title: Sonographic gallstone patterns are of value in predicting the outcome of biliary lithotripsy.
abstract: The purpose of our study was to determine whether the qualitative features of gallstones, as expressed by their sonographic image, are related to the degree of fragmentation by shock-wave lithotripsy and the rate of stone clearance. The sonographic stone images of 73 patients with 1-3 uncalcified gallstones, followed for at least 1 yr after extracorporeal shock-wave lithotripsy, were analyzed and categorized by three independent observers into two distinct groups: type I--crescent to disc shape with gradual attenuation of echoes, and type II--rim-shape with abrupt shadowing. The degree of fragmentation and rate of stone clearance were significantly greater for type I stones than for type II stones. For all subjects, 1 yr after lithotripsy, 56% (27/48) of type I stones and 12% (3/25) of type II stones had cleared completely (p less than 0.0005). The clearance rate for solitary type I stones was 63% (20/32) versus 14% (2/14) for type II stones (p less than 0.005). Our observations suggest that sonographic analysis of stone patterns might help in predicting success, and contribute to greater cost-effectiveness of biliary extracorporeal shock-wave lithotripsy.
authors.affiliation: Division of Gastroenterology, Cabrini Medical Center, New York, New York.
authors.forename: H
authors.initials: H
authors.lastname: Dyrszka
authors.forename: S
authors.initials: S
authors.lastname: Patel
authors.forename: B
authors.initials: B
authors.lastname: Sanghavi
authors.forename: G
authors.initials: G
authors.lastname: Patel
authors.forename: C
authors.initials: C
authors.lastname: Byk
authors.forename: G
authors.initials: G
authors.lastname: Salen
mesh_terms: D001649:Bile Duct Diseases / Q000000981:diagnostic imaging; D002769:Cholelithiasis / Q000000981:diagnostic imaging*; D006801:Humans; D008096:Lithotripsy; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography