A pragmatic review of gallbladder imaging

The broad availability of real-time ultrasonography and cholescintigraphy has improved the diagnostic evaluation of acute and chronic biliary tract disease. However, neither procedure always provides conclusive diagnostic information, and the results must often be interpreted in relation to other clinical and laboratory findings. The consulting radiologist should not only be aware of the advantages and limitations of each technique, but also have an in-depth understanding of the pathophysiology of the disease, so that proper guidance can be given to the referring physician. Because only 13% to 35% of patients with signs and symptoms of acute cholecystitis are ultimately proved to have the disease, and since the clinical diagnosis of acute cholecystitis is inaccurate in up to 23% of patients, identification of a single, reliable imaging modality would be of great diagnostic value. Can this goal be achieved in patients with suspected acute cholecystitis? To answer this question, it is necessary to examine the complementary roles of real-time ultrasonography and cholescintigraphy in the diagnosis of acute and chronic cholecystitis.