnostic accuracy for AC [4]. However, US has non-radiating, easily accessible, and inexpensive characteristics, becoming the first-line diagnostic tool in emergency settings. In recent years, there has been a significant increase in the number of publications regarding the use of US for the diagnosis of AC. Up-to-date evidence is still lacking. Further, US is performed by radiologists traditionally. It is unclear whether the diagnostic performance differs when performed by other sonographers such as emergency physicians (EPs) or surgeons.

Hence, we aim to perform a meta-analysis to investigate the diagnostic performance of US for AC.

Methods

This meta-analysis adhered to the Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies (PRISMA-DTA) Statement [5]. The meta-analysis protocol was registered in PROSPERO (CRD42023425075). The ethical committee review was waived at the study institution.

Search strategy and study selection

To identify relevant articles for our study, we conducted a comprehensive search in three databases: MEDLINE, Embase, and Cochrane Library. The search included articles published before August 2023, without any language restrictions. We employed the search strategy combining the keywords "bedside US", "emergency US" or "point-of-care US" with "AC". Two reviewers (SSH and KWL) 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. We excluded case reports, case series, editorials, and review articles from our search strategy, as well as studies focused on acalculous cholecystitis. The complete literature search strategy is available in Additional file 5: Table S1.

Data extraction and quality assessment

The quality of the included studies was evaluated by two independent reviewers (SSH and KWL) using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool [6]. Any discrepancies between the reviewers were resolved through discussion involving a third author (WCL).

Data synthesis and analysis

We extracted and summarized data from each study into 2 × 2 contingency tables to perform sensitivity and specificity analysis. To mitigate bias in the presence of zero observations in false-positive or false-negative results, we applied a continuity correction of 0.5. Summary estimates of sensitivity, specificity, predictive values, likelihood ratios, and accuracy along with their 95% confidence intervals (CIs) were calculated using a bivariate random-effects model with restricted maximum likelihood estimation for diagnostic meta-analysis [7]. The forest plot was used to visually represent the pooled summary estimates and their 95% CIs.

Additionally, we performed a subgroup analysis to assess the diagnostic performance of US among different sonographers, namely EPs, surgeons, and radiologists. Furthermore, we conducted a separate subgroup analysis to investigate the diagnostic accuracy of various sonographic findings in diagnosing AC.

To measure heterogeneity between the included studies, we utilized the inconsistency index I2. Additionally, we assessed publication bias using Deek’s test [8]. Statistical significance was defined as a p value < 0.05. All analyses were conducted using R software version 4.3.0 (R Foundation for Statistical Computing, Vienna, Australia).

Results

Figure 1 depicts a flowchart that outlines the inclusion and exclusion process. A total of 1309 studies were identified through MEDLINE, Embase, Cochrane Library, and manual searches of the reference list of the included articles. After the initial screening and removal of duplicates, 60 studies were left for full-text article review. Among them, 20 studies were excluded during the full-text review as they did not present relevant findings on the topic or report the diagnostic accuracy of US. Consequently, 40 studies were included for data extraction and meta-analysis [9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48]. We also generated a summary receiver operating characteristics (SROC) curve to assess the performance of US in detecting AC (Additional file 1: Fig. S1).

Fig. 1
figure 1

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) diagram

Full size image

Quality of the included studies

Figure 2 shows the risk of bias and applicability of the included studies. In the risk of bias assessment, the majority of studies, except for patient selection, had a low risk of bias across four domains. However, more than 25% of the studies were identified as having a high risk of bias due to their utilization of a case–control study design and their non-consecutive or non-random enrollment of sample patients. Turning to applicability, most studies received a low-risk score in the reference standard and index test domains. Nevertheless, some studies were deemed to have a high risk of bias in terms of applicability because they exclusively focused on post-cholecystectomy patients instead of a more diverse and representative patient cohort.

