厚壁型胆囊癌与黄色肉芽肿性胆囊炎的影像学鉴别诊断

The imaging in differential diagnosis of wall-thicked gallbladder carcinoma and xanthogranulomatous cholecystitis

目的分析厚壁型胆囊癌和黄色肉芽肿性胆囊炎(XGC)的影像学表现,提高术前诊断正确率。方法回顾性分析经病理证实厚壁型胆囊癌20例,XGC 19例,观察记录两组影像学表现及伴随征象,并进行统计学分析(Fisher确切概率检验)。结果 20例厚壁型胆囊癌中,男性8例,女性12例,19例XGC中男12例,女7例,平均年龄分别为64. 2岁和61. 6岁;厚壁型胆囊癌粘膜中断或消失者16例,XGC 7例;弥漫性增厚13例,XGC 4例;壁内低密度结节3例,XGC15例;胆道梗阻7例,XGC 1例,差别均有统计学意义(P <0. 05)。胆囊囊壁强化方式、邻近肝组织浸润、淋巴结肿大及合并胆囊结石在厚壁型胆囊癌和XGC中均无统计学差异(P> 0. 05)。结论胆囊壁内囊腔或低密度结节的出现及粘膜线完整基本可以排除胆囊癌的诊断;必要时借助磁共振的正反相位序列。

Objective To analyze the imaging manifestation of wall-thicked gallbladder carcinoma(WGBC)and xanthogranulomatous cholecystitis(XGC),to improve the diagnostic accuracy preoperatively and to reduce the unnecessary misdiagnosis.Methods Twenty patients with WGBC and nineteen patients with XGC though surgery were retrospectively identified.For each patient,thickening of the gallbladder wall,hypodense nodules within the wall,integrity of the mucosal line after enhancement,enhancement of the wall,adjacent organs involvement,biliary stones or obstruction and lymphadenectasis were investigated.Fisher’s exact test was used to analyze two count data.Results For 20 patients with WGBC,there were 8 males and 12 females,and for 19 patients with XGC,12 males and 7 females were selected,average age was 64.2Y and 61.6Y separately;16 patients with WGBC and 7 with XGC were shown with incomplete or disappeared mucosal llines,while left presented with complete mucosal lines;13 patients with WGBC and 4 in latter were presented with diffuse thickened wall while other with local thickened wall;3 patients presented with WGBC and 15 with XGC respectively with hypodense nodules within the gallbladder wall;7 in WGBC and 1 in XGC were shown with biliary obstruction;the differences among those were significant(P﹤0.05).Enhancement pattern of wall,adjacent organs involvement,lymphadenectasis and biliary stones were not significant difference between two groups(P﹥0.05).Conclusion The presence with hypodense nodules or cystic cavity within the gallbladder wall and complete mucosal lines are almost benign signs which can exclude diagnosis of gallbladder carcinoma;if necessary,in-phase and out-phase of MRI could do great help too.Imaging performance can provide the basis for differential diagnosis of WGBC and XGC.