原发性胆囊癌的CT诊断(附56例报告)

目的：研究胆囊癌的CT诊断。资料和方法：对照病理回顾分析56例胆囊癌的CT表现。结果:胆囊壁不规则增厚32％；胆囊腔内结节21％；胆囊区肿块46％；肝侵犯52％；胆管扩张53％；胆结石27％；淋巴转移34％。结论：1、胆囊癌CT分型为厚壁型、腔内结节型、肿块型，各型为病理发展中不同的阶段。2、直接侵犯肝脏及胆管受侵扩散为胆囊癌主要转移方式。3、CT对诊断中晚期胆囊癌及判断浸润范围有价值，尤其是增强扫描。     

原发性胆囊癌16例CT诊断分析

目的探讨CT在原发性胆囊癌诊断中的价值。方法回顾性分析16例经手术病理证实的原发性胆囊癌CT特征性表现。结果根据原发性胆囊癌的CT表现,分为肿块型、腔内结节型、壁厚型,其中肿块型最多。结论 CT是诊断原发性胆囊癌的有效方法,对原发性胆囊癌的诊断及鉴别诊断具有重要价值。     

原发性胆囊癌的CT诊断

研究胆囊癌的ＣＴ诊断。对照病理回顾分析５６例胆囊癌的ＣＴ表现。结果；胆囊壁不规则增厚３２％；胆囊腔内结节２１％；胆囊区肿块４６％；肝侵犯５２％，胆管扩张５３％；胆结石２７％；淋巴转移３４％。结论：１，胆囊癌ＣＴ分型为厚壁型，腔内结节型，肿块型，各型为病理发展中不同的阶段。２．直接侵犯肝脏及胆管受侵扩散为胆囊癌主要转移方式。３，ＣＴ对诊断中晚期胆囊癌衣判断浸润范围有价格，尤其是增强扫描。     

螺旋CT在胆囊癌诊断中的价值

目的提高螺旋CT对胆囊癌的诊断率，减少误诊和漏诊。方法搜集38例胆囊癌患者的临床、病理及影像资料，着重观察其原发灶的CT表现。结果38例胆囊癌术前CT确诊31例，误诊7例。其原发灶CT表现为3种类型：胆囊窝肿块型、胆囊壁增厚型和胆囊腔内结节型。增强后扫描病灶均匀或不均匀强化，强化效应明显。结论螺旋CT扫描可较清楚地显示原发灶及其对邻近组织的侵犯和转移，增强扫描原发灶显著强化是其特征性表现。螺旋CT扫描，特别是增强扫描可以为临床提供重要的诊断和治疗依据。     

原发性胆囊癌与慢性化脓性胆囊炎的CT鉴别诊断

目的:探讨原发性胆囊与慢性化脓性胆囊炎的CT诊断及鉴别诊断。材料与方法:回顾性分析29例胆囊癌及12例慢性化脓性胆囊炎的临床表现及CT资料。结果:两组病例临床表现类似。CT显示胆囊癌的胆囊壁增厚6例,突入胆囊腔内肿块16例及肿块占据整个肿囊7例。肝内胆管扩张18例。病灶均有轻度至中度强化。慢性胆囊炎均表现胆囊增大,壁增厚;5例壁内存在低密度区;增强后明显强化。肝内胆管扩张1例。结论:CT显示胆囊癌主要表现为局部肿块及肝内胆管扩张;胆囊炎表现为胆囊壁增厚、边缘模糊,尤其CT可以发现壁内低密度小脓肿。     

超声诊断原发性胆囊癌易误诊的原因

目的:探究超声诊断原发性胆囊癌易发生误诊的主要因素。材料与方法:采用回顾性分析的方法,本文就30例原发性胆囊癌患者的声像图表现及其误诊原因进行研究分析,所有患者在手术前均行超声检查,并经过手术与病理学的证实,结果:经过超声诊断以及病理学证实,可以发现这30例患者超声诊断检出原发性胆囊癌的为24例,符合率为80%,检出的胆囊的肿块声像图可分为四种类型,(1)弥漫性囊壁增厚型为3例,胆囊壁呈弥漫性不规则实性低回声增厚,胆囊体积缩小;(2)局限性囊壁增厚型7例,多位于胆囊颈部和体部,不规则增厚常局限于一段胆囊壁,厚度常超过4mm;(3)乳头状结节型9例,多见于胆囊颈部,早期肿块呈等回声或不均匀回声,为宽基底自胆囊壁凸向囊腔,当肿块增大时,形态不规则,内部回声多不均匀。(4)实性团块型5例,多见于胆囊颈部的实性团块病变,呈低或等回声,此型可直接沿胆囊壁蔓延,堵塞胆囊颈部及胆囊管致胆汁排泄不畅,胆囊体积增大;本组误诊6例,误诊率为20%。误诊原因主要有病变隐匿、长期胆囊炎合并结石、结石干扰判断以及肿块生于颈部等。结论:对原发性胆囊癌患者给予超声诊断具有一定的安全性,能够降低患者的痛苦,超声医师需增强对原发性胆囊癌的认识,仔细观察声像,降低误诊率,为原发性胆囊癌的早期诊断与治疗争取时机。     

