黄色肉芽肿性胆囊炎多层螺旋CT表现及误诊分析  

Xanthogranulomatous cholecystitis： CT features and misdiagnosis analysis

作　　者：王亮亮 刘希胜[2] 孙娜娜[2] 王德杭[2] 徐青[2] 

机构地区：[1]江苏省苏州市高新区人民医院放射科,江苏苏州215129 [2]南京医科大学第一附属医院放射科

出　　处：《实用放射学杂志》2016年第11期1710-1712,共3页Journal of Practical Radiology

摘　　要：目的探讨黄色肉芽肿性胆囊炎（XGC）的多层螺旋CT表现，以期提高XGC的诊断水平。方法收集经手术病理证实的38例XGC病例，回顾性分析其CT影像表现，观察胆囊壁的厚度及范围、胆囊壁内有无低密度结节、胆囊内壁黏膜线连续性、胆道系统有无结石、胆管梗阻情况、邻近组织受累情况。结果38例均有胆囊壁增厚，其中弥漫性增厚36例，局限性增厚2例。17例可见胆囊壁内低密度结节或低密度带，21例胆囊壁未见明显低密度结节。32例显示完整黏膜线，6例显示黏膜线中断。33例胆道系统结石，5例胆道系统内未见阳性结石。8例合并肝内外胆管扩张，2例仅有胆总管扩张。累及肝脏10例，累及胃肠道10例，累及胆总管1例，余病例与周围组织未见明显粘连。CT误诊19例，其中术前诊断胆囊癌8例，慢性胆囊炎11例。结论XGC的CT增强扫描增厚的胆囊壁内低密度结节或低密度带在其诊断和鉴别诊断中有重要的价值。Objective To analyze the CT findings of xanthogranulomatous cholecystitis （XGC） to improve the diagnostic ability. Methods CT findings of XGC in 38 patients which were proved by pathology were retrospectively reviewed. Thickness and scope of gallbladder wall with or without hypodense nodule, mucosal line of gallbladder wall, biliary stones and obstruction, surrounding tis- sues invasion and enlarged lymph nodes were evaluated. Results All patients presented thickened gallbladder walls including diffuse thickening in 36 and regional thickening in 2. Gallbadder wall hypodense nodules were noted in 17 cases,and 21 cases were negative. Complete mucosal lines in 32 and incomplete ones in 6 were showed respectively. 33 patients had biliary stones, but there was no stone in the other 5 cases. Biliary dilation was showed in 8, and the dilation of common bile duct were in 2. Hepatic invasion was found in 10, digestive tract invasion in 10, and common bile duct invasion in 1. Multiple enlarged lymph nodes were showed in 1 patient. In preoperative diagnosis, 8 patients were misdiagnosed as gallbladder carcinoma, and other 11 as chronic cholecystitis. Conclusion Hypodense nodules or lines in gallbladder wall on contrast-enhanced CT play an important role in diagnosis of XGC.

关 键 词：黄色肉芽肿性胆囊炎 胆囊癌 计算机体层成像 

分 类 号：R575.61[医药卫生—消化系统] R814.42[医药卫生—内科学]