Little additional information is gained by the routine addition of a noncontrast phase to a contrast-enhanced phase in this clinical setting [10]. MRI Abdomen with MRCP MRI has not been evaluated sufficiently in acalculous cholecystitis and is often impractical, given patient comorbidity. Therefore, its usefulness in the setting of suspected acalculous cholecystitis is limited. However, MRI may play a role in cases where other imaging tests are equivocal [7]. Several studies have suggested that abdominal MRI is a reliable alternative and can be particularly helpful in the patient who is difficult to examine with US [36- 38]. MRI can be the next best imaging modality when acalculous cholecystitis is excluded, and MRI with MRCP is considered the best modality for evaluating hepatic and biliary abnormalities that are not characterized by US. It can perform superiorly to US in cases of gallstones in the gallbladder neck, the cystic duct, or the common bile duct [7]. Nuclear Medicine Scan Gallbladder Cholescintigraphy is a very sensitive diagnostic test because most cases of acalculous cholecystitis are associated with cystic duct obstruction, similar to the calculous form of the disease. Some cases of acalculous cholecystitis, however, are related to direct inflammation of the gallbladder, leading to false-negative studies when using cholescintigraphy [51]. It should also be noted that the specificity of cholescintigraphy may be limited in the critically ill patient where nonvisualization of the gallbladder may occur in the absence of inflammation despite preimaging cholecystokinin administration. However, cholescintigraphy remains the imaging examination of choice when acalculous cholecystitis is suspected. Image-Guided Biopsy Liver Percutaneous cholecystostomy can be both diagnostic and therapeutic, and it is usually considered safe in hospitalized patients suspected of having acalculous cholecystitis [52,53].
Right Upper Quadrant Pain. Little additional information is gained by the routine addition of a noncontrast phase to a contrast-enhanced phase in this clinical setting [10]. MRI Abdomen with MRCP MRI has not been evaluated sufficiently in acalculous cholecystitis and is often impractical, given patient comorbidity. Therefore, its usefulness in the setting of suspected acalculous cholecystitis is limited. However, MRI may play a role in cases where other imaging tests are equivocal [7]. Several studies have suggested that abdominal MRI is a reliable alternative and can be particularly helpful in the patient who is difficult to examine with US [36- 38]. MRI can be the next best imaging modality when acalculous cholecystitis is excluded, and MRI with MRCP is considered the best modality for evaluating hepatic and biliary abnormalities that are not characterized by US. It can perform superiorly to US in cases of gallstones in the gallbladder neck, the cystic duct, or the common bile duct [7]. Nuclear Medicine Scan Gallbladder Cholescintigraphy is a very sensitive diagnostic test because most cases of acalculous cholecystitis are associated with cystic duct obstruction, similar to the calculous form of the disease. Some cases of acalculous cholecystitis, however, are related to direct inflammation of the gallbladder, leading to false-negative studies when using cholescintigraphy [51]. It should also be noted that the specificity of cholescintigraphy may be limited in the critically ill patient where nonvisualization of the gallbladder may occur in the absence of inflammation despite preimaging cholecystokinin administration. However, cholescintigraphy remains the imaging examination of choice when acalculous cholecystitis is suspected. Image-Guided Biopsy Liver Percutaneous cholecystostomy can be both diagnostic and therapeutic, and it is usually considered safe in hospitalized patients suspected of having acalculous cholecystitis [52,53].