Hepatobiliary scintigraphy. Increasing the accuracy of the preoperative diagnosis of acute cholecystitis.

The ability of hepatobiliary scintigraphy (HBS) to influence accurately the clinical diagnosis of acute cholecystitis was assessed prospectively in 70 consecutive patients with suspected acute cholecystitis. Before and after HBS, the referring surgeons completed a questionnaire on the probability of acute cholecystitis. Accuracy of diagnosis was assessed by clinical follow-up and chart review in all patients and by surgical and pathological evaluation in the 31 patients who underwent laparotomy. There were 27 patients with positive HBS results and 40 with negative HBS results; the results for three patients were indeterminate. None of the positive or negative HBS results were confirmed to be inaccurate. Negative results influenced diagnosis more often than did others. Results were negative in 13 patients whose assigned probability of acute cholecystitis was very high before HBS; in all 13 the assigned probability was very low after HBS, and in none of these patients was acute cholecystitis confirmed subsequently. These results support the use of hepatobiliary scintigraphy before proceeding to urgent cholecystectomy in patients with a clinical diagnosis of acute cholecystitis.