关键CT征象对黄色肉芽肿性胆囊炎与胆囊癌的鉴别诊断效能研究  

Study on the diagnostic efficacy of key CT signs for xanthogranulomatous cholecystitis and gallbladder carcinoma

作　　者：黄晓姗 樊树峰 向军益 熊妍希 黄朕 薛黎明 饶钦盼 HUANG Xiaoshan;FAN Shufeng;XIANG Junyi;XIONG Yanxi;HUANG Zhen;XUE Liming;RAO Qinpan(Department of Radiology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310000, China;Department of Radiology, Shiyan people's Hospital of Hubei, Shiyan 442000, China)

机构地区：[1]浙江中医药大学附属第二医院放射科,浙江杭州310000 [2]湖北省十堰市人民医院放射科,湖北十堰442000

出　　处：《医学影像学杂志》2022年第6期986-989,1002,共5页Journal of Medical Imaging

基　　金：浙江中医药大学研究生教育改革立项项目(编号:731100G00856)。

摘　　要：目的探讨关键CT征象对鉴别黄色肉芽肿性胆囊炎(Xanthogranulomatous cholecystitis,XGC)与胆囊癌(Gallbladder carcinoma,GBCA)的诊断效能,为二者的鉴别诊断提供客观依据。方法选取89例经组织病理学证实的XGC和GBCA患者的平扫+三期增强CT图像特征。统计方法通过Fisher精确检验、独立样本t检验分析,对差异有统计学意义的统计指标绘制受试者工作特征(receiver operating characteristic,ROC)曲线,分别评价各指标的诊断效能,以约登指数最大为原则确定ROC曲线下面积(area Undercurve,AUC)。结果胆囊壁增厚类型、黏膜线连续性、壁内低密度结节、胆囊结石、邻近肝实质动脉期一过性强化差异有统计学意义(P<0.05),其敏感性与特异性、AUC值分别为:75.8%、70.4%、0.73;72.7%、75.0%、0.74;78.8%、76.8%、0.78;69.7%、62.5%、0.66;63.6%、65.3%、0.64;多因素逻辑回归分析显示,胆囊壁增厚类型、黏膜线连续性、壁内低密度结节差异有统计学意义(P<0.05),是两者鉴别诊断的独立预测因子。联合上述5个指标诊断的敏感性为85%,特异性84%,AUC值为0.91。结论胆囊壁增厚类型、黏膜线连续性、壁内低密度结节、胆囊结石、邻近肝实质动脉期一过性强化均能够很好地鉴别黄色肉芽肿性胆囊炎与胆囊癌,其中前三个关键CT征象的诊断价值尤为显著,联合上述5个关键CT影像特征能够明显提高鉴别诊断效能。Objective To discuss the diagnostic efficacy of key CT signs in differentiating xanthogranulomatous cholecystitis(XGC)and gallbladder carcinoma(GBCA),so as to provide objective evidence for the differential diagnosis of the two.Methods We etrospectively evaluated the unenhanced CT image characteristics of 40 patients with XGC and GBCA confirmed by histopathology.The statistical methods were Fisher's exact test and independent sample T-test analysis,receiver operating characteristic(ROC)curves was drawn for statistical indicators with statistical significance.We evaluated the diagnostic power of each indicator separately,based on the principle of maximum Youden index Determine the area under the ROC curve(area Undercurve,AUC).Results The sensitivity,specificity and AUC were 75.8%,70.4%and 0.73;72.7%,75.0%,0.74;78.8%,76.8%,0.78;69.7%,62.5%,0.66;63.6%,65.3%,0.64 respectirey;In multivariate analysis(logistic regression),the type of gallbladder wall thickening,continuity of mucosal line and low-density nodules was statistically significant(P<0.05),which were independent predictors of differential diagnosis between the two groups.The sensitivity,specificity and AUC were 85%,84%and 0.91 respectively.Conclusion The type of gallbladder wall thickening,continuity of mucosal line,intramural low-density nodules,gallstones,and transient enhancement adjacent to hepatic parenchyma artery can well differentiate xanthogranulomatous cholecystitis from gallbladder cancer,among which the first three key CT signs are of great diagnostic value,and the combination of the above five key CT features can significantly improve the differential diagnosis efficiency.

关 键 词：黄色肉芽肿性胆囊炎 胆囊癌 体层摄影术 X线计算机 

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