Division of Gastroenterology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
Corresponding author:
Dong Ki Lee,
ABSTRACT
Background/Aims: Recently in Korea, the incidence of cholesterol gallstones is increasing and the opportunities of the application of non-operative therapy can be increased consequently. Therefore it is the most important to predict pure cholesterol gallstones in selecting the subjects of the non-operative therapy before treatment. This study had been designed to find the effectiveness of ultrasonography (US) and computed tomography (CT) in predicting the cholesterol gallstones by investigating the relationship between the finding of these two imaging studies according to the composition of the gallstones. Methods: Among the gallstones collected from cholecystectomy from July, 1987 to June, 1993, the 96 cases with their gallstones’ diameter of more than or equal to 10 mm had been chosen as our subjects. US and CT had been performed in vitro. The ultrasonographic findings had been classified according to the shapes of anterior surface and the internal echo-patterns. CT finding had been classified according to the calcification patterns. Fourier transform infrared spectrophotometer method had been used for the analysis of the composition of the gallstones. Results: The chemical composition of the gallstones and their frequency were as follows; 47.9% of pure cholesterol gallstones and 37.5% of bilirubin gallstones. When the gallstones were classified into 6 groups according to their ultrasonographlc results, pure cholesterol gallstones had type Ilb with the frequency of 39.1%, type I with 30.4% and type IIa with 13%. The classification of the gallstones into 5 type according to their CT findings resulted in 43.5% for type 5 and 30.4% for type 1 for pure cholesterol gallstones. The classification of gallstones by using US showed that 69.2% of type IIb and 66.7% of type IIa were pure cholesterol gallstones. The classification of gallstone by using CT showed that 76.9% of type 5 and 73.7% of type 1 were pure cholesteral gallstones. When both US and CT were performed, all gallstones with type IIa in US and type 5 in CT, type IIb in US and type 6 in CT were found to be pure cholesterol gallstones, in addition to those with type IIc in US and type 5 in CT. Conclusion: US and CT are helpful in predicting pure cholesterol gallstones and can improve the accuracy of prediction of the composition of gallstones especially when these two imaging studies are used together. Therefore, they are considered to help us decide therapeutic plan of gallstones.
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