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Accuracy of MDCT in the Diagnosis of Choledocholithiasis

Stephan W. Anderson1, Brian C. Lucey1, Jose C. Varghese1 and Jorge A. Soto1

1 All authors: Radiology Department, Boston Medical Center, 88 East Newton Street, 2nd Floor, Boston, MA 02215.


Figure 1
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  		Fig. 1 —82-year-old woman with periumbilical pain and weight loss. Axial contrast-enhanced CT image reveals common bile duct to be well visualized without evidence of choledocholithiasis (arrows). Even in retrospect, small stone retrieved at ERCP could not be identified.

 

Figure 2
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  		Fig. 2 —47-year-old woman postcholecystectomy with persistent right upper quadrant pain. Axial CT image reveals small calcified common bile duct stone (arrow). At ERCP, several small stones of varying sizes were retrieved from common bile duct.

 

Figure 3
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  		Fig. 3 —83-year-old woman with nonspecific abdominal pain. Transverse contrast-enhanced CT image reveals large soft-tissue attenuating common bile duct (CBD) stone (black arrow). Layering sludge is also noted in gallbladder (white arrow). At ERCP, 9-mm stone was retrieved from distal CBD.

 

Figure 4
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  		Fig. 4A —74-year-old woman with abdominal pain. Axial unenhanced CT image from study in which there was no evidence of choledocholithiasis.

 

Figure 5
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  		Fig. 4B —74-year-old woman with abdominal pain. Axial contrast-enhanced CT image reveals soft-tissue attenuating common bile duct (CBD) stone (black arrow). Also noted are dependently layering gallstones (white arrow). ERCP revealed 8-mm distal CBD stone.

 

Figure 6
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  		Fig. 5 —72-year-old man presenting with diarrhea. Axial unenhanced CT image reveals large calcified focus within common bile duct (CBD) (arrow). This is false-negative for one observer that was misinterpretation of large CBD stone as oral contrast material within duodenal diverticulum. At ERCP, single large CBD stone was retrieved.

 

Figure 7
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  		Fig. 6 —77-year-old woman with nonspecific abdominal pain. Axial unenhanced CT image clearly shows calcified focus within common bile duct (arrow). Radiologists hypothesized stone may have passed in interim between CT and ERCP, when no stone was found.

 

Figure 8
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  		Fig. 7 —74-year-old man presenting with pain and pancreatic mass on sonogram. Axial contrast-enhanced CT image shows questionable hyperdense focus (arrow) within common bile duct (CBD). This is a false-positive for one observer, and at consensus review, hyperdensity was concluded to be partial volume averaging of enhanced blood vessel in immediate vicinity of CBD.

 

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