Role of biliary scintiscan in predicting the need for cholangiography

Background: Currently used predictors for bile duct calculi in patients und ergoing cholecystectomy have low specificity resulting in unnecessary chola ngiograms being performed. The role of biliary scintiscan in predicting the presence of bile duct calculi was assessed. Methods: Seventy-five patients with symptomatic gallstone disease were stud ied prospectively regard- ing the value of a history of jaundice or acute p ancreatitis, raised serum bilirubin and serum alkaline phosphatase levels, and visualization of stones or presence of dilated bile ducts on ultrasonog raphy (standard criteria) in detecting bile duct calculi. Results of biliar y scintiscan were evaluated against a combination of standard criteria. The 'gold standard' for evaluation was endoscopic or peroperative cholangiogra phy. Results: Biliary scintiscan had a higher sensitivity and specificity (93 an d 94 per cent) than a combination of the above standard and modified predic tors for biliary calculi (89 and 71 per cent). A combination of ultrasonogr aphy and selective use of scintiscan, in the absence of bile duct dilatatio n only, had higher values (96 and 98 per cent). Conclusion: A combination of ultrasonography and biliary scintiscan can acc urately predict bile duct calculi and could be used as a guide for selectiv e cholangiography.