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A total of 103 consecutive patients with suspected biliary obstruction were studied using both computed tomography (CT) and ultrasound (US) to evaluate the relative accuracy of the methods. In 47 patients with confirmed obstruction, CT and US were comparable accurate in differentiating obstruction from nonobstruction. The precise level of obstruction was identified by CT in 88% and by US in 60%; the cause of obstruction was accurately predicted by CT in 70% and by US in 38%. Both methods detected useful additional information, such as cholelithiasis or retroperitoneal adenopathy. The authors use US as a screening examination; if there is doubt about the level and cause of sonographically demonstrated obstruction, CT has proved to be an accurate means of further evaluation.

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The authors analyzed the clinical and CT findings in 100 normal subjects and 31 patients with gastric disease to determine the significance of thickening of the gastric wall. Ninety per cent of the normal individuals had a wall thickness less than 1 cm with adequate distension of the lumen. Twenty-nine of the 31 patients with gastric disease (94%) had a wall thickness greater than 1 cm. Adenocarcinoma and lymphoma could not be reliably distinguished based solely on the pattern of gastric wall involvement, although most lymphomas had a lobular luminal contour while advanced adenocarcinomas had flattened inner margins. All 4 leiomyosarcomas were seen as large extragastric masses, and some had calcification or central necrosis. CT was helpful in assessing metastatic spread in 25 patients. While it could not distinguish between neoplastic and inflammatory disease or among histological types of tumor, it was a sensitive detector of gastric disease.

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