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[急性胆囊炎的影像学技术]

[Imaging techniques in acute cholecystitis].

作者信息

van Santvoort Hjalmar C

机构信息

UMCU, afd. Chirurgie, Utrecht, the Netherlands.

出版信息

Ned Tijdschr Geneeskd. 2013;157(10):A6028.

Abstract

A recent meta-analysis of 57 studies investigated the diagnostic accuracy of imaging techniques in acute cholecystitis. The main findings were that abdominal ultrasound has a sensitivity of 81% and a specificity of 83%, that ultrasound seems comparable to magnetic resonance imaging (MRI), that cholescintigraphy has a sensitivity of 96% and a specificity of 90%, and that there are insufficient studies to evaluate the role of computed tomography (CT). In daily practice, ultrasound is the preferred modality as it is safe, widely available and cheap. MRI and cholescintigraphy are less available and have additional disadvantages. Patients with a negative or inconclusive ultrasound examination should undergo CT as this is in line with the general diagnostic strategy for acute abdominal pain that results in the highest sensitivity for urgent conditions and lowest exposure to radiation. Patients with clinical suspicion of acute cholecystitis but negative imaging findings should undergo prompt diagnostic laparoscopy and potentially cholecystectomy.

摘要

最近一项对57项研究的荟萃分析调查了成像技术在急性胆囊炎中的诊断准确性。主要发现包括:腹部超声的敏感性为81%,特异性为83%;超声似乎与磁共振成像(MRI)相当;胆囊闪烁扫描的敏感性为96%,特异性为90%;评估计算机断层扫描(CT)作用的研究不足。在日常实践中,超声是首选的检查方式,因为它安全、广泛可用且价格低廉。MRI和胆囊闪烁扫描可用性较低且有其他缺点。超声检查结果为阴性或不确定的患者应接受CT检查,因为这符合急性腹痛的一般诊断策略,该策略对紧急情况的敏感性最高且辐射暴露最低。临床怀疑急性胆囊炎但影像学检查结果为阴性的患者应立即进行诊断性腹腔镜检查,并可能进行胆囊切除术。

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