title: Common bile duct stones on multidetector computed tomography: attenuation patterns and detectability.
abstract: OBJECTIVE
  To investigate the attenuation patterns and detectability of common bile duct (CBD) stones by multidetector computed tomography (MDCT).
  
  
  METHODS
  Between March 2010 and February 2012, 191 patients with suspicion of CBD stones undergoing both MDCT and endoscopic retrograde cholangiopancreatography (ERCP) were enrolled and reviewed retrospectively. The attenuation patterns of CBD stones on MDCT were classified as heavily calcified, radiopaque, less radiopaque, or undetectable. The association between the attenuation patterns of CBD stones on MDCT and stone type consisting of pure cholesterol, mixed cholesterol, brown pigment, and black pigment and the factors related to the detectability of CBD stones by MDCT were evaluated.
  
  
  RESULTS
  MDCT showed CBD stones in 111 of 130 patients in whom the CBD stones were demonstrated by ERCP with 85.4% sensitivity. The attenuation patterns of CBD stones on MDCT were heavily calcified 34 (26%), radiopaque 31 (24%), less radiopaque 46 (35%), and undetectable 19 (15%). The radiopacity of CBD stones differed significantly according to stone type (P < 0.001). From the receiver operating characteristic curve, stone size was useful for the determination of CBD stone by MDCT (area under curve 0.779, P < 0.001) and appropriate cut-off stone size on MDCT was 5 mm. The factors related to detectability of CBD stones on MDCT were age, stone type, and stone size on multivariate analysis (P < 0.05).
  
  
  CONCLUSIONS
  The radiopacity of CBD stones on MDCT differed according to stone type. Stone type and stone size were related to the detectability by MDCT, and appropriate cut-off stone size was 5 mm.
authors.affiliation: Department of Internal Medicine, College of Medicine, The Catholic University of Korea, 505 Banpo-Dong, Seocho-Gu, Seoul 137-701, South Korea.
authors.forename: Chang Whan
authors.initials: CW
authors.lastname: Kim
authors.forename: Jae Hyuck
authors.initials: JH
authors.lastname: Chang
authors.forename: Yeon Soo
authors.initials: YS
authors.lastname: Lim
authors.forename: Tae Ho
authors.initials: TH
authors.lastname: Kim
authors.forename: In Seok
authors.initials: IS
authors.lastname: Lee
authors.forename: Sok Won
authors.initials: SW
authors.lastname: Han
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001654:Bile Pigments / Q000032:analysis; D016009:Chi-Square Distribution; D002760:Cholangiopancreatography, Endoscopic Retrograde; D042883:Choledocholithiasis / Q000737:chemistry / Q000000981:diagnostic imaging*; D002784:Cholesterol / Q000032:analysis; D005260:Female; D042882:Gallstones / Q000737:chemistry / Q000000981:diagnostic imaging*; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies
chemical_list: D001654:Bile Pigments; D002784:Cholesterol
keywords: Common bile duct gallstones; Endoscopic retrograde cholangiography; Gallstones; Multidetector computed tomography
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