黄色肉芽肿性胆囊炎不典型CT征象分析
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摘要
目的分析黄色肉芽肿性胆囊炎(XGC)的不典型CT征象。方法搜集8例经病理证实但CT征象不典型的XGC患者的临床与CT资料,与组织学对照,分析其不典型的影像特征。结果 8例XGC的胆囊壁内均没有发现明确低密度结节,6例胆囊壁为局限性增厚,增强扫描5例病变为轻度强化,1例无明显强化,7例胆囊黏膜线不连续强化。结论当XGC CT表现不典型时,即局限性增厚的胆囊壁内未见明确低密度结节、无明显强化或轻度强化、黏膜线不连续等,需结合临床实验室资料,综合分析以便做出正确诊断。
Objective To analyze the atypical CT signs of Xanthogranulomatous Cholecystitis. Methods The clinical and CT data of 8 patients with xanthogranulomatous cholecystitis confirmed by pathology but atypical CT signs were collected and compared with histology to analyze the atypical imaging features. Results In 8 cases of Xanthogranulomatous Cholecystitis,no clear low-density nodules were found in the gallbladder wall,6 cases of gallbladder wall had localized thickening.Enhanced scan showed mild enhancement in 6 cases,no enhancement in 1 case,and discontinuous enhancement of gallbladder mucosa in 7 cases. Conclusion When the CT manifestations of xanthogranulomatous cholecystitis are atypical,that is,there are no definite low-density nodules in the gallbladder wall with limited thickening,no obvious enhancement or mild enhancement,and mucosal line discontinuity,it should be combined with clinical laboratory data for comprehensive analysis to make the correct diagnosis.
Objective To analyze the atypical CT signs of Xanthogranulomatous Cholecystitis. Methods The clinical and CT data of 8 patients with xanthogranulomatous cholecystitis confirmed by pathology but atypical CT signs were collected and compared with histology to analyze the atypical imaging features. Results In 8 cases of Xanthogranulomatous Cholecystitis,no clear low-density nodules were found in the gallbladder wall,6 cases of gallbladder wall had localized thickening.Enhanced scan showed mild enhancement in 6 cases,no enhancement in 1 case,and discontinuous enhancement of gallbladder mucosa in 7 cases. Conclusion When the CT manifestations of xanthogranulomatous cholecystitis are atypical,that is,there are no definite low-density nodules in the gallbladder wall with limited thickening,no obvious enhancement or mild enhancement,and mucosal line discontinuity,it should be combined with clinical laboratory data for comprehensive analysis to make the correct diagnosis.
引文
1 Wasnik AP,Davenport MS,Kaza RK,et al.Diagnostic accuracy of MDCT in differentiating gallbladder cancer from acute and xanthogranulomatous cholecystitis[J].Clinical Imaging,2018,50:223-228.
2 Guzmán-Valdivia G.Xanthogranulomatous cholecystitis in laparoscopic surgery[J].Journal of Gastrointestinal Surgery,2005,9:494-497.
3 Hsu C,Hurwitzb JL,Schuss A,et al.Radiology pathology conference:Xanthogranulomatous cholecystitis[J].Clin Imag,2003,27:421-425.
4 朱玉春,王建良,沈纪芳,等.黄色肉芽肿性胆囊炎的螺旋CT表现[J].临床放射学杂志,2011,30:366-368.
5 Reed A,Ryan C,Schwartz SI.Xanthogranulomatous cholecystitis[J].J Am Coll Surg,1994,179:249-252.
6 王伟忠,刘文瑾.黄色肉芽肿性胆囊炎CT诊断和误诊原因分析(附9例报告)[J].临床放射学杂志,2011,30:520-522.
7 施勤,周建胜,张峭巍,等.黄色肉芽肿性胆囊炎的CT表现[J].中华放射学杂志,2006,40:86-88.
8 Zhao F,Lu PX,Yan SX,et al.CT and MR features of xanthogranulomatous cholecystitis:An analysis of consecutive 49 cases[J].European Journal of Radiology,2013,82:1391-1397.
9 Goshima S,Chang S,Wang JH,et al.Xanthogranulomatous cholecystitis:diagnostic performance of CT to differentiate from gallbladder cancer[J].Eur J Radiol,2010,74:e79-e83.
10 Lee ES,Kim JH,Joo I,et al.Xanthogranulomatous cholecystitis:diagnostic performance of US,CT,and MRI for differentiation from gallbladder carcinoma[J].Abdom Imaging,2015,40:2281-2292.
