MR T_2加权成像显示胆囊壁增厚点状高信号的意义  

Gallbladder wall thickening: significance of hyperintense spots visualized on T_2-weighted MR imaging

作　　者：靳二虎[1] 马大庆[1] 梁宇婷[1] 王强[1] 

机构地区：[1]首都医科大学附属北京友谊医院放射科,100050

出　　处：《中华放射学杂志》2006年第4期401-405,共5页Chinese Journal of Radiology

摘　　要：目的研究病理组织学证实的胆囊腺肌瘤病、慢性胆囊炎和管壁增厚型胆囊腺癌在MRL加权成像（T2WI）显示病变胆囊壁点状高信号的特征。方法38例患者（胆囊腺肌瘤病16例，慢性胆囊炎13例，管壁增厚型胆囊腺癌9例），每例均进行了MR常规T1WI、常规T2WI和3mm薄层T2WI及MR胰胆管成像（MRCP）。所有患者均接受了胆囊切除手术。2名高年资放射科医生共同分析不同序列MRI，观察胆囊壁增厚及T2WI显示病变胆囊壁点状高信号的不同表现，将观察结果与病理组织学检查所见对照。结果所有患者的胆囊壁均明显增厚，厚度范围5～15mm，平均9mm。T2WI显示病变胆囊壁存在各种各样的点状高信号，在胆囊腺肌瘤病，点状高信号分布于整个增厚的胆囊壁，且数量较多（5～15个／cm^2），较大（直径2～7mm），边界清楚，呈现中等至明显高信号；在慢性胆囊炎，点状高信号主要位于增厚胆囊壁的黏膜侧，数量较少（3～5个／cm^2），较小（直径2～4mm），边界清楚，呈中等至明显高信号；在管壁增厚型胆囊腺癌，点状高信号边界欠清，呈现稍高信号，其数量和大小差异较大，分布范围取决于癌组织浸润胆囊壁的深度。结论胆囊腺肌瘤病、慢性胆囊炎和管壁增厚型胆囊腺癌在T2WI呈现的点状高信号有一定差别，正确识别这些点状高信号的特征有助于鉴别诊断良恶性胆囊壁增厚。Objective To study the characteristics of hyperintense spots on MR imaging in patients with pathologically confirmed gallbladder adenomyomatosis, chronic cholecystitis and gallbladder carcinoma. Methods MR imaging of 38 patients （ 15 male and 23 female, age range 30 to 78 years old, mean 55 years） with gallbladder adenomyomatosis （n = 16 ）, chronic cholecystitis （n = 13 ） and gallbladder adenocarcinoma with mural thickening （n = 9 ） was analyzed. For each patient, conventional T1 WI and T2WI with 7 mm slice thickness, thin-slice T2W1 with 3 mm slice thickness, and single shot fast spin-echo MRCP were obtained. All patients underwent cholecystectomy. Two radiologists correlated the features of hyperintense spots on T2-weighted MR imaging and histopathological findings out of the specimen after surgery; in addition, hyperintense spots were scored according to a five-point scale system. Results Focal or diffuse gallbladder wall thickening （thickness ranged from 5 mm to 15 mm, mean 9 mm ） with hyperintense spots was found in all cases. Some differences of hyperintense spots in signal intensity, location, shape, number, diameter, and border were identified within the thickened wall of the gallbladder among the three diseases. Scores on a five-point confidence scale for evaluating the hyperintense spots were 4. 78 ± 0. 19, 4. 79 ± 0. 23, and 2. 71 ± 0. 21, respectively, in gallbladder adenomyomatosis, chronic cholecystitis, and gallbladder adenocarcinoma with mural thickening. Statistically, the benign gallbladder wall thickening had significantly higher scores than the malignant （P 〈 0. 001, q test）. Scores between gallbladder adenomyomatosis and chronic cholecystitis were not statistically significant （P = 0. 885, q test）. Conclusion Correctly identifying the features of hyperintense spots on T2-weighted MR imaging should be helpful for distinguishing benign gallbladder wall thickening from the malignant.

关 键 词：胆囊疾病 腺肌瘤 磁共振成像 信号 

分 类 号：R445.2[医药卫生—影像医学与核医学]