黄色肉芽肿性胆囊炎的CT诊断价值与误诊分析  

Clinical diagnostic value and misdiagnosis analysis of CT in xanthogranulomatous cholecytitis

作　　者：张建英[1,2] 蒋瑾[2] 母其文[1] 胡凌云[1] 张福州[1] 赵辉[2] ZHANG Jianying JIANG Jin MU Qiwen HU Lingyun ZHANG Fuzhou ZHAO Hui(The Second Clinical Medical College of North Sichuan Medical College, Nanchong Central Hospital, Nanchong 637000, Sichuan China Sichuan Academy of Medical Sciences, Sichuan Provincial People＇s Hospital, Chengdu 610072, China.)

机构地区：[1]川北医学院第二临床医学院.南充市中心医院,四川南充637000 [2]四川省医学科学院.四川省人民医院,四川成都610072

出　　处：《西部医学》2017年第4期543-545,550,共4页Medical Journal of West China

基　　金：国家自然科学基金(81100929)

摘　　要：目的探讨黄色肉芽肿性胆囊炎(XGC)的X线计算机体层摄影(CT)表现特点及诊断价值,并对误诊原因进行分析,提高XGC的CT诊断准确率。方法回顾性分析经手术病理证实的XGC 20例的CT表现,分析其影像学特点。结果 20例中术前诊断正确4例(20%),16例(80%)误诊。CT表现特征:CT平扫发现4例胆囊不同程度增大,9例胆囊缩小,20例胆囊壁均不同程度增厚;增强扫描发现7例增厚胆囊壁内可见低密度结节灶,12例黏膜线完整,肝脏、胆囊床模糊4例,肝脏局部性受侵4例,"夹心饼干征"4例;所有病例中12例合并胆囊结石,1例合并胆总管结石。结论 CT可以发现XGC的相关影像学特征,CT增强扫描后的"夹心饼干征"、低密度结节、黏膜完整和胆囊床清晰等征象,对XGC的诊断和鉴别诊断有重要价值。Objective To analyze the CT features, clinical diagnostic value, and the causes of misdiagnosis for xan- thogranulomatous cholecytitis （XGC） and improve its diagnostic accuracy. Methods The CT features of 20 patients of XGC confirmed by operation and pathology were retrospectively analyzed, and the imaging features of XGC were ana- lyzed. Abdomen CT scans with and without contrast enhancement were performed in all patients. Results Only 4 cases was correctly diagnosed before surgery in all patients. CT features of XGC were included gallbladder enlargement in var- ying degrees （4 cases）, gallbladder shrinking （9 cases） and gallbladder wall thickening （20 cases） by CT common scan. CT enhanced scan findings included hypodense nodules in the thickened walls （7 cases）, continuous mucosal line （12 ca- ses）, fuzzy gallbladder and liver （4 cases）, local infiltration of liver （4 cases）, and ＂hypodense band＂ sign （4 cases）. 12 patients were complicated with calculus of gallbladder. 1 patient was complicated with calculus of common bile duct. Con- clusion The relevant imaging features of XGC can be found by CT scans. After contrast administration, hypoattenuated areas presented in thickened gallbladder wall, ＂hypodense band＂ sign, and continuous mucosal line on contrast-enhanced CT are very important for the diagnosis and differential diagnosis of XGC.

关 键 词：计算机体层摄影 肉芽肿性胆囊炎 诊断价值 误诊分析 

分 类 号：R814.42[医药卫生—影像医学与核医学]