胆囊癌的CT诊断

CT diagnosis of gallbladder carcinoma

目的 :通过对22例胆囊癌CT表现分析 ,探讨胆囊癌CT诊断价值和鉴别诊断 ,提高胆囊癌CT诊断水平。材料与方法 :本文收集经病理证实的22例胆囊癌病例 ,均做CT检查 ,其中10例行B超检查。分析其CT表现。结果 :胆囊癌女性多见 ,男女之比为1∶2.1 ,好发于50岁以上患者。临床表现为上腹痛并肩背痛、黄疸及腹部肿块。CT表现 :①胆囊区肿块 ,密度不均 ,胆囊腔缩小或消失 ;②胆囊壁增厚 ,呈局限或弥漫性不规则增厚 ;③胆囊腔内软组织块影 ;④合并胆结石 ;⑤肝内外胆管扩张 ;⑥肝脏直接受侵犯 ;⑦累及胰和十二指肠 ;⑧肝脏转移 ,侵犯腹壁 ,合并腹水。结论 :胆囊癌并发结石 ,低于国外报道 ,与国内文献报道相近。CT诊断正确率略高于B超检查。CT对胆囊癌的诊断价值 :①CT对软组织分辨率高 ,可较清晰显示胆囊的原发病变和肿瘤扩散范围 ;②造影增强扫描可显示胆囊壁真正的厚度 ,而肿瘤所致增厚的胆囊壁密度高于正常胆囊壁及肝脏。本组1例早癌具有该征象 ,认为该征象极有利于胆囊癌的早期诊断。胆囊癌需与慢性胆囊炎、胆囊息肉及肝癌相鉴别。

Objective:Analyze CT images of 22 cases of gallbladder carcinoma all confirmed by histology. The problems of CT diagnosis and differential diagnosis were discussed. Methods: All 22 cases were examinated by CT. Ten of them with USG.Results:Gallbladder carcinoma of female is more than that of male. It is often found over age of 50. The major CT findings were classified as follows:①mass;②thicken wall;③intraluminal mass;④mass with stone;⑤bileduct dilatation;⑥direct hepatic invasion;⑦hepatic metastasis.Conclusions:CT diagnosis of gallbladder carcinoma is more valuable than USG diagnosis. It is a very important sign of gallbladder carcinoma diagnosis that the density of thicken wall by gallbladder carcinoma is higher than that of normal gallbladder wall and helper.