De Silva Supun Lakmal, Pathirana Ajith Aloka, Wijerathne Thejana Kamil, Gamage Bawantha Dilshan, Dassanayake Buddhika Kemiya, De Silva Mohan Malith
Postgraduate Institute of Medicine, University of Colombo, Colombo 10, Sri Lanka.
Department of Surgery, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka.
J Clin Imaging Sci. 2019 Jun 28;9:31. doi: 10.25259/JCIS-38-2019. eCollection 2019.
Ultrasonography remains the initial imaging modality in the management of biliary disease. This study is designed to evaluate the accuracy of transabdominal ultrasonography in diagnosing biliary pathology in patients with choledocholithiasis.
This was a retrospective study of a continuous sample of patients over a period of 3 years ending in January 2016; these patients were referred for endoscopic management of choledocholithiasis to a tertiary care hospital in Colombo, Sri Lanka. Ultrasound reporting was carried out by different consultant radiologists at both the index and the referring hospitals. The findings of endoscopic retrograde cholangiograms were compared with the ultrasound scan (USS) results.
A total of 247 patients were included in the study. USS was 97.4% accurate in detecting intrahepatic duct dilatation (IHDD). Stone counts and the location of stone(s) in the USSs correlated strongly with the number of stones delivered during endoscopic removal and their location in cholangiograms ( < 0.001). The difference in mean diameter of the common bile duct (CBD) of patients with choledochal cysts (CCs) (18.57 mm) and of patients without them (12.39 mm) is statistically significant ( < 0.001). At 14.5 mm, the negative predictive value for a CC is 99.02%.
Ultrasonography is a reliable tool in predicting IHDD, stone count, and the location of stones in the biliary tree, particularly in a resource-poor setting. A CBD diameter of 14.5 mm in transabdominal ultrasound scan can be used as a cutoff for predicting extrahepatic CC.
超声检查仍然是胆道疾病管理中的初始成像方式。本研究旨在评估经腹超声检查在诊断胆总管结石患者胆道病变中的准确性。
这是一项回顾性研究，对截至2016年1月的3年期间连续纳入的患者样本进行研究；这些患者被转诊至斯里兰卡科伦坡一家三级护理医院接受胆总管结石的内镜治疗。索引医院和转诊医院的不同放射科顾问医生进行超声报告。将内镜逆行胆管造影的结果与超声扫描（USS）结果进行比较。
共纳入247例患者。USS检测肝内胆管扩张（IHDD）的准确率为97.4%。USS中的结石数量和结石位置与内镜取出过程中取出的结石数量及其在胆管造影中的位置密切相关（<0.001）。胆总管囊肿（CCs）患者的胆总管（CBD）平均直径（18.57 mm）与无胆总管囊肿患者的胆总管平均直径（12.39 mm）之间的差异具有统计学意义（<0.001）。在14.5 mm时，CC的阴性预测值为99.02%。
超声检查是预测IHDD、结石数量和胆道树中结石位置的可靠工具，尤其是在资源匮乏的环境中。经腹超声扫描中CBD直径为14.5 mm可作为预测肝外CC的临界值。
