Scanning Electron Microscopic Finding and Sonographic Characteristics of lntrahepatic Stones : An ln Vitro Study

To evaluate the microstructure and sonographic characteristics of intrahepatic stones that may vary according to the types of stones, intrahepatic stones from 32 patients were examined by scanning electron microscope(SEM)and in vitro sonography. The types of stones were determined by gross characteristics on cross section(laminated versus amorphous) and chemical composition. The sonographic patterns were classified into type 1(definable echoes from the whole stone with gradual attenuation) and type 2(arc-like strong echo from the surface of the stone with clear acoustic shadow). Cholesrol stones(mixed stone, n=2) showed randomly oriented cholesterol crystals in it sinner matrix at SEM and sonographic type 1. Calcium bilirubin ate stones with amorphous structure(n=18) showed randomly located calcium palmitate rosetters and cholesterol crystals within the matrix. In calcium bilirubinate stones with laminated structure(n=12) the layer of calcium palmitate rosette could be identified at SEM. Fourteen and 11 calcium bilirubin ate stones showed type 1 and type 2 sonographic patterns, respectively. Five stones were broken and missing during sonography. There was no significant difference in sonographic patterns between the calcium bilirubinate stones with laminate structure and those with amorphous structure. In conclusion,intrahepatic stones showed characteristic SEM findings according to the type of stones. However, any sonographic patterns that might characterize the microstructure and chemical composition of the stones could not be found in this in vitro sonographic study