黄色肉芽肿性胆囊炎影像学表现及其病理学基础

Correlation of Imaging Findings and Pathology in Xanthogranulomatous Cholecystitis

目的探讨黄色肉芽肿性胆囊炎(XGC)的CT与MRI表现及其病理学基础。方法回顾经手术及病理证实的27例XGC患者影像学资料,27例行CT检查,其中20例行MRI检查。分析CT及MRI影像学表现特征,并与病理结果对照分析。结果胆囊扩大(CT 93%、MR 90%),所有患者(100%)均有胆囊壁增厚。局限性增厚(CT 37%、MR 50%),广泛性增厚(CT 63%、MR 50%)。增强扫描见增厚胆囊壁内多发低密度(或信号)结节(CT74%、MR 100%),壁内强化结节(CT 18.5%、MR 15%)胆囊结石(CT 74%、MR 100%)。肝脏及胆囊间隙不清(CT74%、MRI 90%),胆囊内见点状气体(CT 7%MRI 0%)。增强扫描胆囊黏膜线连续(CT 44%、MRI 60%),中断(CT56%、MRI 40%),术前准确诊断XGC(CT 67%、MRI 75%),误诊为胆囊癌(CT 26%、MRI 15%)。结论胆囊壁广泛或局限增厚,增强扫描增厚胆囊壁呈"三明治征"或"夹心饼干征"、囊壁内见强化和/或低密度(信号)结节,黏膜线连续或部分中断可能为XGC特征性CT及MRI表现,有助于该病的准确诊断。

Objective To discuss image and pathology features of xanthogranulomatous choleeystitis （XGC）. Meth- otis Image data of 27 cases with XGC surgically and pathologically confirmed were analyzed retrospectively. All cases re- ceived routine CT examination, 20 of them received MRI examination. CT and MRI imaging features, as well as pathologi- cal results were analyzed Results The image features included ： gallbladder distention （ CT 93% , MR 90% ） , gallbladder wall thickening （ 100% ）, limited wall thickening （ CT 37%, MR 50% ）, diffuse wall thickening （ CT 63%, MR 50% ）, muhiple or single intramural hypodensity or hypointensity nodules （ CT 74% , MR 100% ）, hyperdensity or hyperintensity intramural nodules （ CT 18.5% , MR 15% ） , gallbladder calculus （ CT 74% , MR 100% ） , unclear demarcation between the gallbladder and liver （ CT 74% , MRI 90% ） , gallbladder gas （ CT 7% MRI 0% ） , continuous gallbladder mucosa line after enhancement （ CT 44%, MRI 60% ）, interrupted mucosal line （ CT 55%, MRI 40% ）. Accurate preoperative diag- nosis of XGC was made in 66% cases by CT and 75% cases by MRI （ CT 18/27 66%, MRI 15/20 75% ）, the misdiagno- sis for gallbladder carcinoma was made in some cases（ CT 7/27 26% , MRI 3/20 15% ）. Conclusion Diffuse or focal thickening of the gallbladder wall, mural ＂sandwich＂ or ＂biscuit＂ sign after contrast enhancement, intramural nodules, mueosal line interruption suggest xanthogranulomatous cholecystitis, which are help to make the correct diagnosis.