多排螺旋CT对胆囊壁增厚病变的诊断价值  

Differential diagnosis of benign and malignant gallbladder wall thickening with multidetector computed tomography

作　　者：罗祖炎[1] 李博[1] 徐健[1] 王振[1] 

机构地区：[1]浙江省人民医院放射科,杭州310014

出　　处：《浙江医学》2012年第9期674-677,共4页Zhejiang Medical Journal

基　　金：浙江省医药卫生科学研究基金资助项目（2008A006）

摘　　要：目的 探讨多排螺旋CT（MDCT）在良、恶性胆囊壁增厚病变中的鉴别诊断价值.方法 分析145例经手术病理证实的厚壁型胆囊病变MDCT图像资料,并观察以下内容：（1）直接征象：胆囊壁的厚度、胆囊壁的增厚方式、增厚囊壁黏膜线的完整性、黏膜下水肿、增厚囊壁内有无结节和钙化,胆囊周围有无渗出和积液;（2）间接征象：有无胆道梗阻,邻近肝组织及血管有无受侵犯,邻近有无肿大淋巴结或远处肿大淋巴结,有无合并结石;（3）增厚胆囊壁的强化方式.结果 胆囊壁的增厚方式、增厚囊壁黏膜线的完整性、黏膜下水肿、增厚囊壁内有无结节、囊壁有无钙化,增强后的胆囊壁强化方式（均匀性）、邻近肝组织及血管有无受侵犯、邻近有无肿大淋巴结或远处肿大淋巴结在胆囊癌与其它表现为胆囊壁增厚疾病患者间差异均有统计学意义（均P＜0.05）.结论 多排螺旋CT双期扫描有助于胆囊壁增厚病变的鉴别诊断.胆囊壁局限性不规则增厚,胆囊黏膜不连续、中断、破坏,胆囊壁全层呈单层不规则强化等表现往往是恶性病变的征象.Objective To investigate the diagnostic value of multidetector computed tomography （MDCT） in differentiation of gallbladder carcinoma from benign conditions in patients with thickened gallbladder wall. Methods The MDCT findings of 145 patients including 27 cases of gallbladder carcinomas and 118 cases of benign conditions were retrospectively reviewed. Vari- ous direct and indirect CT findings of benign and malignant gallbladder diseases were evaluated. Differences in CT findings be- tween benign and malignancy were calculated. Additionally, the wall enhancement pattern was evaluated and categorized into five types, according to the presence of striation, thickness of the outer and inner layers, and degree of enhancement of each layer compared with that of normal liver parenchyma. Results The CT findings including wall irregularity, focal wall thickening, discontinuous mucosa, submucosal edema, polypoid mass, direct invasion to adjacent organ, biliary obstruction, regional and paraaortic lymphadenopathy and distant metastasis showed significant differences between benign conditions and malignant diseases. The thickened gallbladder wall with one-layer heterogeneous enhancement （type Ⅰ） was significantly associated with malignancy. By using type Ⅰ enhancement pattern as the indicator for malignancy was sensitive. Conclusion MDCT is a reliable diagnostic method for differentiating between benign and malignant thickened gallbladder wall. Focal and irregular wall thickening are two direct signs that are associated with malignancy. Moreover, the one-layer heterogeneous enhancement of gallbladder wall is suggestive of malignancy.

关 键 词：胆囊癌 胆囊壁增厚 体层摄影术 X线计算机 

分 类 号：R575.6[医药卫生—消化系统]