What is the role of CT in the diagnosis of biliary colic and acute cholecystitis?

Updated: Jan 18, 2017
  • Author: Peter A D Steel, MBBS, MA; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Answer

Answer

Computed tomography (CT) scanning is not the test of choice and is recommended only for the evaluation of abdominal pain if the diagnosis is uncertain. CT scans can demonstrate gallbladder wall edema, pericholecystic stranding and fluid, and high-attenuation bile. A helical CT scan with fine cuts through the biliary tract has not been well studied but may be useful.

Advantages and disadvantages of CT scanning

CT scanning not only provides better information of the surrounding structures than ultrasonography and hepatic 2,6-dimethyliminodiacetic acid (HIDA) scanning, but it is also noninvasive. For complications of cholecystitis and cholangitis, gallbladder perforation, pericholecystic fluid, and intrahepatic ductal dilation, CT scanning may be adequate.

However, CT scanning misses 20% of gallstones, because the stones may be of the same radiographic density as bile. In addition, CT scanning is also more expensive; takes longer because the patient usually has to drink oral contrast; and also, given the radiation dose, may not be ideal in the pregnant patient.


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