Fig. 2
figure 2

The summary of the quality assessment results of the included studies

Full size image

Diagnostic performance of US

Across all 40 studies, a total of 8652 patients were included, with an average age of 45.9 years and a male gender composition of 34%. Detailed information about the included studies can be found in Table 1. The overall sensitivity was 71% (95% CI, 69–72%), while the specificity was 85% (95% CI, 84–86%) (Table 2, Fig. 3). The positive likelihood ratio (PLR) was 4.80 (95% CI, 3.33–6.78), and the negative likelihood ratio (NLR) was 0.33 (95% CI, 0.25–0.41). The accuracy was 0.83 (95% CI, 0.82–0.83), demonstrating good diagnostic performance. Heterogeneity among the studies was high (I2 = 89.7%; 95% CI, 87–92%), which could be due to varying patient enrollment criteria and the presence of potential confounders due to non-randomized assignment in the included studies. No significant publication bias was detected through Deek’s test (p value = 0.39).

Table 1 Detailed information on the included studies
Full size table
Table 2 The pooled estimates of diagnostic performance of ultrasound for acute cholecystitis
Full size table
Fig. 3
figure 3

The forest plot of diagnostic performance of ultrasound for the diagnosis of acute cholecystitis

Full size image

Subgroup analysis for sonographers

The subgroup analysis included 14 studies involving EPs, 3 studies involving surgeons, and 18 studies involving radiologists. Two studies compared the performance between EPs and radiologists, and one compared EPs with surgeons, while 8 did not provide detailed information on the sonographers.

The pooled sensitivity and specificity of US were 71% (95% CI, 67–74%) and 92% (95% CI, 90–93%) performed by 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 (Additional files 2, 3 and 4: Figs. S2, S3 and S4 and Table 2). There were no statistically significant differences in sensitivity, specificity, PLR, NLR, and accuracy among the three groups.

Subgroup analysis of sonographic findings

The sonographic findings and their relationship to the diagnosis of AC are summarized in Table 3. Notably, not all of the included studies provided detailed information regarding individual sonographic findings.

Table 3 The pooled estimates of the sonographic finding for the diagnosis of acute cholecystitis
Full size table

Discussion

We performed a systematic review and meta-analysis to investigate the diagnostic performance of US for AC. Forty studies with a total of 8,652 patients were included. To the best of our knowledge, this is the largest meta-analysis currently, providing updated evidence.

Our results revealed US had a sensitivity of 71%, a specificity of 85%, and an accuracy of 0.83, indicative of good discriminability. Also, the sensitivity and specificity were similar among those performed by EPs, surgeons, and radiologists. Further, the presence of gallstones had a higher sensitivity for AC. However, most of the studies used combinations of sonographic findings for the diagnosis of AC.

Clinical symptoms and signs of AC had varying sensitivity and specificity [49]. The Tokyo guidelines suggest using imaging studies such as US, CT, and HIDA scans for the diagnosis of AC, in conjunction with detailed history, complete clinical examination, and laboratory tests [3]. Although HIDA has excellent diagnostic performance for AC with a sensitivity and specificity above 90% [4], its utilization is limited in emergency practice due to the required resources, time, and exposure to radioactive isotopes [50]. By contrast, US is a valuable tool for its non-ionizing, low-cost, and easy-to-use characteristics. US is considered the first-line imaging modality in recently published guidelines for the diagnosis of AC [3, 50]. Our review provides the evidence that US is a good diagnostic tool with discriminative power.

The American College of Emergency Physicians states that US is an essential skill in emergency practice, and GB-US is included in 12 core applications [51, 52]. It also indicates that 25 sonographic examinations of GB should be performed as a minimum requirement for training and accreditation [51]. In recent years, US has broadly used and increased integration into emergency practice. There were also a rising number of studies regarding the EP-performed US.

In our review, the diagnostic performance was similar between EPs and radiologists. Half of the 14 studies that EPs performed US reported the training background [10, 12, 13, 23, 27, 29, 34]; however, the level of training could range from novices (the first-year residents) to attendings [10]. Summers et al. [29] reported an intraclass correlation coefficient of 0 (95% CI, 0–0.13), suggestive of similar performance at different levels. Although the inter-rater reliability was not thoroughly evaluated in the majority of the studies regarding the EP-performed US, EPs could achieve proficiency using US as a part of physical examination for the assessment of GB diseases [26].