厚壁型胆囊癌与慢性胆囊炎CT鉴别诊断

目的：着重探讨CT对厚壁型胆囊癌与慢性胆囊炎的鉴别诊断价值。材料和方法：回顾性分析15例厚壁型胆囊癌和30例慢性胆囊炎的CT表现特征，并作鉴别诊断。结果：①厚壁型胆囊癌15例中，CT显示为胆囊肿大且壁不均增厚9例（33．3％），胆囊壁僵硬且边界不清8例（53．3％），胆囊壁连续性中断5例（33．3％），胆囊壁均匀强化13例（86．0％），肝门淋巴结肿大5例（33．3％），②慢性胆囊炎30例中，CT显示胆囊壁均匀增厚5例（16．7％），胆囊边缘模糊不清25例（83．3％），胆囊壁轻度强化30例（100．0％），胆囊周围积液、积气4例（13．0％），胆囊炎合并结石9例（30．0％）。结论：螺旋CT双期增强扫描在显示厚壁型胆囊癌与慢性胆囊炎CT表现特征及其鉴别诊断上，具有重要价值。     

螺旋CT增强扫描在胆囊癌诊断中的价值

目的探讨螺旋CT多期增强扫描在胆囊癌诊断中的作用。方法对23例经病理证实的胆囊癌患者的多期螺旋CT表现进行回顾性分析。结果胆囊癌主要CT表现为胆囊壁的不规则增厚和结节状突起以及胆囊内的肿块，增强扫描强化明显且持续时间长。结论螺旋CT多期增强扫描在胆囊癌的定性诊断及了解胆囊癌的侵犯范围上具有重要作用。     

原发性胆囊癌MRI误诊分析

目的分析MIu误诊的原发性胆囊癌影像表现,以期提高MRJ对原发性胆囊癌诊断的准确性。方法回顾性分析2010年1月-2013年3月15例术前MRI误诊为其他疾病而经手术病理证实的原发性胆囊癌的MRj影像学表现,分析其胆囊壁病灶部位、增强扫描强化方式、胆管扩张及是否伴有胆囊结石等特点。结果5例误诊为肝门部占位伴肝内胆管扩张,7例肝内外胆管扩张者误诊为胆管内肿瘤及炎性狭窄,2例诊断肝右叶占位而胆囊病变误诊为胆囊息肉,1例误诊为结石性胆囊炎。回顾性分析发现12例有胆囊壁增厚（其中局限性增厚9例,弥漫性增厚3例）;增强扫描15例胆囊壁均有不同程度强化,11例动脉期有延迟强化特征;8例患者合并胆囊结石;2例出现胆囊壁结节。结论原发性胆囊癌容易引起肝内、外胆管扩张,胆囊癌可表现为局限性或弥漫性囊壁增厚,常伴有胆囊结石等,MRI诊断时需引起充分注意。     

CT在黄色肉芽肿性胆囊炎诊断中的价值

目的：评价CT对黄色肉芽肿性胆囊炎（XGC）的诊断及与壁厚型胆囊癌鉴别诊断的价值。方法：测量13例XGC与19例壁厚型胆囊癌的胆囊壁最大厚度，并对其以下CT征象进行分析：①胆囊壁间低密度结节或低密度带，②黏膜线，③胆囊内壁改变情况，④肝内浸润，⑤肝内胆管扩张，⑥腹膜后淋巴结肿大。结果：13例XGC平均壁厚（24.7±16.0）mm，10例病灶区出现低密度结节或低密度带，8例存在黏膜线，8例病变处胆囊内壁光整，5例出现肝内浸润，1例出现肝内段胆管扩张，均无腹膜后淋巴结肿大；而19胆囊癌平均壁厚（18.3±8.6）mm，6例病灶区出现低密度结节或低密度带，该6例且均存在黏膜线，8例病变处胆囊内壁光整，7例出现肝浸润，12例出现肝内段胆管扩张，4例腹膜后淋巴结肿大。结论：增厚的胆囊壁间出现低密度结节或低密度带，肝内胆管无扩张，是XGC诊断与鉴别诊断的关键CT征象。     

