胆囊腺瘤的CT、MRI诊断

CT and MRI Diagnosis of Gallbladder Adenoma

目的分析胆囊腺瘤(AG)的CT、MRI影像学表现及其诊断价值。方法回顾性分析2014年9月至2018年12月我院收治的86例AG患者临床资料,病理证实20例为恶性、66例为良性,分别纳入恶性组、良性组,观察两组CT、MRI影像特点并分析其诊断价值。结果AG良性病灶呈菜花状,窄基底,伴桑葚征,均匀强化,AG恶性者可见病灶基底部增宽,桑葚征减少,T1WI与T2WI为均匀等信号,增强后明显不均匀强化,附着处胆囊壁局限性增厚,周围组织受侵;MRI检出AG良性者菜花状形态、桑葚征及肿瘤直径高于CT(P<0.05),其他表现比较差异无统计学意义(P>0.05);恶性组平扫、动脉期、静脉期、延迟期各期CT值及ADC值均高于良性组(P<0.05);MRI诊断AG恶性的灵敏度、准确度高于CT,而特异度比较差异无统计学意义(P>0.05)。结论AG的CT、MRI表现有一定特征,若出现基底部增宽、桑葚征减少、明显不均匀强化、附着处胆囊壁局限性增厚应考虑恶变的可能,MRI诊断AG恶变的价值高于CT。

Objective To analyze the CT and MRI findings for adenoma of gallbladder(AG)and their diagnostic value.Methods Clinical data of 86 AG patients admitted to our hospital from September 2014 to December 2018 were retrospectively analyzed.20 cases were confirmed to be malignant and 66 cases were confirmed to be benign by pathology.They were included into the malignant group and the benign group respectively.Results Benign AG showed cauliflower-like shape and narrow basilar part,with mulberry signs and homogeneous enhancement.Malignant AG showed basilar part widening,mulberry signs decreasing,homogeneous equal signals on T1WI and T2WI,obvious inhomogeneous enhancement,local thickening of gallbladder wall at the attachment site and involvement of surrounding tissues.The cauliflower shape,mulberry signs and tumor diameter of benign AG detected by MRI were higher than those by CT(P<0.05),without significant difference in the other findings(P>0.05).The CT values and ADC values of malignant group in plain scan,arterial phase,venous phase and delay phase were higher than those of the benign group(P<0.05).The sensitivity and accuracy of MRI for the diagnosis of AG malignancy were higher than those of CT,but the difference in specificity was not statistically significant(P>0.05).Conclusion The CT and MRI manifestations of AG have certain characteristics.The possibility of malignant transformation should be considered if the basal part is widened,the mulberry sign is reduced,the obvious uneven enhancement,and the local thickening of the gallbladder wall at the attachment.The value of MRI in diagnosing AG malignant transformation is higher than that of CT.