Gallstones: a comparison of real-time ultrasonography and cholecystography with surgical correlation

Real-time ultrasonography is more accurate and technically more efficient than gray scale ultrasonography in establishing the diagnosis of cholecystolithiasis. In prospective studies accuracy may be as high as 96%, and reflects the use of specific sonographic diagnostic criteria. Retrospective studies, however, reveal a lower accuracy rate of 90%, suggesting that practicing radiologists are not ready to accept these restricting criteria. On the other hand, oral cholecystography (OCG) is well tolerated and gives a reproducible, reliable result independent of technical expertise. It is 96% accurate in detecting the presence of gallstones and carries a sensitivity of .97. Both studies are prone to overinterpretation, which skews specificity and adversely affects diagnostic accuracy. In this retrospective review of 234 consecutive cases of cholecystectomy, real-time ultrasound was 90% accurate with a sensitivity of .96 in determining the presence of cholecystolithiasis. Oral cholecystography was 95% accurate with a sensitivity of .97.