黄色肉芽肿性胆囊炎的CT和MR影像特征分析

CT/MR features of xanthogranulomatous cholecystitis

目的探讨黄色肉芽肿性胆囊炎的CT、MR影像学表现。方法收集2017年1月至2021年8月中山大学孙逸仙纪念医院经病理证实的黄色肉芽肿性胆囊炎21例,回顾性分析其CT、MR影像表现。结果共收集21例患者,其中男13例,女8例,年龄28~69岁,平均55岁。行CT增强扫描14例,行MR增强扫描13例,MR平扫3例,均行CT及MR扫描9例。胆囊壁增厚18例(86.00%),其中弥漫性、均匀性增厚9例(50.00%),弥漫性、不均匀性增厚4例(22.22%),局限性增厚5例(27.78%),胆囊壁无增厚3例(14.29%)。肌层均匀强化者13例(72.22%),肌层不均匀强化者3例(16.67%)。胆囊壁内结节8例(38.10%)。胆囊黏膜线连续者18例(85.71%),中断者3例(14.29%)。浸润邻近结构9例(42.86%),边界清楚者12例(57.15%)。周围见肿大淋巴结4例(19.05%)。合并胆囊或胆管结石的有15例(71.43%),其中导致胆道梗阻的有9例(60.00%)。结论胆囊壁增厚、胆囊肌层均匀强化、胆囊壁内结节及胆囊黏膜线连续是黄色肉芽肿性胆囊炎较有特征的影像学表现。

Objective To investigate the CT and MR features of xanthogranulomatous cholecystitis(XGC).Methods Twenty-one patients which were pathologically as xanthogranulomatous cholecystitis from Sun Yat-Sen Memorial Hospital of Sun Yat-sen University in January 2017 to August 2021,and their CT and MR images were analyzed retrospectively.Results Gallbladder wall thickening occurred in 18 cases(86.00%),including diffuse and uniform thickening in nine cases(50.00%),diffuse and heterogeneous thickening in four cases(22.22%),localized thickening in five cases(27.78%),and no thickening of gallbladder wall in three cases(14.29%). There were 13 cases(72.22%)with uniform enhancement of muscularis and three cases(16.67%)with uneven enhancement of muscularis. Nodules in gallbladder wall were found in eight cases(38.10%). The gallbladder mucosal line was continuous in18 cases(85.71%)and interrupted in three cases(14.29%). The adjacent structures were infiltrated in nine cases(42.86%),and the boundary was clear in 12 cases(57.15%). Enlarged lymph nodes were seen in four cases(19.05%). Fifteen cases(71.43%)were complicated with gallbladder or bile duct stones,of which nine cases(60.00%)were complicated with bile duct obstruction.Conclusion Thickening of gallbladder wall,uniform mucosal line enhancement,nodules in gallbladder wall and complete gallbladder mucosal line are characteristics of XGC.