胆囊壁增厚的CT强化分型对胆囊炎病因的鉴别诊断意义  

Value of The Enhancement Pattern of Flat Gallbladder Wall Thickening on MDCT to Differentiate The Causes of Cholecystitis

作　　者：赵欣 张浩[2] 曾红辉[2] 刘东旭 张键 

机构地区：[1]广东省佛山市禅城区中心医院放射科,广东佛山528000 [2]广东省佛山市顺德区新容奇医院放射科,广东佛山528303

出　　处：《中国普外基础与临床杂志》2013年第7期815-819,共5页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的运用对胆囊壁增厚CT强化分层分型的方法,总结不同病因急性胆囊炎胆囊壁水肿与囊周积液的影像学特征及其临床意义。方法选取2009年1月至2012年12月期间,佛山市禅城区中心医院及顺德区新容奇医院临床诊断为急性胆囊炎或确诊为肝病并行上腹部CT增强扫描的患者169例作为研究对象,同时选取同期行上腹部CT增强扫描且诊断胆囊正常者5例作为对照组。研究组中,系非肝病性胆囊炎者146例,肝病性胆囊炎者23例。胆囊壁按囊壁强化及分层的不同分为5型,观察各组胆囊壁强化分型情况,测量胆囊壁黏膜层厚度;比较非肝病组和肝病组的各型发生率及胆囊壁黏膜层厚度之间的差异。结果非肝病组Ⅱ型102例(69.9%),Ⅲ型5例(3.4%),Ⅳ型30例(20.5%),Ⅴ型9例(6.2%);肝病组Ⅱ型2例(8.7%),Ⅲ型11例(47.9%),Ⅳ型5例(21.7%),Ⅴ型5例(21.7%)。Ⅱ型在非肝病组的发生率高于肝病组(P<0.005),而Ⅲ型和Ⅴ型在非肝病组的发生率却低于肝病组(P<0.005,P<0.05),Ⅳ型在2组的发生率之间的差异无统计学意义(P>0.05)。Ⅰ型仅出现在对照组。非肝病组胆囊壁黏膜层厚度为(2.61±1.30)mm,大于肝病组的(2.02±0.52)mm(t=2.22,P<0.05)。结论胆囊壁CT强化分层分型的方法,有利于非肝病性与肝病性胆囊炎的鉴别诊断,对胆囊炎有无穿孔也具有鉴别诊断意义。Objective To evaluate the diagnostic value of analyzing the pattern of gallbladder wall enhancement on MDCT to identify the different causes of acute cholecystitis.Methods In January 2009 to December 2012,169 patients diagnosed with acute cholecystitis caused by various pathologic conditions were performed MDCT scans,the images of portal venous phase and clinical data were retrospectively reviewed by two blinded radiologists.There were 146 cases in non-hepatopathy cholecystitis group and 23 cases in hepatopathy cholecystitis group.The other 5 normal gallbladder cases diagnosed by MDCT scans were retrospectively reviewed as contrast group.Using five patterns according to the enhancement pattern of flat gallbladder wall thickening on MDCT.The study cases were then divided into five patterns and the thickness of the mucous membrane were measured.The occurrence rate of each pattern and the thickness of the mucous membrane between the groups were compared respectively.Results In the non-hepatopathy cholecystitis group,there were type Ⅱ in 102 cases（69.9%）,type Ⅲ in 5 cases（3.4%）,type Ⅳ in 30 cases（20.5%）,and type Ⅴ in 9 cases（6.2%）.In the hepatopathy cholecystitis group,there were type Ⅱ in 2 cases（8.7%）,type Ⅲ in 11 cases（47.9%）,type Ⅳ in 5 cases（21.7%）,and type Ⅴ in 5 cases（21.7%）.The occurrence rate of type Ⅱ in the non-hepatopathy cholecystitis group was significialtly higher than that in the hepatopathy cholecystitis group（P0.005）.The occurrence rate of type Ⅲ and type Ⅴ in the hepatopathy cholecystitis group were significialtly higher than those in the non-hepatopathy cholecystitis group（P0.005,P0.05）.The occurrence rate of type Ⅳ between the two groups had no significant difference（P0.05）.Type Ⅰ only present in the contrast group.The non-hepatopathy group’s mean mucous membrane thickness was（2.61±1.30）mm,which was thicker than the hepatopathy group’s（2.02±0.52）mm（t=2.22,P0.05）.Conclusion Analyzing the enhancement pattern of

关 键 词：急性胆囊炎 胆囊壁增厚分型 X线计算机体层摄影术 鉴别诊断 

分 类 号：R657.4[医药卫生—外科学] R814.42[医药卫生—临床医学]