Computed tomography evaluation of radiolucent gallstones in vivo

Janowitz, P; Zöller, A; Swobodnik, W; Wechsler, J. G.; K, Schumacher; Ditschuneit, H

doi:10.1007/bf01888736

Cited by 26 publications

(12 citation statements)

References 9 publications

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“…Further, the stones analysed by us were obtained from patients who fulfilled all the conventional criteria for oral bile acid therapy. The reported proportion of radiolucent gallstones containing high amounts of calcium has varied from 10% (13) to 54.8% (14), with computed tomography providing higher yields (15,16).…”

Section: Discussionmentioning

confidence: 98%

Chemical Nature and Distribution of Calcium Compounds in Radiolucent Gallstones

Agarwal

Choudhuri²,

Kumar³

1993

Scandinavian Journal of Gastroenterology

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A high failure rate for radiolucent cholesterol gallstones to dissolve with oral bile acids may be due to the presence of insoluble calcium compounds. Twenty sets of radiolucent gallstones, 7-20 mm in diameter, obtained from 20 patients undergoing cholecystectomy, were cut, and the outer surface, outer rim, middle portion, and central core areas were scanned for calcium by energy-dispersive X-ray microanalysis (EDX) and scanning electron microscopy (SEM). Scrapings from the four areas of each stone were analysed by infrared spectroscopy. A sample of the crushed stone was used for chemical estimation of cholesterol. Eleven (55%) of the 20 cholesterol (84-96% dry weight of cholesterol) stones showed presence of calcium by EDX; the distribution was peripheral in 5, homogeneous in 4, and central in 2. The chemical compound was calcium bilirubinate in 10 and calcium carbonate in 8 stones. Calcium compounds are present in a high proportion of radiolucent gallstones considered suitable for chemodissolution by conventional criteria. Their unrecognized presence may explain the high failure rate of such stones to respond to medical therapy.

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Section: Discussionmentioning

confidence: 98%

Chemical Nature and Distribution of Calcium Compounds in Radiolucent Gallstones

Agarwal

Choudhuri²,

Kumar³

1993

Scandinavian Journal of Gastroenterology

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“…12 Barakos et al reported that 21% of gallstones could not be detected by conventional CT. 22 Two in vitro studies also showed that 16% and 26% of gallstones were isoattenuating with bile, which always had a high cholesterol content. 23,24 Black pigment stones, which have a high affinity for calcium carbonate, have a high CT attenuation value while brown pigment stones, consisting mainly of calcium bilirubinate, have a relatively high attenuation although less than that of black pigment Values are mean Ϯ standard error of the mean. ALP, alkaline phosphatase; ALT, alanine transaminase; CBD, common bile duct; CRP, C-reactive protein ; GGT, g-glutamyltransferase; WBC, white cell count.…”

Section: Discussionmentioning

confidence: 99%

Can computed tomography with coronal reconstruction improve the diagnosis of choledocholithiasis?

Tseng

Chen

et al. 2008

J of Gastro and Hepatol

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“…However, this potential drawback of UDCA is not supported by our clinical experience: in none of the 24 patients with C F associated liver disease could we document gallstone formation after periods of treatment as long as three years (unpublished observations). For future studies we would recommend measuring stone density by CT scanning before and after UDCA treatment (24).…”

Section: Discussionmentioning

confidence: 99%

Failure of ursodeoxycholic acid to dissolve radiolucent gallstones in patients with cystic fibrosis

Colombo

Bertolini²,

Assaisso

et al. 1993

Acta Paediatrica

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Ursodeoxycholic acid has been used widely to dissolve cholesterol gallstones and more recently was shown to improve clinical symptoms and biochemical indices in different chronic liver diseases, including that associated with cystic fibrosis. We treated 10 cystic fibrosis patients (5 males, 5 females, age range 2-22 years) with pancreatic insufficiency and normal liver function with ursodeoxycholic acid 15-20 mg/kg/day. Seven patients had radiolucent gallstones (in 3 cases associated with biliary sludge) and 3 had sludge; all were asymptomatic. Before treatment, the gallbladder was well opacified in oral cholecystogram. The gallbladder was scanned by ultrasound in similar conditions and by the same operator before administration of ursodeoxycholic acid and after a median period of treatment of 16 months (range 11-32 months). During treatment, all patients remained asymptomatic and the relative proportion of ursodeoxycholic acid in duodenal bile increased from 4.7 +/- 3.2% at baseline to 34.7 +/- 8.6%. Complete or partial dissolution of gallstones was never observed and the maximum diameter of stones increased from a mean of 6.1 +/- 3.4 to 8.0 +/- 5.3 mm; in one case the development of biliary sludge occurred during bile acid therapy. Sludge disappeared in 1 of the 6 patients who initially had it, while in 2 cases its volume increased. We conclude that ursodeoxycholic acid is not effective in most CF patients with gallstones, probably because cholesterol is not the main component of stone or sludge.

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Computed tomography evaluation of radiolucent gallstones in vivo

Cited by 26 publications

References 9 publications

Chemical Nature and Distribution of Calcium Compounds in Radiolucent Gallstones

Chemical Nature and Distribution of Calcium Compounds in Radiolucent Gallstones

Can computed tomography with coronal reconstruction improve the diagnosis of choledocholithiasis?

Failure of ursodeoxycholic acid to dissolve radiolucent gallstones in patients with cystic fibrosis

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