To investigate a non-operative approach to patients with gallstones we evaluated the physicochemical characteristics of the stone which sould seem to be very important in predicting the outcome of particular treatment modalities. A comparative
ultrasonographic study was made on 91 gallstones comparing a gross appearance, qualitative infrared spectroscopic and specimen radiographic findings. Ultrasonographic findings of gallstones are classified into two main types: type I, surface echo
with
various internal echo patterns and a clean posterior acoustic shadow, and type II, echo of the whole contour of gallstone with a posterior acoustic shadow. Type I is divided into five subtypes: type IA has semilunar-shaped internal echo, type Ib
has
crescenteric internal echo, type Ic has two-layered arcshaped echo, type Id has single arc-shaped echo without internal echo, and type Ie has single arc-shaped echo with a strong point internal echo. Type II is divided into three subtypes: type
IIa
has
echo of whole contour with strong posterior acoustic shadow type IIb has echo of whole contour with weak posterior acoustic shadow, and type IIc has a homogeneous and weak gallstone echo. Cholesterol stones were classified into almost al
ultrasonographic subtypes, but the majority of cases were divided into type IA or IIc. Calcium bilirubinate stones were classifiedinto all but one ultrasonographic subtype, but most were divided into type Ib or Id. Many cases of black pigmented
stones
were classified into type IIa or IIb. When comparing with specimen radiographic findings, the calcification rate was high in ultrasonographic type Id and IIa, but it was absent in type IIc. The relation between infrared spectroscopic and
ultrasonographic classification was very similar to that between gross and ultrasonographic classification. Becasuse nonoperative therapy is effective mainly with cholesterol stones, we recommend that gallstones classified as type IA or IIc by
ultrasonography age selected for this approach.
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