Moreover, US also demonstrates time efficiency in several studies [9, 21, 25]. The mean time interval between the surgeon-performed US and the surgery was significantly lower than that between the radiologist-performed and surgery (2.3 vs. 11.9 h) [9]. Similar results were observed between those receiving radiologist-performed US and HIDA scans [21, 25]. However, evidence regarding the effect of EP-performed US in the fastening clinical management process or patient-centered outcomes (length of stay and mortality) of patients with AC is still lacking.

In our review, the presence of gallstones exhibited optimal performance for the diagnosis of AC. However, most of the included studies used the combination of the presence of gallstones with at least one additional inflammatory sign such as GB wall thickness, peri-GB fluid, and sonographic Murphy sign. Moreover, there have been reported refinements in the use of US to evaluate patients with right upper quadrant pain and suspected AC. Wertz et al. [20] reported the transverse dimension of the GB more than 4 cm was found in 59% of their 60 patients with AC. Perez et al. [15] found that a cystic artery velocity of more than 40 cm/s had a high specificity of 94% for AC. However, the results were still inconclusive and needed further investigation.

This study has several limitations. First, a high risk of bias and applicability concerns in patient selection existed in more than one-fourth of the studies, limiting the generalizability. However, our study is by far the most comprehensive systematic review regarding US for the diagnosis of AC. Second, the majority of studies were conducted in Western countries. The results would be extrapolated cautiously to Asian patients. Third, the details of comorbidities and body mass indexes were lacking across the studies; thus, factors associated with false-negative and false-positive cases could not be thoroughly analyzed. Fourth, acalculous cholecystitis accounts for approximately 10% of patients with AC [53, 54]. However, AC was diagnosed in this review using criteria for the presence of gallstones. The extrapolation of the results should be cautioned for patients with acalculous cholecystitis. Last, patients have to fast for at least 6 h before US for a better illustration of the GB. However, most studies did not provide information on whether the patients were fasting or not. Also, ED patients would visit after a big meal. The diagnostic performance of US would be influenced by non-fasting patients.

Conclusion

US is a good imaging modality for the diagnosis of AC with discriminative power. EP-performed US has a similar diagnostic performance to those by radiologists. Further investigations would be needed for the impact of US on the clinical management process and patient-centered outcomes.

Availability of data and materials

All data analyzed during this study are included in this published article.

Abbreviations

AC:

Acute cholecystitis

ED:

Emergency department

GB:

Gallbladder

US:

Ultrasound

CT:

Computed tomography

HIDA:

Hepatobiliary iminodiacetic acid

EP:

Emergency physician

PRISMA-DTA:

Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies

QUADAS-2:

Quality Assessment of Diagnostic Accuracy Studies-2

CI:

Confidence interval

SROC:

Summary receiver operating characteristics

PLR:

Positive likelihood ratio

NLR:

Negative likelihood ratio

References

  1. Cook MD, Karim SA, Jensen HK, Bennett JL, Burdine LJ, Bhavaraju A, et al. Percutaneous cholecystostomy tubes versus medical management for acute cholecystitis. Am Surg. 2022;88(5):828–33.

    Article  PubMed  Google Scholar 

  2. Gallaher JR, Charles A. Acute cholecystitis: a review. JAMA. 2022;327(10):965–75.

    Article  CAS  PubMed  Google Scholar 

  3. Yokoe M, Hata J, Takada T, Strasberg SM, Asbun HJ, Wakabayashi G, et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci. 2018;25(1):41–54.

    Article  PubMed  Google Scholar 

  4. Kiewiet JJ, Leeuwenburgh MM, Bipat S, Bossuyt PM, Stoker J, Boermeester MA. A systematic review and meta-analysis of diagnostic performance of imaging in acute cholecystitis. Radiology. 2012;264(3):708–20.

    Article  PubMed  Google Scholar 

  5. McInnes MDF, Moher D, Thombs BD, McGrath TA, Bossuyt PM, the P-DTAG, et al. Preferred reporting items for a systematic review and meta-analysis of diagnostic test accuracy studies: the PRISMA-DTA statement. JAMA. 2018;319(4):388–96.

