MSCT胆囊触壁征对判定急性期胆囊炎的价值

Value of the tense gallbladder wall sign on MDCT in the diagnosis of acute cholecystitis

目的描述多层螺旋CT上胆囊触壁征的影像表现,并评价该征象对急性期胆囊炎的诊断价值。方法收集有完整上腹部CT平扫加增强检查资料的胆囊炎患者155例,其中经手术证实急性期胆囊炎105例(A组,包括急性胆囊炎50例和慢性胆囊炎急性发作55例),经临床确诊的慢性胆囊炎50例(B组)。另收集同期上腹部CT检查正常者50例作为阴性对照组(C组)。多层螺旋CT上胆囊触壁征阳性定义为CT平扫或增强图像上,胆囊增大、张力明显,胆囊壁接触腹壁并压迫形成弧形压迹。统计各组的胆囊触壁征阳性率,以及胆囊触壁征阳性为单独征象出现的比例。结果各组的胆囊触壁征阳性率分别为:A组29.52%(31/105)、B组0%、C组0%。胆囊触壁征阳性率在A组明显高于其他组,差异具有统计学意义(P<0.05)。胆囊触壁阳性在平扫图像上的显示率27.62%(29/105),在增强图像上的显示率29.52%(31/105),差异无统计学意义(P>0.05)。A组平扫图像上仅见胆囊触壁征而无其他急性胆囊炎征象者为25例,即胆囊触壁征诊断急性胆囊炎的敏感度为23.81%(25/105),特异度为100%。结论胆囊触壁征阳性对判断急性期胆囊炎的具有很高的特异性,并可在CT平扫图像上评估。

Objective To describe the tense gallbladder wall sign on multi-detector CT and its diagnostic value in acute cholecystitis.Methods Upper abdomen unenhanced and contrast-enhanced MDCT of 155 patients with cholecystitis was retrospectively analyzed.The three groups included surgically confirmed acute cholecystitis(50)and acute exacerbation of chronic cholecystitis(55),clinically diagnosed chronic cholecystitis(50)and 50 control patients with no CT findings of cholecystitis.The tense gallbladder wall sign was defined as indentation of the anterior abdominal wall by the distended gallbladder on CT.The positive rates and ratios of the tense gallbladder wall sign were calculated for each group.Results The positive rates of the tense gallbladder wall sign were significantly higher(P<0.05)in acute cholecystitis(29.52%,31/105)than that in chronic cholecystitis and control group(0%).There was no significant difference(P>0.05)in the positive rates of the tense gallbladder wall sign between unenhanced(27.62%,29/105)and contrast-enhanced(29.52%,31/105)CT.The tense gallbladder wall sign was the only unenhanced CT manifestation of acute cholecystitis with sensitivity of 23.81%(25/105)and specificity of 100%.Conclusion The tense gallbladder wall sign has high specificity for the diagnosis of acute cholecystitis on unenhanced CT.