胆囊病变CT误诊原因分析(附17例报告)

Misdiagnosis and Missed Diagnosis of Gallbladder Disease with CT (a Report of 17 Cases)

目的:探讨胆囊病变(主要是胆囊癌)的CT误诊原因,以提高胆囊病变的CT鉴别诊断价值。方法:搜集17 例CT漏诊和误诊为胆囊癌的病例,回顾性分析其CT表现和误诊原因。结果:17例CT误、漏诊的胆囊病变中,12例为 原发性胆囊癌,CT误诊为其它病变;5例为其它病变,CT误诊为胆囊癌。误诊的原因:①早期胆囊病变CT上发现困难; ②CT扫描显示胆囊底部结构不满意,对此处病变易遗漏;③胆囊癌常合并存在胆囊结石及胆囊其它病变(胆囊萎缩、胆囊 积液等),当肿瘤组织较小时易被忽略;④晚期胆囊癌侵及肝脏时,不易与晚期肝癌侵犯胆囊相鉴别;⑤CT扫描间距过大 或增强效果不佳等技术因素也可造成误诊。结论:只要检查全面(增强与薄层扫描)、观察仔细,胆囊癌的CT误诊率应能 减少。

Objective:To discuss the causes of misdiagnosis of gallbladder disease especially carcinoma with CT and to improve the CT ability in differential diagnosis of gallbladder disease.Methods:CT findings of 17 cases of misdiagnosis and missed diagnosis of gallbladder carcinoma were retrospectively reviewed and the causes of misdiagnosis were analyzed.Results:Five cases were false-positive and 12 were false-negative in 17 cases of misdiagnosis of gallbladder disease with CT.The causes of misdiagnosis and missed diagnosis of gallbladder carcinoma were early lesions,the lesion in the bottom of gallbladder and the carcinomas accompanied with stone and inflammation.Some late stage carcinomas of gallbladder invading liver were misdiagnosed as primary liver carcinoma.The large collimation and low quality enhancement might cause missed diagnosis.Conclusion:Thin slice and good quality contrast enhancement CT and careful observation were needed in diagnosing carcinoma of gallbladder,to reduce misdiagnosis and missed diagnosis of gallbladder carcinoma.