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PubMed1983

Computed tomography of choledocholithiasis.

Computed tomography (CT) correctly diagnosed common bile duct stones in 19 (90%) of 21 surgically proven cases. CT demonstrated calculi in all 13 patients with calcium bilirubinate common duct stones and six of eight patients with predominantly cholesterol stones. There were two false-negative diagnoses in patients with cholesterol calculi scanned at 1 cm intervals. Cholesterol stones are nearly isodense with bile and may be difficult to visualize in the common duct by routine scanning techniques. There are three suggestive CT features of cholesterol common duct calculi: (1) abrupt termination of the distal common bile duct without an obstructing mass, (2) a faint rim of increased density along the peripheral margin of a low-density calculus, and (3) mottled areas of increased density centrally within a calculus elevating its CT number above values for normal bile. Modification of scanning technique to obtain high-resolution images of the extrahepatic biliary tree is stressed to optimize visualization of the above findings.

Adult↗
PubMed1996

Choledocholithiasis: evaluation with MR cholangiography.

OBJECTIVE: We performed this study to evaluate the usefulness of a new T2-weighted MR sequence using a half-Fourier acquisition single-shot turbo spin-echo (HASTE) technique in the diagnosis of bile duct stones. SUBJECTS AND METHODS: We prospectively evaluated 23 patients with suspected bile duct calculi using HASTE MR cholangiography and compared that imaging technique with endoscopic retrograde cholangiography and sonography. The study group consisted of 15 women and eight men who were 42-89 years old. Patients were imaged in the axial, coronal, and sagittal planes with a 1.5-T MR scanner using a body coil. Acquisitions of 13 sec each allowed images to be obtained in a single breath-hold. All images were interpreted by two radiologists in a double-blinded fashion. The presence, number, and size of stones were noted, and common bile duct dilatation was assessed. RESULTS: Fifteen of the 23 patients were proven to have common bile duct stones. Stone size ranged from 3 mm to 35 mm (mean, 11 mm). HASTE MR cholangiography revealed stones in 14 (93%) of 15 patients; sonography revealed stones in nine (60%) of 15 patients. In 12 patients, the common bile duct was dilated, as shown by endoscopic retrograde cholangiography, HASTE MR cholangiography, and sonography. On HASTE MR cholangiograms, we measured the diameter of the bile duct in all patients. The mean diameter was 11 mm, which correlated well (r = .82) with a mean diameter of 13.5 mm as measured on endoscopic retrograde cholangiograms. CONCLUSION: HASTE MR cholangiography can noninvasively and rapidly reveal the presence of stones in the common bile duct and allows readers to assess the degree of biliary dilatation. The sequence should be considered as an alternative to endoscopic retrograde cholangiography in patients with clinical evidence of bile duct calculi and in those for whom endoscopic retrograde cholangiography is impossible.

Adult↗
PubMed1999

[Update on the treatment of choledocholithiasis].

Primitive or residual common bile duct calculi following common bile duct surgery can now be treated with minimum surgery using an endoscopic or X-ray guided approach. Having examined the etiopathogenetic theories, the authors analyse the treatment, in particular the possibility of endoscopic papillosphincterotomy and X-ray guided dilatation of the papilla, affirming that the latter can be extremely valuable in cases where it is difficult to canalize the latter.

Adult↗
PubMed2000

[The role of endoscopic sphincterotomy in the therapy of choledocholithiasis: a review of our experience].

The treatment of common bile duct stones is nowadays endoscopic sphincterotomy. The authors reviewed their series from 1992 to 1999 and confirm that this is a safe, definitive, with low complication rate treatment if is performed in specialized centers and reduces the duration of hospitalization. Operative ERCP is successful is about 96-97% of the cases. There was no mortality related to the technique.

Adult↗