Laing F C, Jeffrey R B, Wing V W
AJR Am J Roentgenol. 1984 Nov;143(5):949-52. doi: 10.2214/ajr.143.5.949.
During a 20 month period, real-time sonography performed on 26 patients achieved an overall sensitivity of 75% for detecting choledocholithiasis. Although previous publications have stressed very low sensitivities for diagnosing choledocholithiasis (13%-55%), it was postulated that the reasons for these disappointing results are primarily related to technique. Most laboratories evaluate the distal common bile duct (where most calculi are located) by obtaining parasagittal scans. Detection of choledocholithiasis can be substantially improved by scanning the intrapancreatic part of the bile duct in a transverse fashion with the patient in an erect position. Advantages of the transverse view include the ability to demonstrate the distal common bile duct in a high percentage of patients and to differentiate shadowing caused by duodenal gas from ductal calculi. The proximal duct is best imaged by obtaining parasagittal scans with the patient in a supine left posterior oblique position. Using these scanning techniques, eight (89%) of nine proximal and 16 (70%) of 23 distal calculi were visualized.
在20个月的时间里，对26例患者进行实时超声检查，检测胆总管结石的总体敏感性为75%。尽管先前的出版物强调诊断胆总管结石的敏感性非常低（13%-55%），但据推测，这些令人失望的结果主要与技术有关。大多数实验室通过获得矢状旁扫描来评估胆总管远端（大多数结石所在的部位）。让患者直立，以横向方式扫描胆管胰腺内部分，可显著提高胆总管结石的检测率。横向视图的优点包括能够在高比例的患者中显示胆总管远端，并区分十二指肠气体引起的阴影与胆管结石。患者仰卧位左后斜位时获得矢状旁扫描，可最佳显示近端胆管。使用这些扫描技术，9枚近端结石中的8枚（89%）和23枚远端结石中的16枚（70%）被显示出来。
