1 Department of Radiology, University of New Mexico, MSC 10 5530, 1 University of New Mexico, Albuquerque, NM 87131.
2 Department of Radiology, Raymond G. Murphy VA Medical Center, Albuquerque, NM.
AJR Am J Roentgenol. 2018 Aug;211(2):W92-W97. doi: 10.2214/AJR.17.18884. Epub 2018 Apr 27.
In 2013, a multidisciplinary group at our Veterans Administration hospital collaborated to improve the diagnosis and treatment of patients with acute cholecystitis (AC) at our facility. Our role in this project was to evaluate the diagnostic accuracies of ultrasound (US) and CT.
AC was diagnosed in 60 patients (62 patient encounters) between July 1, 2013, and July 1, 2015. Of these patients, 56 underwent US, 48 underwent CT, and 42 underwent both. For the same time period, 60 patients without AC underwent US and 60 patients without AC underwent CT, and these imaging studies served as comparison studies. The groups were combined for a total of 182 unique patient encounters. A single radiologist reviewed the studies and tabulated the data.
The sensitivity of CT for detecting AC was significantly greater than that of US: 85% versus 68% (p = 0.043), respectively; however, the negative predictive values of CT and US did not differ significantly: 90% versus 77% (p = 0.24-0.26). Because there were no false-positives, the specificity and positive predictive values for both modalities were 100%. Among the 42 patients who underwent CT and US, both modalities were positive for AC in 25 patients, CT was positive and US was negative in 10 patients, and US was positive and CT was negative in two patients; in five patients, both US and CT were negative.
CT was significantly more sensitive for diagnosing AC than US. CT and US are complementary, and the other modality should be considered if there is high clinical suspicion for AC and the results of the first examination are negative.
2013 年，我们退伍军人管理局医院的一个多学科小组合作，旨在提高我们医院急性胆囊炎（AC）患者的诊断和治疗水平。我们在该项目中的角色是评估超声（US）和 CT 的诊断准确性。
2013 年 7 月 1 日至 2015 年 7 月 1 日期间，我们诊断了 60 例（62 例患者就诊）AC 患者。其中，56 例行 US，48 例行 CT，42 例行 US 和 CT。在同一时期，60 例非 AC 患者行 US，60 例非 AC 患者行 CT，这些影像学检查作为对照研究。将这些组合并得到总共 182 例独特的患者就诊。一位放射科医生对这些研究进行了回顾，并记录了数据。
CT 检测 AC 的敏感性明显高于 US：分别为 85%和 68%（p=0.043）；然而，CT 和 US 的阴性预测值没有显著差异：分别为 90%和 77%（p=0.24-0.26）。由于没有假阳性，两种方法的特异性和阳性预测值均为 100%。在 42 例行 CT 和 US 的患者中，两种方法均对 25 例患者的 AC 呈阳性，10 例患者 CT 阳性而 US 阴性，2 例患者 US 阳性而 CT 阴性，5 例患者 CT 和 US 均为阴性。
CT 诊断 AC 的敏感性明显高于 US。CT 和 US 是互补的，如果对 AC 的临床怀疑很高且首次检查结果为阴性，则应考虑其他方法。
