多层螺旋CT在胆囊炎与肝病性胆囊改变鉴别诊断中的应用  

Application of multi-detector-row CT in differential diagnosis of cholecystitis and gallbladder abnormal changes caused by liver parenchymal diseases

作　　者：唐文才[1] 黄菁慧 李传资[1] 聂忠仕[1] 王绥煌[1] Tang Wencai;Huang Jinghui;Li Chuanzi;Nie Zhongshi;Wang Suihuang(Department of Radiology, Hainan Provincial Nongken General Hospital, Haikou 570311,China)

机构地区：[1]海南省农垦总医院放射科,海口570311

出　　处：《中华肝脏外科手术学电子杂志》2017年第6期499-503,共5页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：海南省自然科学基金(811206)

摘　　要：目的探讨多层螺旋CT在胆囊炎与肝病性胆囊改变鉴别诊断中的应用价值。方法回顾性分析2014年11月至2015年10月在海南省农垦总医院行多层螺旋CT增强检查发现有胆囊异常征象的84例患者临床资料。所有患者均签署知情同意书,符合医学伦理学规定。根据CT诊断结果分为胆囊炎组和肝病组。其中胆囊炎组32例,男16例,女16例;平均年龄(46±3)岁。肝病组52例,男33例,女19例;年龄(47±2)岁。所有患者均采用多层螺旋CT检查,并均经手术病理或其他影像学检查证实。分别观察胆囊炎组和肝病组的多层螺旋CT表现,并比较胆囊炎和肝病性胆囊改变在多层螺旋CT中的不同征象。两组胆囊厚径的比较采用t检验;率的比较采用χ2检验或Fisher确切概率法。结果胆囊炎组的囊壁厚径为(4.5±0.5)mm,明显长于肝病组的(3.7±0.4)mm(t=9.010,P<0.05)。胆囊炎组的囊壁强化率、胆汁密度升高率和邻近肝组织一过性强化率分别为100%、31%、19%,明显高于肝病组的75%、6%、0(χ2=9.465,9.832,-;P<0.05)。胆囊炎组的胆囊轮廓模糊及胆囊周围积液发生率分别为91%、9%,肝病组相应为75%、29%,差异有统计学意义(χ2=34.125,4.461;P<0.05)。胆囊炎组的胆囊周围积液一般偏侧分布,肝病组的胆囊周围积液无流动性,多环绕胆囊分布。结论多层螺旋CT扫描有助于鉴别胆囊炎和肝病性胆囊改变。Objective To investigate the application value of multi-detector-row CT(MDCT)indifferential diagnosis of cholecystitis and gallbladder abnormal changes caused by liver parenchymal diseases.Methods Clinical data of84patients with gallbladder abnormal changes detected by MDCT enhancementexamination in Hainan Provincial Nongken General Hospital between November2014and October2015wereanalyzed retrospectively.The informed consents of all patients were obtained and the local ethical committeeapproval was received.All patients were divided into cholecystitis group and liver disease group accordingto the CT diagnostic results.There were32patients in cholecystitis group,16males and16females,with anaverage age of(46±3)years old,and52in liver disease group,33males and19females,with an average ageof(47±2)years old.All patients were examined by MDCT and confirmed by operative pathology or other imaging findings,and the difference of MDCT features was observed and compared between cholecystitis andgallbladder abnormal changes caused by liver parenchymal diseases.Thickness of cyst wall in both groups wascompared by t test and the rate was compared by Chi-square test or Fisher's exact test.Results Thicknessof cyst wall in cholecystitis group was(4.5±0.5)mm,which was significantly longer than(3.7±0.4)mm inliver disease group(t=9.010,P<0.05).Enhancement rate of cyst wall,bile density increase rate and transientenhancement rate of adjacent liver tissues in cholecystitis group was respectively100%,31%and19%,significantly higher than75%,6%and0in liver disease group(χ2=9.465,9.832,-;P<0.05).The incidence offuzzy contour gallbladder and gallbladder surrounding effusion was respectively91%and9%in cholecystitisgroup,while75%and29%in liver disease group,significant differences were observed between two groups(χ2=34.125,4.461;P<0.05).The gallbladder effusion was observed generally distributing on one side incholecystitis group,while mostly distributing around the gallbladder without flowing in liver disease group.Conclusions MDCT can

关 键 词：体层摄影术 螺旋计算机 胆囊炎 肝硬化 肝炎 慢性 癌 肝细胞 诊断 鉴别 

分 类 号：R657.41[医药卫生—外科学] R816.5[医药卫生—临床医学]