    Article  PubMed  Google Scholar 

  6. Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 2011;155(8):529–36.

    Article  PubMed  Google Scholar 

  7. Reitsma JB, Glas AS, Rutjes AW, Scholten RJ, Bossuyt PM, Zwinderman AH. Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviews. J Clin Epidemiol. 2005;58(10):982–90.

    Article  PubMed  Google Scholar 

  8. Deeks JJ, Macaskill P, Irwig L. The performance of tests of publication bias and other sample size effects in systematic reviews of diagnostic test accuracy was assessed. J Clin Epidemiol. 2005;58(9):882–93.

    Article  PubMed  Google Scholar 

  9. Dumbrava BD, Bass GA, Jumean A, Birido N, Corbally M, Pereira J, et al. The accuracy of point-of-care ultrasound (POCUS) in acute gallbladder disease. Diagnostics (Basel). 2023;13(7):1248.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Zitek T, Fernandez S, Newberry MA, De Oca RM, Kinas D, Kheradia T, et al. The use of additional imaging studies after biliary point-of-care ultrasound in the emergency department. Emerg Radiol. 2023;30(1):19–26.

    Article  PubMed  Google Scholar 

  11. Martin WT, Stewart K, Sarwar Z, Kennedy R, Quang C, Albrecht R, et al. Clinical diagnosis of cholecystitis in emergency department patients with cholelithiasis is indication for urgent cholecystectomy: a comparison of clinical, ultrasound, and pathologic diagnosis. Am J Surg. 2022;224(1 Pt A):80–4.

    Article  PubMed  Google Scholar 

  12. Wehrle CJ, Talukder A, Tien L, Parikh S, Devarakonda A, Holsten SB, et al. The accuracy of point-of-care ultrasound in the diagnosis of acute cholecystitis. Am Surg. 2022;88(2):267–72.

    Article  PubMed  Google Scholar 

  13. Sharif S, Vlahaki D, Skitch S, Truong J, Freeman S, Sidalak D, et al. Evaluating the diagnostic accuracy of point-of-care ultrasound for cholelithiasis and cholecystitis in a canadian emergency department. CJEM. 2021;23(5):626–30.

    Article  PubMed  Google Scholar 

  14. Evans DP, Tozer J, Taylor L, Vitto MJ, Joyce M. A retrospective evaluation of point of care ultrasound for acute cholecystitis in a tertiary academic hospital setting. Ultrasound J. 2021;13(1):28.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Perez MG, Tse JR, Bird KN, Liang T, Brooke Jeffrey R, Kamaya A. Cystic artery velocity as a predictor of acute cholecystitis. Abdom Radiol (NY). 2021;46(10):4720–8.

    Article  PubMed  Google Scholar 

  16. Shaish H, Ma HY, Ahmed FS. The utility of an under-distended gallbladder on ultrasound in ruling out acute cholecystitis. Abdom Radiol (NY). 2021;46(6):2498–504.

    Article  PubMed  Google Scholar 

  17. MacDonald AA, Richardson M, Sue L, Hakiwai A, Stephenson G, Harman R, et al. Bedside ultrasonography for acute gallstone disease: a diagnostic accuracy study of surgical registrars and emergency medicine physicians. ANZ J Surg. 2020;90(12):2467–71.

    Article  PubMed  Google Scholar 

  18. Hiatt KD, Ou JJ, Childs DD. Role of ultrasound and CT in the workup of right upper quadrant pain in adults in the emergency department: a retrospective review of more than 2800 cases. AJR Am J Roentgenol. 2020;214(6):1305–10.

    Article  PubMed  Google Scholar 

  19. Tootian Tourghabe J, Arabikhan HR, Alamdaran A, Zamani MH. Emergency medicine resident versus radiologist in detecting the ultrasonographic signs of acute cholecystitis; a diagnostic accuracy study. Emerg (Tehran). 2018;6(1):e19.

