Comparative efficiency of of ultrasonography and computed tomography in detection of common bile duct stones taking MRCP as gold standard

Debasis Deoghuria; Sumanta Kumar Mandal; Arijit Mishra

Volume : VIII, Issue : VI, June - 2019

Comparative efficiency of of ultrasonography and computed tomography in detection of common bile duct stones taking MRCP as gold standard

Debasis Deoghuria, Sumanta Kumar Mandal, Arijit Mishra

Abstract :

Background: Choledocholithiasisis a fairly common problem encountered in surgical practice. It can be primary in-situ stones in common hepatic duct or common bile duct or secondary due to gallstone slipping into CHD or CBD. Secondary stones are more common in obese, middle aged females as these subset of populations are more prone to develop gallstones.considering the morbidity and the complications of obstructive jaundice and early diagnosis and treatment-i.e. open access surgery or ERCP guided extraction whichever is suited for a given patient-is mandatory. In this article we have interviewed to decipher the comparative efficacy of USG and CT in detection of stones in CHD or CBD taking MRCP as the gold standard. Aims: To evaluate comparative efficiency of ultrasonography and computed tomography in reaching a definitive diagnosis of choledocholithiasis. Materials and Methods: A total of 100 cases of clinically suspected choledocholithiasis were included in our study. All of them were subjected to USG. Patients with sonographically proven obstructive jaundice-i.e. dilated intrahepatic biliary radicals and /or CHD and CBD with or without detectable stones were then subjected to CT scan and MRI in that sequence. Patients were interrogated with 2-5 mHz convex transducer of HD-7 USG machine( Philips), Siemens 16 slice CT scanner and Brivo 1.5 Tesla(G.E.) MRI machine using protocol for MRCP. Data were analysed, sensitivity and specificity of both USG and CT were calculated and compared using ANOVA method. Results: Of the hundred cases of clinically suspected choledocholithiasis ultrasonography detected 68 cases. CT scan could detect 12 cases while MRCP detected 96 cases. ERCP and surgery revealed choledocholithiasis in 96 cases. 4 cases had benign stricture and two cases had cholangiocarcinoma at the lower end. Conclusion: Ultrasonography is superior to CT scan in detecting choledocholithiasis while MRI remains the gold standard. We recommend USG for every patient of clinically suspected choledocholithiasis or obstructive jaundice followed by MRCP for confirmation.