Cholelithiasis: evaluation with CT.

Computed tomography (CT) is often the first imaging modality used in the diagnosis of patients with suspected abdominal disease. While it is known that early generation CT scanners often detect gallstones, the detection rate of newer equipment is not widely known. Abdominal CT scans of 226 patients who had undergone ultrasonographic (US) studies of the gallbladder were reviewed in a blinded study to determine the accuracy of state-of-the-art CT scanning equipment in the detection of cholelithiasis.

Hepatobiliary imaging in choledocholithiasis. A comparison with ultrasound.

A retrospective analysis of preoperative biliary imaging and ultrasound in 22 patients with surgically proven choledocholithiasis was performed. Ultrasound detected dilated ducts greater than 7 mm in 11 of 14 jaundiced patients (79%). Hepatobiliary imaging was able to detect either absent or delayed bowel visualization or prominent bile ducts in 13 of 14 jaundiced patients (93%).

Pheochromocytoma: detection by unenhanced CT.

During a 2 1/2-year period, 10 patients with suspected pheochromocytoma were evaluated by unenhanced computed tomography (CT). Six adrenal masses, one hyperplastic adrenal gland, and two extraadrenal retroperitoneal masses were detected in seven patients; CT of the adrenals and retroperitoneum was normal in three patients. Scintigraphy with iodine-131 metaiodobenzylguanidine (131I-MIBG) was performed in nine of the 10 patients and corroborated the CT findings in all cases.

Real-time sonography in suspected acute cholecystitis. Prospective evaluation of primary and secondary signs.

Sonographic findings in 497 patients with suspected acute cholecystitis were analyzed prospectively. Combined use of primary and secondary sonographic signs led to excellent positive and negative predictive values. Positive predictive values for stones combined with either a positive sonographic Murphy sign (92.

The insensitivity of sonography in the detection of choledocholithiasis.

To determine the sensitivity of sonography in the detection of choledocholithiasis, the sonograms of 138 patients with surgically proven common bile duct stones were reviewed. A definite diagnosis of choledocholithiasis could be made on the basis of the sonograms in 22% of cases. Overall, 23% had common ducts of normal caliber (less than or equal to 7 mm diam) and 23% had normal total bilirubin levels at the time of the examination.

Predicting the cause of common bile duct obstruction with sonographic data: analysis of binary variables.

A retrospective analysis of 71 patients with proven common bile duct obstruction, who had not undergone previous biliary surgery, was performed. To determine optimal criteria for differentiating stone from nonstone obstruction by ultrasonography, five sonographic signs were analyzed as binary variables. These signs are the demonstration of (1) common duct stones, (2) mass at the site of the common bile duct, (3) gallbladder stones, (4) gallbladder volume greater than a critical value, and (5) common duct diameter greater than a critical value.

Sonography of pyogenic splenic abscess.

Pyogenic splenic abscess is an uncommon lesion associated with high mortality. Diagnosis may be difficult, especially in deep-seated abscesses. Plain radiographs and nuclear medicine techniques may be helpful, but can be insufficiently specific.

Prospective evaluation of the sonographic Murphy sign in suspected acute cholecystitis.

The sonographic Murphy sign, the presence of maximal tenderness elicited over a sonographically localized gallbladder, has been considered useful in the evaluation of patients with suspected acute cholecystitis. We prospectively evaluated this sign in 427 consecutive patients referred for evaluation of acute cholecystitis. The overall accuracy of the sonographic Murphy sign in the 219 patients with sufficient confirmation to be included in the statistical analysis was 87.

Gray-scale ultrasonography of hepatic amoebic abscesses.

Retrospective analysis of the ultrasonograms of 42 hepatic amoebic abscesses in 34 patients was performed. All lesions were less echogenic than normal liver. All but 1 were contiguous with the liver capsule and had slight distal sonic enhancement.