Objective To evaluate the diagnostic value of analyzing the pattern of gallbladder wall enhancement on MDCT to identify the different causes of acute cholecystitis.
Methods In January 2009 to December 2012, 169 patients diagnosed with acute cholecystitis caused by various pathologic conditions were performed MDCT scans, the images of portal venous phase and clinical data were retrospectively reviewed by two blinded radiologists. There were 146 cases in non-hepatopathy cholecystitis group and 23 cases in hepatopathy cholecystitis group. The other 5 normal gallbladder cases diagnosed by MDCT scans were retrospectively reviewed as contrast group. Using five patterns according to the enhancement pattern of flat gallbladder wall thickening on MDCT. The study cases were then divided into five patterns and the thickness of the mucous membrane were measured. The occurrence rate of each pattern and the thickness of the mucous membrane between the groups were compared respectively.
Results In the non-hepatopathy cholecystitis group, there were typeⅡin 102 cases (69.9%), typeⅢin 5 cases (3.4%), typeⅣ in 30 cases (20.5%), and typeⅤ in 9 cases (6.2%). In the hepatopathy cholecystitis group, there were typeⅡin 2 cases (8.7%), typeⅢ in 11 cases (47.9%), typeⅣin 5 cases (21.7%), and typeⅤin 5 cases (21.7%). The occurrence rate of typeⅡin the non-hepatopathy cholecystitis group was significialtly higher than that in the hepatopathy cholecystitis group (P<0.005). The occurrence rate of typeⅢ and typeⅤ in the hepatopathy cholecystitis group were significialtly higher than those in the non-hepatopathy cholecystitis group(P<0.005, P<0.05). The occurrence rate of type Ⅳ between the two groups had no significant difference (P>0.05). TypeⅠonly present in the contrast group. The non-hepatopathy group’s mean mucous membrane thickness was (2.61±1.30) mm , which was thicker than the hepatopathy group’s (2.02±0.52) mm(t=2.22, P<0.05).
Conclusion Analyzing the enhancement pattern of a thickened gallbladder wall on MDCT is helpful in identifying the causes of acute cholecystitis, and the gallbladder perforation or not.
Citation:
ZHAO Xin,ZHANG Hao,ZENG Honghui,LIU Dongxu,ZHANG Jian. Value of The Enhancement Pattern of Flat Gallbladder Wall Thickening on MDCT to Differentiate The Causes of Cholecystitis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2013, 20(7): 815-819. doi:
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Copyright © the editorial department of CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY of West China Medical Publisher. All rights reserved
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闫丽娟, 马苏关, 周怀琪, 等. 肝硬化胆囊壁的高频超声分型与门静脉主干及右支血流动力学的关系[J]. 中国医学影像技术, 2010, 26(3):525-528.
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邬颖华, 宋彬, 罗小华, 等. 肝病性胆囊改变与胆囊炎性改变的多排螺旋CT鉴别诊断[J]. 中国普外基础与临床杂志, 2005, 12(1): 82-86.
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邬颖华, 宋彬 , 冯泽华. 肝病性与非肝病性胆囊炎的CT 鉴别诊断[J]. 四川省卫生管理干部学院学报, 2008, 27(4):245-248.
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唐少珊, 黄丽萍, 刘守君, 等. 胆囊穿孔的超声表现[J]. 中国超声医学杂志, 2012, 28(12): 160-162.
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张甫政, 刘利. 胆囊穿孔的CT诊断及鉴别诊断(附12例分析)[J]. 实用医学影像杂志, 2012, 13(3):173-175.
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Kim PN, Lee KS, Kim IY, et al. Gallbladder perforation:comparison of US findings with CT[J]. Abdom Imaging, 1994, 19(3):239-242.
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Morris BS, Balpande PR, Morani AC, et al. The CT appearancesof gallbladder perforation[J]. Br J Radiol, 2007, 80(959):898-901.
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Kim SJ, Lee JM, Lee JY, et al. Analysis of enhancement patternof flat gallbladder wall thickening on MDCT to differentiate gallbladder cancer from cholecystitis[J]. AJR Am J Roentgenol, 2008, 191(9):765-771 .
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罗祖炎, 李博, 徐健, 等. 多排螺旋CT 对胆囊壁增厚病变的诊断价值[J]. 浙江医学, 2012, 34(9):674-677.
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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(4): 520-522.
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11. |
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(1):86-88.
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杜训松, 魏渝清. 厚壁型胆囊癌与慢性胆囊炎的CT鉴别诊断[J]. 临床放射学杂志, 2008, 27(10):1331-1334.
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13. |
余红胜, 沈又剁, 吉六舟, 等. 慢性胆囊炎与壁厚型胆囊癌的CT鉴别诊断[J]. 中国医学计算机成像杂志, 2012, 18(4):322-325.
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14. |
闫丽娟, 马苏美, 周怀琪. 非胆源性疾病胆囊壁双边影与低蛋白血症的关系[J]. 临床超声医学杂志, 2009, 11(11): 750-752.
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15. |
郑荣琴, 吕明德, 苏中振, 等. 超声评价肝脏炎症及纤维化程度的指标筛选[J]. 中国超声医学杂志, 2002, 18(1):20-22..
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张海英, 孟繁坤, 丁惠国. 慢性病毒性肝炎患者胆囊壁超声改变与肝组织病理关系的探讨[J]. 影像诊断与介入放射学, 2006, 15(6): 271-273 .
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程黎阳, 钟世镇, 李忠华. 肝硬化时胆囊壁增厚的机制及其临床意义[J]. 广东医学, 2002, 32(9):916-918.
