黄色肉芽肿性胆囊炎与厚壁型胆囊癌的螺旋CT鉴别诊断

Evaluation of Helical CT Scanning in Differentiating Xanthogranulomatous Cholecystitis with Wall-Thickened Gallbladder Cancer

目的比较黄色肉芽肿性胆囊炎(XGC)和厚壁型胆囊癌(GBC)的螺旋CT特点,旨在提高两者鉴别诊断中的准确率。方法搜集临床或病理确诊的22例XGC和25例GBC的临床和螺旋CT资料进行对照研究。结果CT征象对照中,胆囊壁内低密度结节、胆囊壁内黏膜线完整情况以及胆道梗阻情况、淋巴结肿大等差异有显著统计学意义(P=0.000,0.002,0.010,0.031),而胆囊壁最大厚度,厚壁范围、强化方式、强化程度、邻近肝脏浸润、合并胆囊、胆管结石以及周围脂肪间隙清晰征象差异无显著统计学意义(P=0.826,0.595,0.820,0.064,0.798,0.062,0.110)。结论增厚的胆囊壁内低密度结节和完整的胆囊内壁黏膜线是诊断XGC较具特征性CT表现,胆囊壁内低密度结节具有很高的敏感性和准确度,有利于两者的鉴别。

Objective To investigate the CT features of xanthogranulomatous eholecystitis and wall-thickened gallblad- der cancer in order to improve their differentiation. Methods A total of 22 patients with pathologically-proved xanthogran-ulomatous cholecystitis and 25 patients with pathologically-proved wall-thickened gallbladder cancer were enrolled in this study. The clinical data and spiral CT findings were retrospectively analyzed. Results The differences in CT features,in- cluding low-density nodules in the gallbladder wall, the integrity of gallbladder wall mucosal line, biliary obstruction and lymphadenopathy were statistically significant between xanthogranulomatous cholecystitis and wall-thickened ga!!bladder cancer （P =0. 000, P = 0. 002, P = 0. 010 and P = 0. 031 respectively）, while no statistically significant differences in maximum gallbladder wall thickness, the range of wall thickness, the enhancement pattern, the enhancement degree, the involvement of adjacent liver and the definition of surrounding fat layer, etc. existed between xanthogranulomatous chole- cystitis and wall-thickened gallbladder cancer （P = 0. 826, P = 0. 595, P = 0. 820, P = 0. 064, P = 0. 798, P = 0. 062, and P = 0.110 respectively）. Conclusion Low-density nodules within the thickened gallbladder wall and a complete line of gallbladder mucosal lining are characteristic signs for the diagnosis of xanthogranulomatous cholecystitis. Low-density nodule within the thickened gallbladder wall has higher sensitivity and accuracy in the differentiation of xanthogranulomatous cholecystitis with gallbladder cancer.