    PubMed  Google Scholar 

  20. Wertz JR, Lopez JM, Olson D, Thompson WM. Comparing the diagnostic accuracy of ultrasound and CT in evaluating acute cholecystitis. AJR Am J Roentgenol. 2018;211(2):W92–7.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Rodriguez LE, Santaliz-Ruiz LE, De La Torre-Bisot G, Gonzalez G, Serpa MA, Sanchez-Gaetan F, et al. Clinical implications of hepatobiliary scintigraphy and ultrasound in the diagnosis of acute cholecystitis. Int J Surg. 2016;35:196–200.

    Article  PubMed  Google Scholar 

  22. Naidu K, Beenen E, Gananadha S, Mosse C. The yield of fever, inflammatory markers and ultrasound in the diagnosis of acute cholecystitis: a validation of the 2013 Tokyo guidelines. World J Surg. 2016;40(12):2892–7.

    Article  CAS  PubMed  Google Scholar 

  23. Hasani SA, Fathi M, Daadpey M, Zare MA, Tavakoli N, Abbasi S. Accuracy of bedside emergency physician performed ultrasound in diagnosing different causes of acute abdominal pain: a prospective study. Clin Imaging. 2015;39(3):476–9.

    Article  PubMed  Google Scholar 

  24. Hwang H, Marsh I, Doyle J. Does ultrasonography accurately diagnose acute cholecystitis? Improving diagnostic accuracy based on a review at a regional hospital. Can J Surg. 2014;57(3):162–8.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Kaoutzanis C, Davies E, Leichtle SW, Welch KB, Winter S, Lampman RM, et al. Abdominal ultrasound versus hepato-imino diacetic acid scan in diagnosing acute cholecystitis–what is the real benefit? J Surg Res. 2014;188(1):44–52.

    Article  PubMed  Google Scholar 

  26. Katirci Y, Soyuduru M, Başpinar I, Yurdakul MS, Demirtaş E, Ramadan H, et al. Assessment of the usability of ultrasonography by emergency physicians in the diagnosis of acute cholecystitis. Acta Medica Mediterranea. 2014;30(2):509–13.

    Google Scholar 

  27. Torres-Macho J, Anton-Santos JM, Garcia-Gutierrez I, de Castro-Garcia M, Gamez-Diez S, de la Torre PG, et al. Initial accuracy of bedside ultrasound performed by emergency physicians for multiple indications after a short training period. Am J Emerg Med. 2012;30(9):1943–9.

    Article  PubMed  Google Scholar 

  28. Golea A, Badea R, Suteu T. Role of ultrasonography for acute cholecystic conditions in the emergency room. Med Ultrason. 2010;12(4):271–9.

    PubMed  Google Scholar 

  29. Summers SM, Scruggs W, Menchine MD, Lahham S, Anderson C, Amr O, et al. A prospective evaluation of emergency department bedside ultrasonography for the detection of acute cholecystitis. Ann Emerg Med. 2010;56(2):114–22.

    Article  PubMed  Google Scholar 

  30. Al-Azawi D, Mc Mahon D, Rajpal PK. The diagnosis of acute cholecystitis in patients undergoing early laparoscopic cholecystectomy in a community hospital. Surg Laparosc Endosc Percutan Tech. 2007;17(1):19–21.

    Article  PubMed  Google Scholar 

  31. De Vargas MM, Lanciotti S, De Cicco ML, Coniglio M, Gualdi GF. Ultrasonographic and spiral CT evaluation of simple and complicated acute cholecystitis: diagnostic protocol assessment based on personal experience and review of the literature. Radiol Med. 2006;111(2):167–80.

    Article  Google Scholar 

  32. Bingener J, Schwesinger WH, Chopra S, Richards ML, Sirinek KR. Does the correlation of acute cholecystitis on ultrasound and at surgery reflect a mirror image? Am J Surg. 2004;188(6):703–7.

    Article  PubMed  Google Scholar 

  33. Oh KY, Gilfeather M, Kennedy A, Glastonbury C, Green D, Brant W, et al. Limited abdominal MRI in the evaluation of acute right upper quadrant pain. Abdom Imaging. 2003;28(5):643–51.