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周康荣, 严福华, 曾蒙苏, 等. 腹部CT诊断学[M]. 上海: 复旦大学出版社, 2011:429-437.
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卢艳, 许学年, 冯正. 肝吸虫与肝胆疾病(综述)[J]. 国际医学寄生虫病杂志, 2007, 34(2): 107-112.
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纪建松, 邵初晓, 涂建飞, 等. 隐匿性胆囊穿孔的CT、MRI诊断[J]. 中华肝胆外科杂志, 2009, 15(5): 382-385.
|
21. |
石双任, 陈宏伟. 炎性胆囊改变与慢性肝病继发胆囊改变的CT鉴别诊断[J]. 临床误诊误治, 2011, 24(3):82-83.
|
22. |
蔡昌平, 代小思. 胆囊床内血管的应用解剖[J]. 中国临床解剖学杂志, 2005, 23(5): 451-453..
|
23. |
庄清武, 方冰儿. 肝硬化患者与胆囊壁厚度的关系[J]. 广东医学, 2006, 27(6): 890-891.
|
24. |
齐石, 李宏军, 赵大伟. 胆囊壁增厚与乙型肝炎后肝硬化相关因素研究[J]. 磁共振成像, 2011, 2(6):408-412.
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- 1. 闫丽娟, 马苏关, 周怀琪, 等. 肝硬化胆囊壁的高频超声分型与门静脉主干及右支血流动力学的关系[J]. 中国医学影像技术, 2010, 26(3):525-528.
- 2. 邬颖华, 宋彬, 罗小华, 等. 肝病性胆囊改变与胆囊炎性改变的多排螺旋CT鉴别诊断[J]. 中国普外基础与临床杂志, 2005, 12(1): 82-86.
- 3. 邬颖华, 宋彬 , 冯泽华. 肝病性与非肝病性胆囊炎的CT 鉴别诊断[J]. 四川省卫生管理干部学院学报, 2008, 27(4):245-248.
- 4. 唐少珊, 黄丽萍, 刘守君, 等. 胆囊穿孔的超声表现[J]. 中国超声医学杂志, 2012, 28(12): 160-162.
- 5. 张甫政, 刘利. 胆囊穿孔的CT诊断及鉴别诊断(附12例分析)[J]. 实用医学影像杂志, 2012, 13(3):173-175.
- 6. Kim PN, Lee KS, Kim IY, et al. Gallbladder perforation:comparison of US findings with CT[J]. Abdom Imaging, 1994, 19(3):239-242.
- 7. Morris BS, Balpande PR, Morani AC, et al. The CT appearancesof gallbladder perforation[J]. Br J Radiol, 2007, 80(959):898-901.
- 8. Kim SJ, Lee JM, Lee JY, et al. Analysis of enhancement patternof flat gallbladder wall thickening on MDCT to differentiate gallbladder cancer from cholecystitis[J]. AJR Am J Roentgenol, 2008, 191(9):765-771 .
- 9. 罗祖炎, 李博, 徐健, 等. 多排螺旋CT 对胆囊壁增厚病变的诊断价值[J]. 浙江医学, 2012, 34(9):674-677.
- 10. 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(4): 520-522.
- 11. 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(1):86-88.
- 12. 杜训松, 魏渝清. 厚壁型胆囊癌与慢性胆囊炎的CT鉴别诊断[J]. 临床放射学杂志, 2008, 27(10):1331-1334.
- 13. 余红胜, 沈又剁, 吉六舟, 等. 慢性胆囊炎与壁厚型胆囊癌的CT鉴别诊断[J]. 中国医学计算机成像杂志, 2012, 18(4):322-325.
- 14. 闫丽娟, 马苏美, 周怀琪. 非胆源性疾病胆囊壁双边影与低蛋白血症的关系[J]. 临床超声医学杂志, 2009, 11(11): 750-752.
- 15. 郑荣琴, 吕明德, 苏中振, 等. 超声评价肝脏炎症及纤维化程度的指标筛选[J]. 中国超声医学杂志, 2002, 18(1):20-22..
- 16. 张海英, 孟繁坤, 丁惠国. 慢性病毒性肝炎患者胆囊壁超声改变与肝组织病理关系的探讨[J]. 影像诊断与介入放射学, 2006, 15(6): 271-273 .
- 17. 程黎阳, 钟世镇, 李忠华. 肝硬化时胆囊壁增厚的机制及其临床意义[J]. 广东医学, 2002, 32(9):916-918.
- 18. 周康荣, 严福华, 曾蒙苏, 等. 腹部CT诊断学[M]. 上海: 复旦大学出版社, 2011:429-437.
- 19. 卢艳, 许学年, 冯正. 肝吸虫与肝胆疾病(综述)[J]. 国际医学寄生虫病杂志, 2007, 34(2): 107-112.
- 20. 纪建松, 邵初晓, 涂建飞, 等. 隐匿性胆囊穿孔的CT、MRI诊断[J]. 中华肝胆外科杂志, 2009, 15(5): 382-385.
- 21. 石双任, 陈宏伟. 炎性胆囊改变与慢性肝病继发胆囊改变的CT鉴别诊断[J]. 临床误诊误治, 2011, 24(3):82-83.
- 22. 蔡昌平, 代小思. 胆囊床内血管的应用解剖[J]. 中国临床解剖学杂志, 2005, 23(5): 451-453..
- 23. 庄清武, 方冰儿. 肝硬化患者与胆囊壁厚度的关系[J]. 广东医学, 2006, 27(6): 890-891.
- 24. 齐石, 李宏军, 赵大伟. 胆囊壁增厚与乙型肝炎后肝硬化相关因素研究[J]. 磁共振成像, 2011, 2(6):408-412.