What are the ACR Appropriateness Criteria imaging recommendations for the diagnosis of cholecystitis?

Updated: May 20, 2021
  • Author: Alan A Bloom, MD; Chief Editor: BS Anand, MD  more...
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The American College of Radiology (ACR) Appropriateness Criteria offer the following imaging recommendations [1] :

  • Ultrasonography is the preferred initial imaging test for the diagnosis of acute cholecystitis; scintigraphy is the preferred alternative.

  • CT is a secondary imaging test that can identify extrabiliary disorders and complications of acute cholecystitis, such as gangrene, gas formation, and perforation.

  • CT with intravenous (IV) contrast is useful in diagnosing acute cholecystitis in patients with nonspecific abdominal pain.

  • MRI, often with IV gadolinium-based contrast medium, is also a possible secondary choice for confirming a diagnosis of acute cholecystitis.

  • MRI without contrast is useful for eliminating radiation exposure in pregnant women when ultrasonography has not yielded a clear diagnosis.

  • Contrast agents should not be used in patients on dialysis unless absolutely necessary.

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