    Article  CAS  PubMed  Google Scholar 

  34. Rosen CL, Brown DF, Chang Y, Moore C, Averill NJ, Arkoff LJ, et al. Ultrasonography by emergency physicians in patients with suspected cholecystitis. Am J Emerg Med. 2001;19(1):32–6.

    Article  CAS  PubMed  Google Scholar 

  35. Kendall JL, Shimp RJ. Performance and interpretation of focused right upper quadrant ultrasound by emergency physicians. J Emerg Med. 2001;21(1):7–13.

    Article  CAS  PubMed  Google Scholar 

  36. Hakansson K, Leander P, Ekberg O, Hakansson HO. MR imaging in clinically suspected acute cholecystitis. A comparison with ultrasonography. Acta Radiol. 2000;41(4):322–8.

    Article  CAS  PubMed  Google Scholar 

  37. Chatziioannou SN, Moore WH, Ford PV, Dhekne RD. Hepatobiliary scintigraphy is superior to abdominal ultrasonography in suspected acute cholecystitis. Surgery. 2000;127(6):609–13.

    Article  CAS  PubMed  Google Scholar 

  38. Juvonen T, Kiviniemi H, Niemela O, Kairaluoma MI. Diagnostic accuracy of ultrasonography and C reactive protein concentration in acute cholecystitis: a prospective clinical study. Eur J Surg. 1992;158(6–7):365–9.

    CAS  PubMed  Google Scholar 

  39. Lauritsen KB, Sommer W, Hahn L, Henriksen JH. Cholescintigraphy and ultrasonography in patients suspected of having acute cholecystitis. Scand J Gastroenterol. 1988;23(1):42–6.

    Article  CAS  PubMed  Google Scholar 

  40. Soiva M, Haveri M, Taavitsainen M, Suramo I. The value of routine sonography in clinically suspected acute cholecystitis. Scand J Gastroenterol. 1986;21(1):70–4.

    Article  CAS  PubMed  Google Scholar 

  41. Martinez A, Bona X, Velasco M, Martin J. Diagnostic accuracy of ultrasound in acute cholecystitis. Gastrointest Radiol. 1986;11(4):334–8.

    Article  CAS  PubMed  Google Scholar 

  42. Norrby S, Frank M, Sjodahl R. Intravenous cholecystography and ultrasonography in the diagnosis of acute cholecystitis. A prospective comparative study. Acta Chir Scand. 1985;151(3):255–9.

    CAS  PubMed  Google Scholar 

  43. Samuels BI, Freitas JE, Bree RL, Schwab RE, Heller ST. A comparison of radionuclide hepatobiliary imaging and real-time ultrasound for the detection of acute cholecystitis. Radiology. 1983;147(1):207–10.

    Article  CAS  PubMed  Google Scholar 

  44. Ralls PW, Colletti PM, Halls JM, Siemsen JK. Prospective evaluation of 99mTc-IDA cholescintigraphy and gray-scale ultrasound in the diagnosis of acute cholecystitis. Radiology. 1982;144(2):369–71.

    Article  CAS  PubMed  Google Scholar 

  45. Freitas JE, Mirkes SH, Fink-Bennett DM, Bree RL. Suspected acute cholecystitis. Comparison of hepatobiliary scintigraphy versus ultrasonography. Clin Nucl Med. 1982;7(8):364–7.

    Article  CAS  PubMed  Google Scholar 

  46. Shuman WP, Mack LA, Rudd TG, Rogers JV, Gibbs P. Evaluation of acute right upper quadrant pain: sonography and 99mTc-PIPIDA cholescintigraphy. AJR Am J Roentgenol. 1982;139(1):61–4.

    Article  CAS  PubMed  Google Scholar 

  47. Zeman RK, Burrell MI, Cahow CE, Caride V. Diagnostic utility of cholescintigraphy and ultrasonography in acute cholecystitis. Am J Surg. 1981;141(4):446–51.

