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

doi:10.3877/cma.j.issn.2095-3232.2017.06.018

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。

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

Objective

To investigate the application value of multi-detector-row CT (MDCT) in differential diagnosis of cholecystitis and gallbladder abnormal changes caused by liver parenchymal diseases.

Methods

Clinical data of 84 patients with gallbladder abnormal changes detected by MDCT enhancement examination in Hainan Provincial Nongken General Hospital between November 2014 and October 2015 were analyzed retrospectively. The informed consents of all patients were obtained and the local ethical committee approval was received. All patients were divided into cholecystitis group and liver disease group according to the CT diagnostic results. There were 32 patients in cholecystitis group, 16 males and 16 females, with an average age of (46±3) years old, and 52 in liver disease group, 33 males and 19 females, with an average age of (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 and gallbladder abnormal changes caused by liver parenchymal diseases. Thickness of cyst wall in both groups was compared by t test and the rate was compared by Chi-square test or Fisher's exact test.

Results

Thickness of cyst wall in cholecystitis group was (4.5±0.5) mm, which was significantly longer than (3.7±0.4) mm in liver disease group (t=9.010, P<0.05). Enhancement rate of cyst wall, bile density increase rate and transient enhancement rate of adjacent liver tissues in cholecystitis group was respectively 100%, 31% and 19%, significantly higher than 75%, 6% and 0 in liver disease group (χ²=9.465, 9.832, -; P<0.05). The incidence of fuzzy contour gallbladder and gallbladder surrounding effusion was respectively 91% and 9% in cholecystitis group, while 75% and 29% 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 in cholecystitis group, while mostly distributing around the gallbladder without flowing in liver disease group.

Conclusions

MDCT can help to differentiate cholecystitis from gallbladder abnormal changes caused by liver parenchymal diseases.

Key words: Tomography, spiral computed, Cholecystitis, Liver cirrhosis, Hepatitis, chronic, Carcinoma, hepatocellular, Diagnosis, differential

图1 胆囊炎组患者胆囊多层螺旋CT表现

图2 肝病组患者胆囊多层螺旋CT表现

表1 胆囊炎组和肝病组胆囊改变在多层螺旋CT中的不同征象比较

组别	例数	囊壁厚径（mm，±s）	囊壁强化（例）		胆囊轮廓模糊（例）		胆汁密度升高（例）		邻近肝组织一过性强化（例）		胆囊周围积液（例）
组别	例数	囊壁厚径（mm，±s）	无	有	无	有	无	有	无	有	无	有
胆囊炎组	32	4.5±0.5	00	32	03	29	22	10	26	6	29	03
肝病组	52	3.7±0.4	13	39	39	13	49	03	00	0	37	15
统计值	?	t=9.010	χ²=9.465		χ²=34.125		χ²=9.832		-		χ²=4.461
P值	?	<0.001	0.002		<0.001		0.002		0.001		0.035

表1 胆囊炎组和肝病组胆囊改变在多层螺旋CT中的不同征象比较

组别	例数	囊壁厚径（mm，±s）	囊壁强化（例）		胆囊轮廓模糊（例）		胆汁密度升高（例）		邻近肝组织一过性强化（例）		胆囊周围积液（例）
组别	例数	囊壁厚径（mm，±s）	无	有	无	有	无	有	无	有	无	有
胆囊炎组	32	4.5±0.5	00	32	03	29	22	10	26	6	29	03
肝病组	52	3.7±0.4	13	39	39	13	49	03	00	0	37	15
统计值	?	t=9.010	χ²=9.465		χ²=34.125		χ²=9.832		-		χ²=4.461
P值	?	<0.001	0.002		<0.001		0.002		0.001		0.035

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

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