Abstract
Since medical treatment of gallstones is confined to cholesterol-rich stones, the ability of clinical radiographs to predict gallstone type was tested prospectively by comparing the preoperative radiological appearance of gallstones from 57 unselected patients with cholelithiasis coming to cholecystectomy with the subsequent analysis of the stones both by X-ray diffraction and by chemical techniques. Fifty-two per cent of the patients had 'non-functioning' gallbladders which failed to opacify after at least two contrast examinations and 25 out of 50 had radioopaque stones. Of the 25 patients with radiolucent stones, the stones in 20 ((80%) were predominantly cholesterol in type but radiology was misleading in five; three contained 40-55% calcium salts but were still radiolucent while two were amorphous and contained less than 10% cholesterol by weight on chemical analysis. While radiology was sometimes misleading when the stones were small and irregular, large radiolucent stones with a smooth profile were invariably cholesterol-rich stones. The results also show that in men calcified stones were commoner than in women and that in older women the gallstones contained more calcium salts and less cholesterol than in younger women less than 50 yr). This paper analyses critically the value and limitations of clinical radiology in predicting gallstone type.
Full text
PDFSelected References
These references are in PubMed. This may not be the complete list of references from this article.
- ABEL L. L., LEVY B. B., BRODIE B. B., KENDALL F. E. A simplified method for the estimation of total cholesterol in serum and demonstration of its specificity. J Biol Chem. 1952 Mar;195(1):357–366. [PubMed] [Google Scholar]
- Bell G. D., Sutor D. J., Whitney B., Dowling R. Factors influencing human gallstone dissolution in monkey, dog, and human bile. Gut. 1972 Oct;13(10):836–836. [PubMed] [Google Scholar]
- Bell G. D., Whitney B., Dowling R. H. Gallstone dissolution in man using chenodeoxycholic acid. Lancet. 1972 Dec 9;2(7789):1213–1216. doi: 10.1016/s0140-6736(72)92266-0. [DOI] [PubMed] [Google Scholar]
- CARR J. J., DREKTER I. J. Simplified rapid technic for the extraction and determination of serum cholesterol without saponification. Clin Chem. 1956 Oct;2(5):353–368. [PubMed] [Google Scholar]
- Danzinger R. G., Hofmann A. F., Schoenfield L. J., Thistle J. L. Dissolution of cholesterol gallstones by chenodeoxycholic acid. N Engl J Med. 1972 Jan 6;286(1):1–8. doi: 10.1056/NEJM197201062860101. [DOI] [PubMed] [Google Scholar]
- James O., Cullen J., Bouchier A. D. Proceedings: A study of the effectiveness, toxicity, and bile salt kinetics of chenodeoxycholic acid in the treatment of human gallstones. Gut. 1973 Oct;14(10):827–827. [PubMed] [Google Scholar]
- Mok H. Y., Bell G. D., Dowling R. H. Effect of different doses of chenodeoxycholic acid on bile-lipid composition and on frequency of side-effects in patients with gallstones. Lancet. 1974 Aug 3;2(7875):253–257. doi: 10.1016/s0140-6736(74)91415-9. [DOI] [PubMed] [Google Scholar]
- Nakayama F. Quantitative microanalysis of gallstones. J Lab Clin Med. 1968 Oct;72(4):602–611. [PubMed] [Google Scholar]
- Sutor D. J., Wooley S. E. A statistical survey of the composition of gallstones in eight countries. Gut. 1971 Jan;12(1):55–64. doi: 10.1136/gut.12.1.55. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Sutor D. J., Wooley S. E. The nature and incidence of gallstones containing calcium. Gut. 1973 Mar;14(3):215–220. doi: 10.1136/gut.14.3.215. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Sutor D. J., Wooley S. E. The organic matrix of gallstones. Gut. 1974 Jun;15(6):487–491. doi: 10.1136/gut.15.6.487. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Sutor D. J., Wooley S. E. The sequential deposition of crystalline material in gallstones: evidence for changing gallbladder bile composition during the growth of some stones. Gut. 1974 Feb;15(2):130–131. doi: 10.1136/gut.15.2.130. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Sutor D. J., Wooley S. E. X-ray diffraction studies of the composition of gallstones from English and Australian patients. Gut. 1969 Aug;10(8):681–683. doi: 10.1136/gut.10.8.681. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Thistle J. L., Hofmann A. F. Efficacy and specificity of chenodeoxycholic acid therapy for dissolving gallstones. N Engl J Med. 1973 Sep 27;289(13):655–659. doi: 10.1056/NEJM197309272891303. [DOI] [PubMed] [Google Scholar]
- Thistle J. L., Schoenfield L. J. Lithogenic bile among young Indian women. N Engl J Med. 1971 Jan 28;284(4):177–181. doi: 10.1056/NEJM197101282840404. [DOI] [PubMed] [Google Scholar]
- Wolpers C. Morphologie der Gallensteine. Leber Magen Darm. 1974 Apr;4(2):43–57. [PubMed] [Google Scholar]