    Article  CAS  PubMed  Google Scholar 

  48. Down RH, Arnold J, Goldin A, Watts JM, Benness G. Comparison of accuracy of 99mTc-pyridoxylidene glutamate scanning with oral cholecystography and ultrasonography in diagnosis of acute cholecystitis. Lancet. 1979;2(8152):1094–7.

    Article  CAS  PubMed  Google Scholar 

  49. Jain A, Mehta N, Secko M, Schechter J, Papanagnou D, Pandya S, et al. History, physical examination, laboratory testing, and emergency department ultrasonography for the diagnosis of acute cholecystitis. Acad Emerg Med. 2017;24(3):281–97.

    Article  PubMed  Google Scholar 

  50. Pisano M, Allievi N, Gurusamy K, Borzellino G, Cimbanassi S, Boerna D, et al. 2020 world society of emergency surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis. World J Emerg Surg. 2020;15(1):61.

    Article  PubMed  PubMed Central  Google Scholar 

  51. ACEP. Ultrasound guidelines: emergency, point-of-care, and clinical ultrasound guidelines in medicine. Ann Emerg Med. 2023;82(3):e115–55.

    Article  Google Scholar 

  52. ACEP. Emergency ultrasound guidelines. Ann Emerg Med. 2009;53(4):550–79.

    Article  Google Scholar 

  53. Huffman JL, Schenker S. Acute acalculous cholecystitis: a review. Clin Gastroenterol Hepatol. 2010;8(1):15–22.

    Article  PubMed  Google Scholar 

  54. Laurila J, Syrjala H, Laurila PA, Saarnio J, Ala-Kokko TI. Acute acalculous cholecystitis in critically ill patients. Acta Anaesthesiol Scand. 2004;48(8):986–91.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

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Funding

National Science and Technology Council, Taiwan (NSTC 112–2410-H-002 -171).

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Authors and 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

    Sih-Shiang Huang, Kai-Wei Lin & Wan-Ching Lien

  2. Department of Medical Imaging, National Taiwan University Cancer Center, National Taiwan University Hospital, Taipei, Taiwan

    Kao-Lang Liu

  3. Department of Medical Imaging, College of Medicine, National Taiwan University, Taipei, Taiwan

    Kao-Lang Liu

  4. Department of Surgery, College of Medicine, National Taiwan University, Taipei, Taiwan

    Yao-Ming Wu

  5. Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan

    Wan-Ching Lien

  6. Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan

    Hsiu-Po Wang

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  4. Yao-Ming Wu
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  5. Wan-Ching Lien
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  6. Hsiu-Po Wang
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Contributions

SS and WC conceived the study and designed the trial. SS, KW, KL, YM, and WC did acquisition of the data. SS, KW, and WC done analysis and interpretation of the data. SS and WC drafted the manuscript, and all authors contributed substantially to its revision. HP supervised the study. WC critically revised the manuscript for important intellectual content and took responsibility for the paper as a whole. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Wan-Ching Lien.

Ethics declarations

Ethics approval and consent to participate

This study was waived approval by the Institutional Review Board of the Research Ethics Committee of the National Taiwan University Hospital due to the hospital policy.

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Not applicable.

Competing interests

The authors declare that they have no competing interests.

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Supplementary Information

Additional file 1

: Fig. S1 The summary receiver operating characteristic (SROC) curve of the included studies.

Additional file 2

: Fig. S2 The forest plot of diagnostic performance of ultrasound performed by emergency physicians.

Additional file 3

: Fig. S3 The forest plot of diagnostic performance of ultrasound by surgeons.

Additional file 4

: Fig. S4 The forest plot of diagnostic performance of ultrasound by radiologists.

Additional file 5

: Table S1 The complete literature search strategy.

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Huang, SS., Lin, KW., Liu, KL. et al. Diagnostic performance of ultrasound in acute cholecystitis: a systematic review and meta-analysis. World J Emerg Surg 18, 54 (2023). https://0-doi-org.brum.beds.ac.uk/10.1186/s13017-023-00524-5

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  • DOI: https://0-doi-org.brum.beds.ac.uk/10.1186/s13017-023-00524-5

Keywords

World Journal of Emergency Surgery

ISSN: 1749-7922