胆囊息肉样病变的螺旋CT增强扫描及超声诊断与病理对照的比较研究

Comparative Study on Spiral CT Enhancement Scan and Ultrasound Diagnosis of Polypoid Lesions of Gallbladder and Pathology

目的评估螺旋CT增强扫描及超声鉴别诊断胆囊息肉样病变良、恶性的临床应用价值。方法对照研究术前均经螺旋CT增强扫描及超声诊断并经病理证实为胆囊息肉样病变的18例患者的影像表现与病理结果,包括良性病变:胆囊胆固醇性息肉、炎性息肉、厚壁性胆囊炎、胆囊腺肌症、胆囊腺瘤;恶性病变:胆囊腺癌、小胆囊癌。结果 18例胆囊息肉样病变,恶性占7例,良性占11例;螺旋CT增强扫描诊断胆囊息肉样病变恶变6例,定性准确率85.71%(6/7),超声诊断胆囊息肉样病变恶变5例,定性准确率71.43%(5/7);在11例良性病变中,螺旋CT增强扫描与病理诊断符合7例,准确率63.64%(7/11),超声检查与病理诊断符合10例,准确率90.91%(10/11)。结论螺旋CT增强扫描诊断胆囊息肉样病变恶变有优势,优于超声检查,但两者都不能确定其组织学类型;而超声检查对胆囊息肉样病变良性病变的分型优于螺旋CT增强扫描,对胆囊胆固醇性息肉的诊断更具特征性。

Objective To evaluate the clinical value of spiral CT enhancement scan and ultrasound in differential diagnosis of benign or malignant polypoid lesions of gallbladder.Methods Comparative study of the 18 patients whose imaging findings and pathology results had been recognized as polypoid lesion of gallbladder with the above techniques.The scope included benign lesion（cholesterol polypus,inflammatory polypus,thick-wall cholecystitis,adenomyomatosis of gallbladder,adenoma of gallbladder tumor） and malignant change（adenocarcinoma of the gallbladder,carcinoma of gallbladder）.Results Among 18 cases of polypoid lesions of gallbladder,malignant accounted for 7 cases,benign accounted for 11 cases.Enhanced spiral CT scan diagnosis of malignant lesions of gallbladder had 6 cases,with qualitative accuracy of 85.71%（6/7）.Ultrasound diagnosis of malignant lesions of gallbladder had 5 cases,with qualitative accuracy of 71.43%（5/7）.Among 11 cases of benign lesions,7 cases＇ spiral CT enhancement scan and pathological diagnosis were consistent,with accuracy of 63.64%（7/11）,while 10 cases＇ ultrasound examination and pathological diagnosis were consistent,with accuracy of 90.91%（10/11）.Conclusion Spiral CT enhancement scan is advantagous in diagnosing malignant lesions of gallbladder and better than ultrasound diagnosis,neither of which can categorize the histologic type of malignant changes.However,ultrasound diagnosis is superior to spiral CT enhancement scan in distinguishing benign lesion of polypoid lesions of gallbladder,contributing more on diagnosis of cholesterol polypus.