Comparison of ultrasound and hepatobiliary imaging in the early detection of acute total common bile duct obstruction.

We retrospectively reviewed the clinical data of 17 selected patients who underwent hepatobiliary imaging studies using technetium Tc 99m iprofenin that demonstrated acute complete common bile duct obstruction, and who also had a temporally related ultrasonographic study of the hepatobiliary tree. We compared the accuracy of the two methods in the detection of common duct obstruction. The average duration of symptoms was 2.9 days. Serum bilirubin levels averaged 3.3 mg/dL and the average alkaline phosphatase level was 336 mg/dL. The serum amylase level was elevated in only three patients. Ultrasonographic dilatation of the ductal structures was present in seven (41%) of 17 patients; 88% of the patients had other manifestations of gallbladder disease on ultrasonography--either cholelithiasis, dilatation of the gallbladder, or wall thickening. Of 15 patients who were operated on, 11 had stones impacted at the ampulla of Vater. There was a poor correlation of ultrasonographic ductal dilatation and operative findings of ductal dilatation. This study shows the superiority of nuclear imaging over ultrasonography in the early detection of acute, common bile duct obstruction.