急性坏疽性胆囊炎合并穿孔的MSCT征象分析

Analysis of Msct Features of Acute Gangrenous Cholecystitis with Perforation

目的:分析急性坏疽性胆囊炎合并穿孔的MSCT征象,以提高对该病的诊断准确率,为临床治疗提供可靠的影像学依据。方法:收集经手术病理证实的27例急性坏疽性胆囊炎合并穿孔患者的临床和影像资料,全部病例均行MSCT平扫和双期增强扫描。回顾性分析其影像资料,总结其影像特征。结果:胆囊体积增大16例(59%);胆囊壁水肿增厚,黏膜层线样强化不连续27例(100%),其中胆囊壁广泛性模糊呈低密度强化6例(22%),模糊灶状低-中度强化21例(78%),胆囊壁连续性中断或局限性缺损,强化缺失22例(81%);胆囊腔内、壁间积气1例(4%);合并胆囊结石23例(85%);血管重建显示胆囊动脉节段性狭窄、闭塞21例(78%)。胆囊炎症周边渗出及穿孔胆汁外流形成间接征象包括胆囊周围脂肪间隙密度增高或条索状影;胆囊床邻近肝实质动脉期一过性强化,并发肝脓肿;局限性或弥漫性腹膜炎征象。胆囊内外积气提示气肿坏疽性胆囊炎合并穿孔。结论:急性坏疽性胆囊炎合并穿孔的MSCT征象多种多样,直接征象及间接征象具有明确诊断及重要提示作用。

Objective:To analyze the MSCT features of acute gangrenous cholecystitis with perforation,improve the accuracy of diagnosis,and provide imaging basis for clinical treatment.Methods:The clinical and the imaging date of 27 patients with surgery and pathology proven acute gangrenous cholecystitis with perforation were collected and analyzed.All patients underwent plain and dual-phase contrast-enhanced MSCT scanning.Imaging findings were analyzed retrospectively and summarized.Results:Gallbladder volume increased in 16 cases(59%).The wall of gallbladder thickened with edema,and mucous membranes of gallbladder showed intermittent linear enhancement in 27 cases(100%).Among which,the gallbladder wall showed low-density enhancement in 6 cases(22%)with extensive blur,low-moderate enhancement in 21 cases(78%)with fuzzy foci,and discontinuity,focal defects or enhancement loss in 22 cases(81%).Gas accumulation within gallbladder wall and lumen was observed in 1 case(4%).Cholecystolithiasis was observed in 23 cases(85%).Vascular reconstruction showed segmental stenosis and occlusion of gallbladder artery in 21 cases(78%).Exudation around inflamed gallbladder and the out-low of bile from perforated gallbladder led to indirect signs,including:the density of fat clearance around the gallbladder increased or shadow like-rope,transient hepatic parenchyma enhancement surrouding the gallbladder bed in the arterial phase and liver abscess formation.Gas accumulation inside and outside gallbladder was found,which indicated emphysematous gangrenous cholecystitis with gallbladder perforation.Conclusion:MSCT features of acute gangrenous cholecystitis with perforation were various,and direct and indirect imaging features would contribute to definte diagnosis and provide important indications.