黄色肉芽肿性胆囊炎的影像表现分析

The Imaging Features Analysis of Xanthogranulomatous Cholecystitis

目的研究黄色肉芽肿性胆囊炎的影像学表现特点,提高对本病的诊断水平。方法回顾松原吉林油田医院12例2012年1月至2020年6月间经手术病理证实为黄色肉芽肿性胆囊炎的影像资料,分析CT动态增强扫描及MRI动态增强扫描检查的影像表现,探讨病灶形态、密度及信号特点,增强扫描强化方式。结果12例患者胆囊壁均出现增厚,增强扫描强化明显,弥漫性增厚11例(91.7%),局限增厚1例(8.3%),12例(100%)伴有胆囊结石,3例胆囊管结石,5例(41.7%)出现“夹心饼干征”,胆囊壁黏膜层和浆膜层明显强化,中间肌层增强扫描相对弱强化,8例(66.7%)增厚胆囊壁内见小结节影CT呈略低密度,T1WI等或稍低信号,T2WI呈稍高及高信号,增强扫描强化不明显,6例(50.0%)胆囊临近肝组织增强扫描出现动脉期异常灌注。结论黄色肉芽肿性胆囊炎影像学表现为胆囊壁弥漫增厚,部分出现“夹心饼干征”,胆囊壁内可见小结节状物强化灶,具有一定特征性,影像表现在黄色肉芽肿性胆囊炎的临床诊治中有不可替代应用价值,可提高诊断准确率,有助于外科医生选择合适的手术方式。

Objective To investigate the imaging manifestations of xanthogranulomatous cholecystitis,in order to raise the diagnostic level of this disease.Methods The imaging data of 12 cases of xanthogranulomatous cholecystitis confirmed by surgery and pathology from January 2012 to June 2020 were retrospectively collected.The image manifestations of CT dynamic enhanced scanning and MRI dynamic enhanced scanning were analyzed,and the morphology,density and signal characteristics of lesions were discussed.Results All the 12 patients showed thickening of gallbladder wall,with obvious enhancement on enhanced scan,including 11 cases(91.7%)of diffuse thickening,1 case(8.3%)of limited thickening,12 cases(100%)of gallstone,3 cases of gallbladder duct stones,and 5 cases(41.7%)of"sandwich cookie sign".Gallbladder mucosa and serosa layer significantly strengthened,and the middle enhancement scan is relatively weak to strengthen muscle layer,8 cases(66.7%)within the gallbladder wall thickening see small nodules shadow CT slightly low density,or slightly low signal such as T1WI,T2WI was slightly higher and higher signal,strengthen the scan is not obvious,6 cases(50.0%)of the gallbladder near liver tissue appeared abnormal arterial perfusion scan.Conclusion Xanthogranulomatous cholecystitis imaging findings of gallbladder wall thickening,part of a"sandwich biscuit",strengthen the focal nodules can be seen in the gallbladder wall synthesis,has a certain characteristic,image performance in xanthogranulomatous cholecystitis with irreplaceable application value in clinical diagnosis and treatment,can improve the diagnostic accuracy and help the surgeon to choose the right means of surgery.