双能CT鉴别诊断胆固醇息肉和腺瘤性胆囊息肉的临床价值

Clinical value of dual-energy CT in differential diagnosis of cholesterol polyps and adenomatous gallbladder polyps

目的:探究双能CT鉴别诊断胆固醇息肉和腺瘤性胆囊息肉的临床价值。方法:选取2021年7月至2022年7月我院疑似胆囊息肉患者162例作为研究对象。术前均接受双能CT和64层螺旋CT检测,以病理结果为金标准,比较2种CT诊断效能,并分析胆囊息肉影像学特征。结果:病理确诊胆囊息肉阳性118例,阴性44例,其中双能CT检出真阳性115例,真阴性33例,敏感度97.46%、特异度75.00%、准确度91.36%、Kappa值0.768。64层螺旋CT检出真阳性102例,真阴性31例,敏感度86.44%、特异度70.45%、准确度82.10%、Kappa值0.557。2种息肉在大小、基底范围、血管征象方面有统计学意义(P<0.05)。胆固醇息肉多为1 cm以下、窄基底、病灶/胆囊周围血管增多增粗强化。腺瘤性胆囊息肉多为2 cm及以上、宽基底、病灶内血管强化。结论:双能CT诊断胆囊息肉较64层螺旋CT及超声更好,基于多平面重建5 mm结合血管征能促进CT对胆囊息肉诊断,同时通过息肉大小、基底范围、血管征象等方面能有效鉴别诊断胆固醇息肉和腺瘤性胆囊息肉。

Objective:To explore the clinical value of dual-energy CT in the differential diagnosis of cholesterol polyps and adenomatous gallbladder polyps.Methods:162 patients with suspected gallbladder polyps in our hospital from July 2021 to July 2022 were selected as the study objects.Preoperative dual-energy CT and 64-slice spiral CT were used as the gold standard.The diagnostic efficiency of the two kinds of CT was compared,and the imaging features of gallbladder polyps were analyzed.Results:118 cases were positive and 44 cases were negative.Dual-energy CT detected 115 true positive and 33 true negative polyps.Sensitivity was 97.46%,specificity was 75.00%,accuracy was 91.36%,Kappa value was 0.768.There were 102 true positive cases and 31 true negative cases detected by 64-slice spiral CT,with sensitivity 86.44%,specificity 70.45%,accuracy 82.10%and Kappa value 0.557.There were statistical significance in size,basal area and vascular signs of the two types of polyps(P<0.05).Cholesterol polyps were mostly less than 1cm,narrow base,and increased and thickened blood vessels around lesion/gallbladder.Most adenomatous gallbladder polyps were 2 cm or more,with a wide base and vascular enhancement in the lesion.Conclusion:Dual-energy CT is better than 64-slice spiral CT and ultrasound in the diagnosis of gallbladder polyps.The combination of 5-mm multi-plane reconstruction and vascular signs can promote the diagnosis of gallbladder polyps by CT,and can effectively differentiate the diagnosis of cholesterol polyps from adenomatous gallbladder polyps by the aspects of polyp size,base range and vascular signs.