Original Research Article|Articles in Press

Imaging acute cholecystitis, one test is enough

Published:February 23, 2023DOI:


      • Multiple imaging studies including MRI, CT and ultrasound may be obtained during evaluation of acute cholecystitis.
      • Direct size measurements of most structures can be obtained be each of these studies.
      • The measurements obtained from one imaging study are nearly identical to other imaging studies.
      • Additional imaging studies should not be obtained while evaluating acute cholecystitis for biliary system measurements.



      Patients with right upper quadrant pain are often imaged using multiple modalities with no established gold standard. A single imaging study should provide adequate information for diagnosis.


      A multicenter study of patients with acute cholecystitis was queried for patients who underwent multiple imaging studies on admission. Parameters were compared across studies including wall thickness (WT), common bile duct diameter (CBDD), pericholecystic fluid and signs of inflammation. Cutoff for abnormal values were 3 mm for WT and 6 mm for CBDD. Parameters were compared using chi-square tests and Intra-class correlation coefficients (ICC).


      Of 861 patients with acute cholecystitis, 759 had ultrasounds, 353 had CT and 74 had MRIs. There was excellent agreement for wall thickness (ICC = 0.733) and bile duct diameter (ICC = 0.848) between imaging studies. Differences between wall thickness and bile duct diameters were small with nearly all <1 mm. Large differences (>2 mm) were rare (<5%) for WT and CBDD.


      Imaging studies in acute cholecystitis generate equivalent results for typically measured parameters.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Jensen K.H.
        • Jørgensen T.
        Incidence of gallstones in a Danish population.
        Gastroenterology. 1991; 100: 790-794
        • Cafasso D.E.
        • Smith R.R.
        Symptomatic cholelithiasis and functional disorders of the biliary tract.
        Surg Clin. 2014 Apr; 94: 233-256
        • Shaffer E.A.
        Epidemiology and risk factors for gallstone disease: has the paradigm changed in the 21st century?.
        Curr Gastroenterol Rep. 2005 May; 7: 132-140
        • Sandler R.S.
        • Everhart J.E.
        • Donowitz M.
        • et al.
        The burden of selected digestive diseases in the United States.
        Gastroenterology. 2002 May; 122: 1500-1511
        • Gallaher J.R.
        • Charles A.
        Acute cholecystitis: a review.
        JAMA. 2022; 327: 965-975
        • Kiewiet J.J.
        • Leeuwenburgh M.M.
        • Bipat S.
        • Bossuyt P.M.
        • Stoker J.
        • Boermeester M.A.
        A systematic review and meta-analysis of diagnostic performance of imaging in acute cholecystitis.
        Radiology. 2012; 264: 708-720
        • Håkansson K.
        • Leander P.
        • Ekberg O.
        • Håkansson H.O.
        MR imaging in clinically suspected acute cholecystitis. A comparison with ultrasonography.
        Acta Radiol. 2000; 41: 322-328
        • McGillicuddy E.A.
        • Schuster K.M.
        • Brown E.
        • Maxfield M.W.
        • Davis K.A.
        • Longo W.E.
        Acute cholecystitis in the elderly: use of computed tomography and correlation with ultrasonography.
        Am J Surg. 2011; 202: 524-527
        • Fagenholz P.J.
        • Fuentes E.
        • Kaafarani H.
        • et al.
        Computed tomography is more sensitive than ultrasound for the diagnosis of acute cholecystitis.
        Surg Infect. 2015; 16: 509-512
        • Wertz J.R.
        • Lopez J.M.
        • Olson D.
        • Thompson W.M.
        Comparing the diagnostic accuracy of ultrasound and CT in evaluating acute cholecystitis.
        AJR Am J Roentgenol. 2018; 211: W92-W97
        • Rubens D.J.
        Hepatobiliary imaging and its pitfalls.
        Radiol Clin. 2004; 42: 257-278
        • Hendee W.R.
        • Becker G.J.
        • Borgstede J.P.
        • et al.
        Addressing overutilization in medical imaging.
        Radiology. 2010; 257: 240-245
        • Brenner D.J.
        • Hall E.J.
        Computed tomography--an increasing source of radiation exposure.
        N Engl J Med. 2007; 357: 2277-2284
        • American College of Radiology
        Appropriateness criteria.
        (Available at:)
        Date accessed: June 15, 2022
        • Schuster K.M.
        • O'Connor R.
        • Cripps M.
        • et al.
        Multicenter validation of the American Association for the Surgery of Trauma grading scale for acute cholecystitis.
        J Trauma Acute Care Surg. 2021; 90: 87-96
        • Pisano M.
        • Allievi N.
        • Gurusamy K.
        • et al.
        World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis.
        World J Emerg Surg. 2020; 15 (2020): 61
        • Yang C.B.
        • Zhang S.
        • Jia Y.J.
        • et al.
        Clinical application of dual-energy spectral computed tomography in detecting cholesterol gallstones from surrounding bile.
        Acad Radiol. 2017; 24: 478-482
        • Yokoe M.
        • Hata J.
        • Takada T.
        • et al.
        Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis.
        J Hepatobiliary Pancreat Sci. 2018; 25: 41-54
        • Boys J.A.
        • Doorly M.G.
        • Zehetner J.
        • Dhanireddy K.K.
        • Senagore A.J.
        Can ultrasound common bile duct diameter predict common bile duct stones in the setting of acute cholecystitis?.
        Am J Surg. 2014; 207: 432-435