Diagnosis of Intrahepatic Stone by Endoscopic Retrograde Intrahepatic Cholangiography A Comparative Study with Intravenons Radionuclide Cholescintigraphy and Ultrasonography

Abstract

In our analysis of the diagnostic result of ERIC in intrahepatic stone, it revealed that 74 among 93 patients with intrahepatic stone were correctly diagnosed by ERIC. On the other hand, 6 among 232 patients of non-intrahepatic stone were incorrectly diagnosed as intrahepatic stone by ERIC. As a result, the diagnostic sensitivity, specificity and accuracy of ERIC in intrahepatic stone were assessed to be 79.6%, 97.4% and 92.3% respectively. The ERIC would clearly show out the entire biliary tract, local stenosis, and location and size of stone. Preoperatively, it is one of the most useful and effective methods in accurate diagnosis on both intrahepatic stone and its associated abnormalities of biliary tree. Comparing the sensitivity, specificity and accuracy among ERIC, IVRC and US, we find that: (a) both sensitivity and accuracy are the best in US, (b) the specificity shows no significant difference among ERIC, IVRC and US. Although US is the most sensitive diagnostic procedure for intrahepatic stone, the local stenosis of bile duct and spetial relationship between stone and entire biliary tree are unable to be clearly demonstrated by US. Therefore, preoperatively, a direct cholangiography by ERIC or PTC is further necessary for obtaining a better surgical result. IVRC is also effective in diagnosis of intrahepatic stone. However, because of having two dis-advantages of limited anatomic resolution and non-efficiency in detecting extrahepatic stone, the usefulness of IVRC in common practice has largely been reduced.