Abstract
Ultrasonography of 53 patients with stones in either the common bile duct (CBD) or the gallbladder neck/cystic duct revealed respective sensitivities of only 30% and 29% for detection of calculi. The data, which were collected over a period of 40 mo., were also analyzed with respect to an early experience (first 24 mo.) vs. a later experience (last 16 mo.). Although there was no improvement in the diagnosis of gallbladder neck/cystic duct calculi (only those in the gallbladder neck could be identified), significant improvement occurred in the diagnosis of choledocholithiasis, with a sensitivity of 15% in the early period and a sensitivity of 55% in the later period. In part this was due to greater dependence upon real-time equipment and more emphasis on the examination of the distal CBD. A limiting factor in the diagnosis of choledocholithiasis was the normal caliber of the duct in 30% of these patients. Despite improved equipment and technique, ultrasonography cannot detect cystic duct obstruction and the ultrasonographic diagnosis of CBD calculi remains difficult.