胆囊癌与貌似胆囊癌的CT征象差异分析

Analysis on the Difference of CT Signs between Gallbladder Carcinoma and Pseudo Gallbladder Carcinoma

目的探讨胆囊癌及非胆囊癌的CT征象差异在临床中应用价值。方法对经手术病理证实的112例胆囊病变CT征象进行回顾性分析,采用t检验及卡方检验比较胆囊壁增厚类型、强化方式、黏膜完整性及胆囊周围情况等10项差异,回归分析胆囊癌的相关因素和诊断胆囊癌的敏感性、特异性等。结果112例胆囊病变中,胆囊癌共66例,非胆囊癌46例;胆囊病变的CT征象中,发现:胆囊病变的类型(P=0.003)、胆囊壁增厚程度(P<0.001)、动脉期CT值是否高于肝实质(P=0.009)、是否合并有结石(P=0.023)、是否伴有肿大淋巴结(P<0.001)、胆囊黏膜完整性(P<0.001)及胆囊壁周围肝情况(P=0.003),此7项影像征象在胆囊癌与非胆囊癌差异有显著统计学意义(P<0.05)。回归分析表明,动脉期CT值高于同期肝实质及黏膜不完整性与胆囊癌有密切相关,其诊断胆囊癌的敏感性、特异性、准确性分别为57.57%、67.39%、61.61%及87.87%、80.43%、84.82%。结合两项可进一步提高胆囊癌的诊断准确性。结论胆囊的一些非肿瘤性病变貌似胆囊癌,但如出现动脉期CT值高于同期肝实质及黏膜壁不完整征象则多为胆囊癌。

Objective It is to explore the clinical application value of the difference of CT signs between gallbladder carcinoma and non-gallbladder carcinoma.Methods We conducted a retrospective analysis on CT signs in 112 cases of gallbladder lesions confirmed by operation and pathology,and the t-test and chi-square test were used to compare their differences in 10 aspects,including the gallbladder wall thickening type,the enhancement method,the mucosal integrity,the ambient condition of gallbladder,etc.It also carried out a regression analysis on the correlation factors of gallbladder carcinoma,the sensitivity and specificity in diagnosis of gallbladder carcinoma,etc.Results There were 66 cases of gallbladder carcinoma and 46 cases of non-gallbladder carcinoma in 112 cases of gallbladder lesions;The CT signs of gallbladder lesions,such as:types of gallbladder wall thickening(P=0.003),thickening degree of gallbladder wall(P<0.001),the CT attenuation of arterial phase being higher than that of liver parenchyma(P=0.009),combining gallbladder stones(P=0.023),combining enlarged lymph nodes(P<0.001),mucosal integrity of the gallbladder wall(P<0.001),and surrounding hepatic parenchyma of the gallbladder wall were significantly different between gallbladder cancer and non-cancer lesion(P=0.003),(both P<0.05).Further regression analysis showed that the CT attenuation in arterial phase to be higher than that of hepatic parenchyma and mucosal incompleteness in the same period was closely related to gallbladder carcinoma.The sensitivity,the specificity,and the accuracy of diagnosing gallbladder carcinoma were 57.57%、67.39%、61.61%and 87.87%、80.43%、84.82%respectively.The combination of the two items could further improve the accuracy of gallbladder cancer.Conclusion Many non-neoplastic lesions of gallbladder mimic gallbladder carcinoma.However,the gallbladder carcinoma could be diagnosed in most cases if the CT attenuation of arterial phase was higher than that of liver parenchyma in the same period as well as the presence of an incomplete mucosal wall.