title: Tissue harmonic sonography in the diagnosis of common bile duct stones: a comparison with endoscopic retrograde cholangiography.
abstract: OBJECTIVE
  To revisit the diagnostic accuracy of sonography in the detection of choledocholithiasis using modern equipment with tissue harmonic imaging (THI) and endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy as the gold standard.
  
  
  METHODS
  A total of 107 patients with clinically suspected choledocholithiasis were examined with THI before undergoing ERCP. The sonographic findings that were prospectively evaluated included the presence of choledocholithiasis, size of common bile duct, sonographic view and patient position that best visualized the stone(s), visualization of the distal common duct, and duration of examination. The accuracy of sonography compared with ERCP and sphincterotomy was calculated.
  
  
  RESULTS
  Sonography correctly detected stones in 65 of 76 patients (sensitivity of 86%). The specificity and the overall accuracy were 87% and 86%, respectively. The sensitivity of sonography was higher with dilated extrahepatic duct (44% in patients with common bile duct measuring less than 6 mm in diameter, 82% between 6 and 10 mm, and 100% with common bile duct larger than 10 mm). The lateral approach with the patient in left lateral decubitus position of the patient was the most effective in 47% of the cases.
  
  
  CONCLUSIONS
  Sonography with THI is an accurate technique for the detection of choledocholithiasis that may be used as the first-choice technique to avoid unnecessary procedures in a high percentage of patients, especially those with dilated biliary tree.
authors.affiliation: Department of Radiology, Hospital Universitario Dr. Peset, 90 Gapar Aguilar Avenue, Valencia 46017, Spain.
authors.forename: Tomás
authors.initials: T
authors.lastname: Ripollés
authors.forename: Cristina
authors.initials: C
authors.lastname: Ramírez-Fuentes
authors.forename: María J
authors.initials: MJ
authors.lastname: Martínez-Pérez
authors.forename: Fructuoso
authors.initials: F
authors.lastname: Delgado
authors.forename: Esther
authors.initials: E
authors.lastname: Blanc
authors.forename: Antonio
authors.initials: A
authors.lastname: López
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003135:Common Bile Duct / Q000000981:diagnostic imaging*; D042882:Gallstones / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D014463:Ultrasonography