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. 1999 Nov;45(5):744–749. doi: 10.1136/gut.45.5.744

Helical computed tomographic cholangiography versus endosonography for suspected bile duct stones: a prospective blinded study in non-jaundiced patients

M Polkowski 1, J Palucki 1, J Regula 1, A Tilszer 1, E Butruk 1
PMCID: PMC1727710  PMID: 10517914

Abstract

BACKGROUND—Helical computed tomography performed after intravenous administration of a cholangiographic contrast material (HCT-cholangiography) may be useful for detecting bile duct stones in non-jaundiced patients. However, this method has never been compared with other non-invasive biliary imaging tests.
AIMS—To compare prospectively HCT-cholangiography and endosonography (EUS) in a group of non-jaundiced patients with suspected bile duct stones.
METHODS—Fifty two subjects underwent both HCT-cholangiography and EUS. Endoscopic retrograde cholangiography (ERCP), with or without instrumental bile duct exploration, served as a reference method, and was successful in all but two patients.
RESULTS—Thirty four patients (68%) were found to have choledocholithiasis at ERCP. The sensitivity for HCT-cholangiography in stone detection was 85%, specificity 88%, and accuracy 86%. For EUS the sensitivity was 91%, specificity 100%, and accuracy 94%. The differences were not significant. No serious complications occurred with either method.
CONCLUSIONS—HCT-cholangiography and EUS are safe and comparably accurate methods for detecting bile duct stones in non-jaundiced patients.


Keywords: bile duct; calculi; endoscopic ultrasonography; computed tomography; cholangiography.

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Figure 1  .

Figure 1  

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Small stone, 4 mm in diameter, in the distal part of undilated common bile duct (CBD). (A) Endosonographic image showing the stone (black arrow) with acoustic shadowing (arrowheads). (B) Helical computed tomographic cholangiography; maximum intensity projection image shows the gall bladder and both the intrahepatic and extrahepatic bile ducts. The small filling defect (white arrow) close to the end of the common bile duct represents the stone.

Figure 2  .

Figure 2  

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A single 10 mm bile duct stone shown by endosonography (A) and helical computed tomographic (HCT)-cholangiography (B, C). (A) A hyperechoic structure (white arrow) is seen associated with acoustic shadowing (black arrowheads), which is a typical appearance of a stone at endosonography; CBD indicates the common bile duct. (B) HCT-cholangiography; an axial image at the level of the distal common bile duct shows a filling defect (black arrow) which corresponds to the stone seen at endosonography. White arrowheads delineate the cross section of the common bile duct containing contrast enhanced bile. (C) HCT-cholangiography; multiplanar reconstruction image in the same patient. The stone (white arrow) is seen as a polygonal filling defect.

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