The Utility of Hepatobiliary Scintigraphy Scans in the Tokyo Guidelines Era for Acute Cholecystitis

•The Tokyo Guideline components associate with HIDA results in the treatment of acute cholecystitis.•A prediction model using the Tokyo Guideline components is able to predict HIDA results.•Predicting HIDA results can avoid unnecessary studies. Hepatobiliary Scintigraphy (HIDA) aids the diagnosis of...

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Bibliographic Details
Published in:The Journal of surgical research 2021-12, Vol.268, p.667-672
Main Authors: Romero-Velez, Gustavo, Pereira, Xavier, Mandujano, Cosman Camilo, Parides, Michael K., Muscarella, Peter, Melvin, W. Scott, Love, Charito, McAuliffe, John C.
Format: Article
Language:English
Subjects:
Acute cholecystitis
Cholecystitis
Hepatobiliary scintigraphy
HIDA
Tokyo guidelines
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Summary:•The Tokyo Guideline components associate with HIDA results in the treatment of acute cholecystitis.•A prediction model using the Tokyo Guideline components is able to predict HIDA results.•Predicting HIDA results can avoid unnecessary studies. Hepatobiliary Scintigraphy (HIDA) aids the diagnosis of acute cholecystitis (AC) but has limitations. We sought to design a model based on the Tokyo Guidelines 2018 (TG18) to predict HIDA results. A retrospective review of patients who underwent a HIDA scan during the evaluation of AC was performed. Using logistic regression techniques incorporating the TG18 criterion and additional readily available patient characteristics, a prediction model was created to identify patients likely to test negative for acute cholecystitis by HIDA scan. In 235 patients with suspected AC, a HIDA scan was performed. Variables associated with positive HIDA results were male gender (RR 2.0 (CI 1.33-2.99), age (OR 1.02 (CI 1.01-1.04), right upper quadrant tenderness (RR 1.7 (CI 1.1-2.8)), clinical Murphy's sign (RR 2.2 (CI 1.5-3.4)), ultrasound findings suggestive of AC by any of its components (RR 3.2 (CI 1.6-6.5)), gallbladder wall thickening (RR 2.0 (CI 1.3-3.1)), and gallbladder distention (RR 1.9 (CI 1.3-2.9)). These variables allowed for creation of a model to predict HIDA results. The model predicted HIDA results in 36.9% of patients with an area under the curve of 0.81. In the era of TG18, HIDA is probably over utilized. We developed an accurate, simple model based on TG18 that identifies a group of patients for whom a HIDA scan is unnecessary to establish the diagnosis of AC.
ISSN:0022-4804
1095-8673
DOI:10.1016/j.jss.2021.08.009