胆囊腺瘤的CT影像特征及分析

CT features of carcinogenesis in gallbladder adenoma

目的分析胆囊腺瘤的CT表现,提高胆囊腺瘤的CT征象及临床特征的认识水平。方法回顾性分析经手术病理证实的17例胆囊腺瘤的临床资料及CT表现。结果17例中13例为单发病灶,4例多发。病灶最大径39 mm,结节状5例,分叶状10例,另外2例多发病例同时存在结节状、分叶状病灶。4例多发病灶在胆囊内散在分布。17例中15例病灶平扫密度均匀,另外2例中1例病灶内见一点状钙化灶,1例见短条状低密度影。增强后动脉期病灶轻度~明显强化,门脉期CT值持续强化,强化密度稍上升或减低,延时扫描强化减低。轻度强化5例,中度强化2例,明显强化10例。合并急性胆囊炎2例,慢性胆囊炎10例,合并胆囊结石5例。17例中5例局部癌变,病灶均呈分叶状,增强扫描动脉期及门脉期明显不均匀强化,延时扫描肿瘤强化较均匀,其中2例动脉期及门脉期病灶明显强化区域内见点状或条状更高密度强化影。5例胆囊腺瘤恶变者基底胆囊壁和/或周围胆囊壁僵硬,其中3例局部可见波浪状隆起改变,1例肿瘤周围胆囊壁局部明显增厚。病理证实2例癌变病例侵犯肿瘤基底部。结论胆囊腺瘤CT表现较有特征,当其表现为分叶状、宽基底、不均匀明显强化,基底及周边胆囊壁僵硬或凹陷,或周边胆囊壁不均匀增厚并明显强化时,应考虑存在癌变。

Objective To analyze the CT features of carcinogenesis in gallbladder adenoma.Methods CT of 17 patients with pathologically proven gallbladder adenomas were analyzed retrospectively.Results The lesions were solitary(13)or multiple scattered(4),lobulated(10),nodular(5)or nodular-lobulated(2)with largest diameter of 39 mm.There were homogeneous CT densities(15),punctuate calcification(1)and short stripes of low attenuation(1)with mild(5),moderate(2)or marked(10)contrast enhancement in the arterial phase,continuously increased or slightly decreased in the portal venous phase and washout in the delayed phase.There were accompanying acute cholecystitis(2),chronic cholecystitis(10)and cholelithiasis(5).Local carcinogenesis was found in 5/17 adenomas with lobulated contour,marked heterogeneous enhancement in the arterial and portal venous phases and homogeneous enhancement in delayed phase.Stripes of higher enhancement were found in 2 patients with marked enhancement in the arterial and portal venous phases.The basal and/or peripheral gallbladder wall was stiff(5)with wavy protrusion(3/5)and focal mural thickening at the periphery of the tumor(1/5).The histology confirmed tumor invasion of the basal wall(2/5).Conclusion CT features of carcinogenesis in gallbladder adenoma include lobulated and broad tumor base with marked enhancement,rigidity of the base and peripheral gallbladder wall,heterogeneous thickening and marked enhancement of the peripheral gallbladder wall.