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原发性胆囊癌的CT、MRI诊断价值

廖茜,汪俊萍,孙浩然,赵新   

  1. 天津医科大学总医院放射科
  • 收稿日期:2010-06-24 修回日期:2010-11-29 出版日期:2011-05-15 发布日期:2011-05-15
  • 通讯作者: 廖茜

Primary Gallbladder Carcinoma:Evaluation with Multi-spiral CT and MRI

  • Received:2010-06-24 Revised:2010-11-29 Published:2011-05-15 Online:2011-05-15
  • Contact: LIAO Qian

摘要: 目的:探讨胆囊癌的MSCT、MRI表现,提高胆囊癌的影像诊断水平。方法:回顾性分析30例经手术病理证实为胆囊癌的CT、MRI影像学资料,其中28例行CT检查,14例行MRI检查。分析原发病灶的直接征象和间接征象,并与大体病理进行对照。结果:胆囊壁不规则增厚、胆囊腔内结节和/或胆囊区肿块为胆囊癌的直接征象,其中厚壁型11例,腔内型10例,肿块型9例;增强检查后,增厚的胆囊壁、结节和/或肿块呈明显持续强化。其他表现包括:合并胆囊石23例;肝内外胆管扩张13例;肝脏直接受侵11例;累及胃和十二指肠分别为3例、5例;淋巴结转移16例;肝脏转移3例;上述征象MRI均能显示,4例肿大淋巴结于CT上难以判断,3例等密度胆囊石于CT上未检出。结论:CT及MRI能清楚地显示胆囊癌的原发灶,并能较准确地评价胆囊癌浸润程度及扩散范围,且MRI对胆囊石、区域淋巴结转移等间接征象的显示要优于CT。

关键词: 胆囊癌, 体层摄影术, X线计算机, 磁共振成像

Abstract: [Abstract] Objective: To investigate the imaging features of gallbladder carcinoma, and to elevate the ability of MSCT and MRI in diagnosis of gallbladder carcinoma. Methods: All imaging data of 30 patients confirmed by surgery and pathology were retrospectively analyzed. MSCT scans were performed in 28 patients, 14 patients accepted MRI examinations. The direct signs and indirect signs of primary gallbladder carcinoma lesions were evaluated.All images were compared with gross pathology. Results: Gallbladder carcinoma apeared at CT and MRI as irregular gallblader wall thickening, intraluminal nodules, and mass completely occupying or replacing the gallbladder lumen. 11of all were focal or diffuse asymmetric gallbladder wall thickening, 10 were intraluminal nodules, 9 were mass occupying or replacing the gallbladder lumen. Irregularly thickened gallblader wall, intraluminal nodules and/or mass were strongly enhanced after triple-phase enhanced scan.There were 23 cases with gallbladder stones, 13 with dilated intra/extrahepatic bile duct, 11 directly invading adjacent liver parenchyma, 3 involving the stomach and 5 involving duodenum, 16 with lymph node metastasis, 3 with liver metastasis, 5 with ascites. MRI could show all above-mentioned signs. It was difficult to judge the lymph nodes on CT in 4 cases. 3 cases with isodensity stones were not detected on CT. Conclusions: CT and MRI could clearly show the primary tumor, and accurately evaluate the extent and spread of invasion. However, MRI showed indirect signs, such as gallbladder stones and regional lymph node metastasis better than CT.

Key words: Gallbladder carcinoma, Tomography, X-ray computed, Meganetic resonance imaging