[Is it still useful to integrate cholecystography with direct radiography in the cholecystokinetic test?]

There are discordant opinions in literature on the techniques of execution of the cholecystography. The authors have examined 104 consecutive patients with the clinical suspicion of gallstones in order to verify the usefulness of the plain radiogram and of the cholecystokinetic test. All the patients have been studied systematically with the plain radiogram of the hepatic region, with cholecystography completed by cholecystokinetic test and with ultrasound. In two cases of radiopaque gallstones (7.1%) the plain radiogram was indispensable for the diagnosis while the cholecystokinetic test has permitted to visualize, in one patient (3.5%), a small radiopaque gallstone previously hidden by the gallbladder opacity. In one subject (50%) the cholecystokinetic test has permitted the identification of a small adenomyoma later confirmed by ultrasound. As a conclusion, the diagnostic accuracy of the cholecystography is inferior to that of ultrasound (in the diagnosis of gallbladder stones and adenomyoma) if the first one is not integrated both with the plain radiogram and with the cholecystokinetic test; the Authors consider on the other side, that this last procedures can be substituted if cholecystography is systematically associated to ultrasound examination.