J Korean Radiol Soc.  1983 Mar;19(1):161-167. 10.3348/jkrs.1983.19.1.161.

Ultrasonic differential diagnosis of stones and carcinomas in the extrahepatic biliary tree

• Cho DH
• Kim KT
• Shinn KS
• Bang CY
• Yoon SC
• Bahk YW

• KMID: 2463217
• DOI: http://doi.org/10.3348/jkrs.1983.19.1.161

Abstract

Ultrasonography is a simple, noninvasive and relatively accurate method to differentiate carcinomas from stones in the extrahepatic biliary tree. We analysed ultrasonic findings in 18 stoen cases and 10 carcinoma cases of the extrahepatic biliary tree, which were confirmed by microscopic examination or percutaneous transhepatic cholangiography during the period of May 1980 through May 1982 in Kangnam St. Mary's Hospital. The results were as follows: 1. The number of incidences of multiple echogenecities was 11 out of the 18 stone cases (61.1%) but there were no incidences of multiple echogenecities among the carcinoma cases. Eight cases, four of stoens and carcinomas each , were not detected by sonography. 2. The average diameter of the stones was below 20mm in 13 of the 18 cases (72 .2%) and the number of the stoens over 20mm in diameter was only one of the 18(5.6%), while the number of carcinomas over 20mm was three of the 10 cases (30%). 3. In the 18 patients with stoens, the degree of echogenecity was uniformly high in seven (38.9%) and mixed-moderate in seven (38.9%) . All the carcinomas, however, presented mixed-slight echogenecity. The marginal sharpness was well defined in nine of the 18 stone cases (50%), but only one among the carclnomas. 4. The obstructive site in the biliary tree in the stone cases showed a typical meniscus in 10 (55 .6%), abrupt cutting in four (22_2%) and were indiscernible in four (22.2%). But of the 10 carcinoma cases four (40%) were of abrupt cutting, two (20%) funnel -shaped and were indiscernible in four (40%). 5. The frequency of posterior acoustic shadows was 11(61.1%) in the stones and only one in the carcrnmnas. 6. The diameter of the extrahepatic biliary tree proximal to the obstructive site did not seem to be definite factor in differentiating carcinomas from stones since both stoen and carcinoma cases showed dilatation of the extrahepatic bile duct. 7 The extrahepatic biliary stones in general were characteristic of multiple, high or moderate echogenecity with a sharp margin as well as a posterior acoustic shadow. The extrahepatic biliary carcinomas, however, presented single slight echogenecity with a blurred margin without a posterior acoustic shadow.

MeSH Terms

Acoustics
Bile Ducts, Extrahepatic
Biliary Tract*
Cholangiography
Diagnosis, Differential*
Dilatation
Humans
Incidence
Methods
Ultrasonics*
Ultrasonography