合并肝侵犯的黄色肉芽肿性胆囊炎与胆囊癌的鉴别

Differential Diagnosis Between Xanthogranulomatous Cholecystitis with Liver Invasion and Gallbladder Carcinoma

目的 通过对比术前增强CT影像合并肝侵犯的黄色肉芽肿性胆囊炎(XGC)与胆囊癌(GBC)特征差异,以提高XGC与GBC的鉴别诊断能力。方法 搜集经本院经病理证实的合并肝侵犯的XGC患者39例、GBC患者55例为研究对象。所有患者术前均行双期CT增强扫描。通过Logistics回归分析与诊断XGC独立相关的特征,运用Logit变换演算建立鉴别XGC和GBC模型公式,通过受试者工作特征(ROC)曲线评价模型的预测效能。结果单因素分析显示,性别、胆囊壁增厚的范围、胆囊壁强化方式、黏膜线的连续性、胆囊壁内低密度结节、夹心饼干征、胆囊结石、是否与周围组织黏连或浸润、肝门及腹膜后有无肿大淋巴结在合并肝侵犯的XGC与GBC间具有统计学意义(P<0.05)。多因素分析显示,胆囊壁弥漫增厚、胆囊黏膜线连续、胆囊壁内低密度结节、肝门部及腹膜后无淋巴结肿大与XGC独立相关(P均<0.05)。基于与XGC独立相关的影像特征建立的模型公式,曲线下面积(AUC)为0.972(95%CI:0.936~1.000),特异度为0.909,敏感度为0.949。结论 胆囊壁弥漫增厚、黏膜线的连续性、壁内低密度结节、肝门部及腹膜后有无肿大淋巴结是XGC鉴别于GBC的独立相关因素。通过独立相关因素建立模型公式能进一步提高合并肝侵犯的XGC的诊断能力,以避免非必要的扩大手术。

Objective To improve the differential diagnosis efficiency of xanthogranulomatouscholecystitis(XGC)and gallbladder carcinoma(GBC),the differences between preoperative enhancedCT image features and clinical features in XGC and GBC with liver invasion were compared.Methods 39 cases of XGC and 55 cases of GBC with liver invasion confirmed by pathological examination,those patients were collected as research objects.All patients underwent dual phase enhanced CT scans before cholecystectomy.Logistic regression analysis was conducted to diagnose the independently correla⁃ted features of XGC,a modelformula for distinguishing XGC and GBC was established by Logit transformation calculus.The prediction efficiency of the model was evaluated by receiver operating characteristiccurve.Results Univariate analysis showed that there were statistically significant differences between XGC and GBC in gender,gallbladder wall thickeningpat⁃tern,CT enhancement method,the continuity of mucosal line,intramural nodules of gallbladder wall,sandwich biscuit sign,gallstones,peripheral enlargement lymph nodes(P<0.05).Multivariate analysis showed that diffuse thickening of the gall⁃bladder wall,continuous gallbladder mucosal line,intramural nodules of gallbladder wall and no peripheral enlargement lymph nodes were independently associated with XGC(all P<0.05).Based on the above imaging features independently related to XGC,a Logit transformation algorithm was used to establish a differentiation model formula between XGC and GBC.The AUC was 0.972(95%CI:0.936-1.000),the specificity was 0.909,and the sensitivity was 0.949.Conclu⁃sion Diffuse thickening of the gallbladderwall,continuous mucosal line,Intramural nodules of gallbladder wallandno Pe⁃ripheral enlargement lymph nodes are independent related factors for distinguishing XGC from GBC.The prediction model formula established by independent related factors can further improve the diagnostic accuracy of XGC with liver invasion,soas to avoid unnecessary extended resection.