原发性胆囊癌的CT、MRI诊断价值

Diagnostic Value of CT and MRI in Primary Gallbladder Carcinoma

目的:探讨胆囊癌的CT、磁共振成像(MRI)表现,提高胆囊癌的影像诊断水平。方法:回顾性分析30例经手术病理证实为胆囊癌的CT、MRI影像学资料,其中28例行CT检查,14例行MRI检查。分析原发病灶的直接征象和间接征象,并与大体病理进行对照。结果:胆囊壁不规则增厚、胆囊腔内结节和(或)胆囊区肿块为胆囊癌的直接征象,其中厚壁型11例,腔内型10例,肿块型9例;增强检查后,增厚的胆囊壁、结节和(或)肿块明显持续强化。其他表现包括合并胆囊结石23例,肝内外胆管扩张13例,肝脏直接受侵11例,累及胃和十二指肠者分别为3例和5例,淋巴结转移16例,肝脏转移3例。上述征象MRI均能显示,4例肿大淋巴结于CT上难以判断,3例等密度胆囊结石于CT上未检出。结论:CT及MRI能清楚地显示胆囊癌的原发灶,并能较准确地评价胆囊癌浸润程度及扩散范围,且MRI对胆囊结石、区域淋巴结转移等间接征象的显示要优于CT。

Objective：To investigate the imaging features of gallbladder carcinoma in CT and magnetic resonance imaging（MRI）,and to improve the diagnosis of gallbladder carcinoma.Methods：All imaging data of 30 patients confirmed by surgery and pathology were retrospectively analyzed.CT scans were performed in 28 patients,and 14 patients accepted MRI examinations.The direct and indirect signs were evaluated in lesions of primary gallbladder carcinoma.All images were compared with gross pathology.Results：There were irregular wall thickening of gallbladder,intraluminal nodules and mass in gallbladder area by CT and MRI.Of which,11 were wall-thickening type,10 were intraluminal nodule type,9 were mass type.It was found that after triple-phase enhanced scan,irregularly thickened gallbladder wall,intraluminal nodules and/or mass were strongly enhanced.There were 23 cases combined with gallbladder stones,13 with dilated intra/extrahepatic bile duct,11 with directly invading adjacent liver parenchyma,3 involving the stomach and 5 involving duodenum,16 with lymph node metastasis and 3 with liver metastasis.MRI also showed all above-mentioned signs.It was difficult to judge the lymph nodes on CT in 4 cases.Three cases with isodensity stones were not detected on CT.Conclusion：CT and MRI could clearly show the primary gallbladder carcinoma,and accurately evaluate the extent and spread of invasion.However,MRI is better than CT for showing indirect signs,such as gallbladder stones and regional lymph node metastasis.