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Paper Information

Journal:   MEDICAL JOURNAL OF MASHHAD UNIVERSITY OF MEDICAL SCIENCES   Fall 2004 , Volume 47 , Number 85; Page(s) 239 To 245.



Introduction: Diagnosis of choledocholithiasis (CDL) is very difficult and in some cases it is only possible with laparotomy. On the other hand diagnosis of cholelithiasis is easily made via ultra sonogeraphy (US). Endoscopic Retrograde Cholangiopancreatography (ERCP) and computerizing tomography (CT) are also used in CDL diagnosis. In this study the investigators compared the sensitivy and specificity of ERCP, US and CT procedures.
Material and Methodes: patients suffering from incomplete obstructive jaundice, biliary colic and cholangitis with or without history of previous cholecystectomy underwent US and CT scan after performing liver function tests and after bile duct lesion was confirmed ERCP was conducted. Results: A total of268 cases of ERCP was conducted. Among them 140 (52.2%) patients had either single or multiple common bile duct (CBD) stones.The youngest patient was a 17 year old girl and the oldest one an 85 years old man. The mean age of the patients was 61.7±19.1 years. US was conducted in all patients and in 23 (16.4%) cases showed the stone exactly, but in 36 (25.7%) cases showed only dilation of intrahepatic bile duct without signs of stone in CBD, this was due to air accumulation in C-Ioop of the duodenum, also 81(57.8%) had normal US. If we concider dianosis of stone in CBD as the gold standard than the sensitiviy of US would be 16.4%, tut if we consider both dilation of bile duct and presence of stone as diagnostic indications than the sensitivity would rise to 65.5%, at the same time the specificity for US would be 63.3%. CT was done in 12 cases and in 5 showed a mass or tumor which was proven by ERCP to be stone there for giving a sensitivity of 41.6%. In 3 cases CT showed only dilation of intrahepatic ducts without any mass or tumor in CBD, therefore considering both conditions the sensitivity rise to 66.6%. In 4 cases CT showed nothing. The specificity for CT in CBD stonediagnosis was 28.5%. sensitivity and was calculated 28.5%. Sensitivity and specificity for ERCP in our study were 87.8% and 75% respectively
Conclusion: In our study both US and CT had less sensitivity and specificity in comparisson with ERCP.

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