Gangrenous Cholecystitis: Does Contrast Enhanced Ultrasound (CEUS) Improve diagnostic accuracy? A systematic review and meta-analysis.

Shaunna Smith, Ultrasound Hull and East Yorkshire


Gangrenous cholecystitis is the most common complication of acute cholecystitis with associated high mortality rates. Clinical detection is poor due to unspecific clinical/laboratory findings. Computed tomography (CT) is the imaging gold standard for pre-surgical detection, however involves ionising radiation and delayed diagnosis. This review aim is to compare diagnostic accuracy of CEUS to cholecystectomy for detection of gangrenous cholecystitis pre-operatively. 


A systematic search of electronically published literature identified 1,226 studies. Two studies met the inclusion criteria and one study was further identified by hand-searching reference lists of potential studies. Three studies were included for analysis. Study quality was assessed using QUADAS-2, data extraction performed then meta-analysis.


Three prospective cohort studies with a total of 233 patients were included. All studies had moderate-high methodological quality. Pooled sensitivity and specificity for contrast ultrasound was 83% (76-89% 95% CI) and 86% (77-89% 95% CI). Ultrasound diagnosed 12 false positives, 5 due to perforation, the remainder not specified. There was a total of 25 false negatives.


The sensitivity and specificity of contrast ultrasound are comparable to that of computed tomography, therefore is feasible to use as a non-ionising alternative. However further research is required to determine the economical implication of departments learning a new technique.

View the Poster Here