Experimental assessment of imaging variables associated with operative ultrasonic and radiographic cholangiography

The comparative accuracies of operative ultrasonic and radiographic cholangiography to detect biliary calculi 1 mm in diameter inside tubes of different calibers were assessed. One hundred eighty tubes were prepared to provide ten tubes each for the following variables: three sizes of tubes (6, 13, 20 mm), three concentrations of contrast material (15, 30, 60 per cent), and presence or absence of calculi. Real-time B-mode ultrasound scans with a single gain and time gain compensation (TGC) setting were performed and contrast radiographs were also made at a single optimal exposure. Sixty ultrasonic and 180 radiographic examinations were studied. All ultrasonic interpretations were correct regardless of size of tube. Under optimal conditions, radiographic interpretations were also correct. However, whereas a single gain and TGC setting was applicable for all ultrasound examinations, variable contrast concentrations were required for the best radiographic imaging. Optimal radiographic contrast concentrations differed with tube diameters. The authors conclude that both ultrasonic and radiographic contrast imaging are highly accurate for the detection of small biliary calculi. However, contrast radiography requires stricter optimization of variables needed to provide the high accuracy. Thus, operative ultrasonography may be a more practical and reliable diagnostic procedure because of high sensitivity and greater ease of performance and interpretation.