磁共振扩散加权成像鉴别良恶性厚壁型胆囊病变  

Diffusion-Weighted MRI for Differentiation of Benign from Malignant Wall-Thickening Type Lesions in the Gallbladder

作　　者：胡翼江[1] 丰宇芳[2] 贾迪[1] 徐正道[1] 王姣[1] 蔡惠芳[1] 杨伟[1] 王兆平[1] 张同华[1] 李玉洁[1] 陈建新[1] 沈钧康[3] 

机构地区：[1]江苏省张家港市第一人民医院(苏州大学附属张家港医院)影像科,215600 [2]江苏省张家港市第一人民医院(苏州大学附属张家港医院)病理科,215600 [3]苏州大学附属第二医院放射科,215004

出　　处：《临床放射学杂志》2017年第10期1461-1467,共7页Journal of Clinical Radiology

基　　金：江苏张家港市社会发展科技支撑计划(编号:ZKS1317)

摘　　要：目的评价磁共振扩散加权成像(DWI)对于良恶性厚壁型胆囊病变的鉴别诊断价值。方法本研究包含了2007年11月到2014年5月在本院收治的79例良性病变[其中慢性胆囊炎25例,急性胆囊炎45例和黄色肉芽肿性胆囊炎(XGC)9例]和14例胆囊癌共93例厚壁型胆囊病变,将其按照DWI上分层表现、病灶形态以及是否扩散受限分成3种类型。由两名不知道病理结果的观察者在PACS工作站进行观察分析记录各自的分型结果,如有不一致时经协商获得一致同意。分型结果运用Fisher确切概率法进行统计学分析,多组间的两两比较采用Bonferroni校正,P<0.05认为有统计学意义;对于良恶性病变对应DWI分型结果计算其敏感性、特异性、阳性预测值和阴性预测值。结果 93例厚壁型胆囊病变中,Ⅰ型51例,其中胆囊癌3例(5.9%),慢性胆囊炎19例(37.3%),急性胆囊炎26例(51.0%),XGC 3例(5.9%);Ⅱ型17例,其中胆囊癌0例(0.0%),慢性胆囊炎3例(17.6%),急性胆囊炎12例(70.6%),XGC 2例(11.8%);Ⅲ型25例,其中胆囊癌11例(44.0%),3例(12.0%)为慢性胆囊炎,7例(28.0%)为急性胆囊炎,4例(16.0%)为XGC。经Fisher精确检验DWI分型与疾病构成比差别有统计学意义(P=0.000),经Bonferroni校正发现对于Ⅲ型表现,胆囊癌与慢性胆囊炎、急性胆囊炎之间差异均有显著性,胆囊癌与XGC之间无显著性差异;如将Ⅲ型表现认为是胆囊癌,其敏感性、特异性、阳性预测值和阴性预测值分别为78.6%、82.3%、44.0%和95.6%。对于慢性胆囊炎、急性化脓性胆囊炎和慢性胆囊炎急性发作亚组病例,慢性胆囊炎以Ⅰ型表现为主,急性化脓性胆囊炎以Ⅱ型+Ⅲ型表现为主,其差异具有显著性(P=0.0032)。结论 DWI分型结合常规MRI序列有助于良恶性厚壁型胆囊病变的鉴别,胆囊壁扩散受限一定程度反映了急性胆囊炎病变的严重性,并有助于鉴别急性化脓性胆囊炎和慢性胆囊炎,而对鉴别厚壁型胆囊癌与XGC帮�Objective To investigate the value of diffusion-weighted imaging（DWI） for differentiating benign from malignant wall-thickening type lesions in the gallbladder.Methods The study population consisted of 79 benign （25 chronic cholecystitis,45 acute cholecystitis and 9 xanthogranulomatous cholecystitis） and 14 malignant wall-thickening type gallbladder lesions treated in our hospital from November 2007 to May 2014.Two radiologists categorized gallbladder lesions into three types on DWI （b =800 s/mm2）,according to layered patterns,morphology of the lesion,and diffusion restriction.Disagreements were resolved in consensus.DWI types were correlated with pathologic findings and compared by using Fisher exact,with a Bonferroni correction for multiple comparisons.Differences were seen to be statistically significant when P 〈0.05.The sensitivity,specificity,positive predictive value （PPV） and negative predictive value （NPV） for diagnosing gallbladder carcinoma were calculated.Results on DWI （b =800 s/mm2）,94 patients had lesions that were classified as type Ⅰ 51 cases [malignant （n =3,5.9%）,chronic cholecystitis （n =19,37.3%）,acute cholecystitis （n =26,51.0%）,XGC （n =3,5.9%）];type]Ⅱ17 cases[malignant （n =0,0.0%）,chronic cholecystitis （n =3,17.6%）,acute cholecystitis （n =12,70.6%）,XGC （n =2,11.8%）],and type Ⅲ 25 cases [malignant （n =11,44.0%）,chronic cholecystitis （n =3,12.0%）,acute cholecystitis （n =7,28.0%）,XGC （n =4,16.0%）].Fisher exact test with a Bonferroni correction for multiple comparisons find the statistical significance between gallbladder carcinoma and chronic cholecystitis and acute cholecystitis based on type Ⅲ （P =0.000）,and no difference between malignant and XGC.The sensitivity,specificity,PPV and NPV on DWI manifest type Ⅲ as malignant were 78.6%,82.3%,44.0% and 95.6%,respectively.In cholecystitis subtype,there shows the statistical difference between acute suppurative cholecystitis and chronic cholecystitis based on di

关 键 词：胆囊 扩散加权成像 原发肿瘤 胆囊炎 

分 类 号：R445.2[医药卫生—影像医学与核医学] R575.6[医药卫生—诊断学]