Diagnostic Accuracy of Transabdominal Ultrasound in the Detection of Choledocholithiasis, Keeping Magnetic Resonance Cholangiopancreatography (MRCP) as the Gold Standard

Shaista Shoukat; Omaimah Siddiqui; Atiqa Hasan; Dua Zainab; Muneeba Rafique; Ayesha Bibi

doi:10.54112/bcsrj.v6i6.2201

Authors

Shaista Shoukat Department of Radiology, JPMC, Karachi, Pakistan
Omaimah Siddiqui Department of Radiology, JPMC, Karachi, Pakistan
Atiqa Hasan Department of Radiology, JPMC, Karachi, Pakistan
Dua Zainab Department of Radiology, SMBBIT, Karachi, Pakistan
Muneeba Rafique Department of Radiology, SMBBIT, Karachi, Pakistan
Ayesha Bibi Department of Radiology, JPMC, Karachi, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v6i6.2201

Keywords:

Choledocholithiasis; Transabdominal ultrasound; MRCP; Diagnostic accuracy; Common bile duct stones; ROC curve.

Abstract

Choledocholithiasis is a common cause of obstructive jaundice and biliary sepsis. Transabdominal ultrasound (TAUS) is widely used as a first-line investigation; however, its ability to detect common bile duct (CBD) stones varies. This study assessed the diagnostic accuracy of TAUS for detecting choledocholithiasis, using magnetic resonance cholangiopancreatography (MRCP) as the gold standard. Objective: To determine the diagnostic accuracy of transabdominal ultrasound in the detection of choledocholithiasis, taking MRCP as the reference standard. Methods: A cross-sectional diagnostic accuracy study was conducted on 100 patients with clinical suspicion of choledocholithiasis from November 15, 2024, to May/ 15, 2025. All participants underwent TAUS followed by MRCP. MRCP findings were taken as the gold standard for the presence or absence of CBD stones. A 2×2 contingency table was constructed, and sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy of TAUS were calculated. ROC curve analysis was also performed. Results: The mean age was 44.59 ± 14.59 years; 60% were female and 40% male. Jaundice was present in 47%, fever in 17%, and RUQ pain in 78%. Mean total bilirubin was 3.85 ± 2.66 mg/dL, ALP 246.86 ± 123.4 IU/L, and CBD diameter on ultrasound 7.26 ± 2.08 mm. MRCP detected choledocholithiasis in 40% (n=40). TAUS identified 23 true positives, 56 true negatives, 4 false positives, and 17 false negatives, yielding a sensitivity 57.5%, a specificity 93.3%, a PPV 85.2%, an NPV 76.7%, and an overall accuracy 79%. ROC analysis demonstrated an AUC of 0.755 (P < 0.0001), indicating acceptable discriminative performance. Conclusion: TAUS demonstrated high specificity but only moderate sensitivity for detecting choledocholithiasis compared with MRCP. A positive TAUS result reliably confirmed CBD stones, but a negative TAUS did not exclude disease; therefore, MRCP should be considered in patients with persistent clinical or biochemical suspicion despite negative or equivocal ultrasound findings.

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