11 王建良,朱玉春,邢伟,等.黄色肉芽肿性胆囊炎与厚壁型胆囊癌的螺旋 CT鉴别诊断[J].临床放射学杂志,2015,34:74-78.
12 马黎斌,夏进东,林江,等.黄色肉芽肿性胆囊炎影像学表现及其病理学基础[J].临床放射学杂志,2013,32:991-995.
13 Shuto R,Kiyosue H,Komatsu E,et al.CT and MR imaging findings of xanthogranulomatous cholecystitis:correlation with pathologic findings[J].Eur Radiol,2004,14:440-446.
14 Parra JA,Acinas O,Bueno J,et al.Xanthogranulomatous cholecystitis:clinical,sonographic,and CT findings in 26 patients[J].AJR,2000,174:979-983.
15 Uchiyama K,Ozawa S,Ueno M,et al.Xanthogranulomatous cholecystitis:the use of preoperative CT findings to differentiate it from gallbladder carcinoma[J].Journal of Hepatobiliary Pancreatic Surgery,2009,16:333-338.
16 王嗣伟,栾维志.黄色肉芽肿性胆囊炎CT诊断价值的探讨(2例报告结合文献复习) [J].实用医学影像杂志,2008,9:233-235.
17 Chang BJ,Kim SH,Park HY,et al.Distinguishing xanthogranulomatous cholecystitis from the wall-thickening type of early-stage gallbladder cancer[J].Gut and Liver,2010,4:518-523.
2 Guzmán-Valdivia G.Xanthogranulomatous cholecystitis in laparoscopic surgery[J].Journal of Gastrointestinal Surgery,2005,9:494-497.
3 Hsu C,Hurwitzb JL,Schuss A,et al.Radiology pathology conference:Xanthogranulomatous cholecystitis[J].Clin Imag,2003,27:421-425.
4 朱玉春,王建良,沈纪芳,等.黄色肉芽肿性胆囊炎的螺旋CT表现[J].临床放射学杂志,2011,30:366-368.
5 Reed A,Ryan C,Schwartz SI.Xanthogranulomatous cholecystitis[J].J Am Coll Surg,1994,179:249-252.
6 王伟忠,刘文瑾.黄色肉芽肿性胆囊炎CT诊断和误诊原因分析(附9例报告)[J].临床放射学杂志,2011,30:520-522.
7 施勤,周建胜,张峭巍,等.黄色肉芽肿性胆囊炎的CT表现[J].中华放射学杂志,2006,40:86-88.
8 Zhao F,Lu PX,Yan SX,et al.CT and MR features of xanthogranulomatous cholecystitis:An analysis of consecutive 49 cases[J].European Journal of Radiology,2013,82:1391-1397.
9 Goshima S,Chang S,Wang JH,et al.Xanthogranulomatous cholecystitis:diagnostic performance of CT to differentiate from gallbladder cancer[J].Eur J Radiol,2010,74:e79-e83.
10 Lee ES,Kim JH,Joo I,et al.Xanthogranulomatous cholecystitis:diagnostic performance of US,CT,and MRI for differentiation from gallbladder carcinoma[J].Abdom Imaging,2015,40:2281-2292.
11 王建良,朱玉春,邢伟,等.黄色肉芽肿性胆囊炎与厚壁型胆囊癌的螺旋 CT鉴别诊断[J].临床放射学杂志,2015,34:74-78.
12 马黎斌,夏进东,林江,等.黄色肉芽肿性胆囊炎影像学表现及其病理学基础[J].临床放射学杂志,2013,32:991-995.
13 Shuto R,Kiyosue H,Komatsu E,et al.CT and MR imaging findings of xanthogranulomatous cholecystitis:correlation with pathologic findings[J].Eur Radiol,2004,14:440-446.
14 Parra JA,Acinas O,Bueno J,et al.Xanthogranulomatous cholecystitis:clinical,sonographic,and CT findings in 26 patients[J].AJR,2000,174:979-983.
15 Uchiyama K,Ozawa S,Ueno M,et al.Xanthogranulomatous cholecystitis:the use of preoperative CT findings to differentiate it from gallbladder carcinoma[J].Journal of Hepatobiliary Pancreatic Surgery,2009,16:333-338.
16 王嗣伟,栾维志.黄色肉芽肿性胆囊炎CT诊断价值的探讨(2例报告结合文献复习) [J].实用医学影像杂志,2008,9:233-235.
17 Chang BJ,Kim SH,Park HY,et al.Distinguishing xanthogranulomatous cholecystitis from the wall-thickening type of early-stage gallbladder cancer[J].Gut and Liver,2010,4:518-523.