胆囊癌胆囊周围结构侵犯CT和MRI影像学特征及手术指导价值分析

Analysis of CT and MRI Imaging Features and The Value of Surgical Guidance for the Invasion of the Perigallbladder Structure in Gallbladder Carcinoma

目的探讨胆囊癌胆囊周围结构侵犯CT和MRI影像学特征及手术指导价值。方法将2016年1月至2018年11月于我院就诊治疗的63例胆囊癌患者作为研究对象,收集患者相关影像学资料、临床资料等,总结分析MSCT、MRI检查中胆囊癌对邻近结构侵犯情况、图像特征。结果腔内结节型26例,病变基底部增厚,增强后肿块明显强化;肿块型31例,呈局限性厚壁型6例;厚壁型胆囊壁厚平均壁厚1.10cm,胆囊壁局限或弥漫不规则增厚。其中54例患者手术及病理证实肿瘤侵犯邻近肝实质,MRI及MSCT图像中,胆囊肿块与邻近受侵的肝实质分界模糊、伴肝实质异常强化。横断位、冠状位及矢状位观察、测量侵犯的深度比较,数据无统计学差异(P>0.05);胃窦受侵CT、MRI三维断面图像表现:(1)胃窦受压变形,胃窦浆膜面模糊,脂肪间隙消失;胃窦壁增厚伴强化异常。胆囊内合并胆结石呈结节状高密度影或结节状低信号影;肝内转移瘤密度低,轻度边缘性强化;MRI图像显示,6例患者胆管和肝门淋巴结出现转移压迫,MSCT扫描MPR显示胆道梗阻,肝内胆管不同程度扩张;肿瘤侵犯血管7例。行根治性切除手术者36例,占比57.14%;姑息性切除手术者12例,占比19.04%;无法切除改行探查手术5例,占比7.96%。结论CT和MRI检出均可显示胆囊癌侵犯胆囊周围血管、肝实质等影像学征象,为临床制定手术方案提供可靠影像学资料。

Objective To investigate the analysis of CT and MRI imaging features and the value of surgical guidance for the invasion of the perigallbladder structure in gallbladder carcinoma.Methods Sixty-three patients with gallbladder cancer who were treated in our hospital from January 2016 to November 2018 were taken as the research objects.Relevant imaging and clinical data were collected to summarize and analyze the invasion of adjacent structures and image characteristics of gallbladder cancer in MSCT and MRI.Results In 26 cases of intraluminal nodule type,the basal part of the lesion was thickened and the tumor was obviously strengthened after enhancement.There were 31 cases with tumor type and 6 cases with localized thick wall type.The average wall thickness of the thick-walled gallbladder was 1.10cm.In 54 patients,surgery and pathology confirmed that the tumor invaded adjacent liver parenchyma.In MRI and MSCT images,the boundary between the gallbladder mass and adjacent invaded liver parenchyma was blurred,accompanied by abnormal enhancement of liver parenchyma.There was no statistical difference in the depth of invasion observed and measured in the transverse position,coronal position and sagittal position(P>0.05).CT and MRI 3d sectional images of gastric antrum invaded:(1)the gastric antrum was compressed and deformed,the gastric antrum serosal surface was blurred,and the fat gap disappeared;Gastric antral wall thickening with abnormal enhancement.The cholelithiasis in gallbladder presented nodular high density shadow or nodular low signal shadow.Intrahepatic metastatic tumor had low density and mild marginal enhancement.MRI images showed metastatic compression of bile duct and hilar lymph node in 6 patients.MSCT scan MPR showed biliary tract obstruction and intrahepatic bile duct dilation to different degrees.Tumor invasion of blood vessels in 7 cases.Radical resection was performed in 36 cases(57.14%).There were 12 cases of palliative resection,accounting for 19.04%.5 cases(7.96%)underwent exploratory surgery instead of excision.Conclusion CT and MRI can show the gallbladder cancer invasion of peripheral blood vessels,liver parenchyma and other imaging signs,providing reliable imaging data for the clinical development of surgical procedures.