Diagnosis of choledocholithiasis by computed tomography

In order to determine the value of CT in the diagnosis of choledocholithiasis, the authors retrospectivelystudied 33 cases of choledocholithiasis proven by surgery from January 1983 to June 1985. Among them, 15 caseswere examined by both CT and ultrasonography. The results were as follows: 1. There were 12 men and 21 women withmean age of 57 years. 2. CT correctly diagnosed choledocholithiasis in 29(88%) of total 33 cases. There were 4false negative diagnoses and there were no false positive. 3. In 15 cases which were examined by both CT andultrasonography, 13(86%) cases were correctly diagnosed by CTand 7(46%) by utrasonography. 4. The majority(88%) ofcholedocholithiasis were demonstrated as calcific density and 4 cases(12%) were nearly isodense to pancreas. 5.Most cases were shown as homogenous density and 5 cases(16%) as ringlike structure with low density center andhigh density periphery. 6. Additional findings, such as intrahepatic and/or GB stones, pericholangitic abscess, GBempyema, ascites, and liver cirrhosis were also identified by CT. 7. CT is effective for noninvasive and accuratedetection of choledocolithiasis. So invasive cholangiography, such as E.R.C.P or P.T.C can be reserved in manycases of choledocholithiasis.

Diagnostic Importance of Computed Tomography for the Gastric Carcinoma ;in Terms of the Staging System

The authors analysed the CT findings in 75 cases diagnosed as gastric carcinoma by U.G. I.S. or endoscopy in a 3)1, year period. The comparative analysis betw~en CT findings and surgical pathologic findings was done in 55 cases who underwent surgery. 20 cases could not be operated upon because of distant metastasis. The gastric carcinoma was devided into 4′ stages according to the staging system of the American joint Committee on Cancer. The CT findings were then compared and the following results noted : 1. The relationship with gastric wall thickening and penetratioil degree of tumori no thickening (Iesser than 1.0 cm) of 3 cases showed all of T1, 11 of localized thickening (1. 0.1 .5cm) showed 7 of T2, 38 of localized thickening (more than 1.5 cm) showed 37 of T3 and 3 of diffuse thickening showed all of T4a. 2. The accuracy of Iymph node detection by CT scan, 1) Regionaf tymph node showed 86% in operative f in ding and 73% in pathologic. 2) Extragastric Iymph node showed 87% in operative finding and 89% in pathologic. 3) Retro-peritoneallymph node showed 96% in operative finding and 95% in pathologic. ic. 3. In operated cases, there was one case of false positive distant metastasis and three false negative cases. 20 cases of non-operated cases showed distant metastasis such as liver, lung or kidney. 4. 55 cases were classified as stage 1 in 4 cases, 11 in 18, 111 in 23 and IV in 10 by pathologic findings, and 1 in 3, 11 in 24, 111 in 19 and IV in 9 by CT. The overall accuracy by CT stagi ng is 75%. 5. Among a total of 75 cases, there were 46 operable cases by CT finding an d 43 operabl e cases by pathologic staging. There we re 29 inoperable cases by CT finding and 27 cases by pathologic staging. Therefore, there was a 93% overall accuracy by CT stagi ng in terms of determination of operability. 6. The accuracy of adhesion into adjacent structure by CT finding was 69%. compared with operable finding.

Direct coronal computed tomography of the body

Direct coronal CT scans of the body have been carried out in 78 cases of the thoracic and abdnominal diseases. The results are as follows: 1. Among total 78 patients, 66 cases were successfully scanned by the direct coronal CT. 2. Direct co ronal CT scan most accurately detected retroperitoneal diseases, especially renal diseases. 3. In comparison with multiplanar reformating (MPR) image, direct coronal CT of the body has three advantages: (a) improved image quality: (b) improved definition of the coronal anatomy : (c) shorter examination time. 4. Direct coronal CT has advantages in evaluation of the mass nature and relationship with other organs. 5. Disadvantages or limitations of the direct coronal CT are as follows: in creased radiation exposure and insufficient positioning for disabled patients. 6. In our experience, direct coronal CT is considered as helpful method for presurgical evaluation and the rapeutic management of various diseases, especially gross tumor of the retroperitoneum.