胆囊癌的临床分期和CT诊断

目的:探讨螺旋CT对原发性胆囊癌临床分期的诊断价值。方法:搜集经手术病理证实的胆囊癌患者32例,回顾性分析其术前CT资料。结果:32例胆囊癌中腔内型5例,壁厚型17例,肿块型10例。腔内型属于胆囊癌的较早期表现,预后较好;厚壁型和肿块型属于胆囊癌的中晚期表现,伴局部或邻近组织器官浸润,血行及淋巴结转移。结论:胆囊癌为胆道系统常见的恶性肿瘤,CT检查能准确描述其病变范围和特征,评价其分期为临床手术治疗提供帮助。     

Carcinoma of the gallbladder: CT findings in 50 cases

Fifty patients with histologically proven carcinoma of the gallbladder were examined by computed tomography (CT). The gallbladder masses were categorized into two broad groups: group 1 (74%) included patients in whom the gallbladder was identified along with a mass lesion; and group 2 (26%), where a large mass was present in the gallbladder fossa with no identifiable gallbladder. Group 1 was further divided into three types according to the nature of the tumor: Type 1, mass almost filling the entire gallbladder lumen; Type 2, a polypoidal mass projecting into the lumen; type 3, an infiltrating tumor seen as focal or diffuse wall thickening. Liver involvement, in the form of localized invasion in the vicinity of the primary gallbladder malignancy, was the most common associated finding (80%). Other ancillary features included presence of calculi, lymphadenopathy, and biliary obstruction. CT was found useful for characterizing and defining the extent of carcinoma of the gallbladder. However, it may not consistently demonstrate involvement of the gastrointestinal tract, omentum, and abdominal wall. CT can also be used for aspiration/biopsy guidance of the gallbladder mass in selected cases.     

胆囊癌的CT诊断

目的:探讨CT对胆囊癌的诊断价值。材料与方法:回顾性分析了29例经病理证实的CT表现。3例作了CT随访。结果:肿块型11例、腔内型8例、厚壁型10例,增强后肿瘤明显强化,密度不均匀;肝脏直接受侵20例、肝转移7例、胆管扩张8例、淋巴结转移10例及静脉瘤栓3例,10例合并胆囊结石。结论:CT能很好地显示胆囊癌的大小、形态、分型及扩散范围,对临床治疗有较大的帮助。     

Carcinoma of the gallbladder associated with clonorchiasis: clinicopathologic and CT evaluation

BACKGROUND: The computed tomographic (CT) features of three cases with pathologically proven adenocarcinoma of the gallbladder associated with clonorchiasis. METHODS: CT scans of three cases with pathologically proven adenocarcinoma of the gallbladder associated with clonorchiasis were retrospectively reviewed. Scans were analyzed for the following parameters: (a) gross morphologic pattern (intralumenal mass lesion, mass replacing the gallbladder, focal or diffuse wall thickening); (b) contrast enhancement of the tumors; (c) associated gallstones or Chlonorchis sinensis worms; (d) direct invasion into the liver; (e) metastasis to adjacent viscera (pancreas, duodenum); (f) the extrahepatic bile duct (dilatation, metastasis, stone, C. sinensis worms); (g) the intrahepatic bile duct (dilatation); and (h) lymphadenopathy and metastasis. RESULTS: The gross morphologic pattern of three cases with carcinoma of the gallbladder was an intralumenal mass lesion (the least common type), whereas the patterns of infiltration and a mass replacing the gallbladder were not identified. Mild contrast enhancement of the tumors relative to the liver was demonstrated in all patients. Gallstones and C. sinensis worms were not visualized in the gallbladder and the extrahepatic bile duct. An unusual metastasis to the distal common bile duct and the pancreas was found in this series. CONCLUSION: Three cases with adenocarcinoma of the gallbladder associated with clonorchiasis showed intralumenal mass lesions within the gallbladder lumen. The cause-and-effect relation between clonorchiasis and gallbladder carcinoma is discussed.     

原发性胆囊癌的超声诊断及漏误诊分析

目的分析原发性胆囊癌的超声特点及误诊原因,提高超声对胆囊癌的诊断正确率。方法回顾性分析26例经手术和病理证实的胆囊癌的超声资料,分析胆囊癌超声表现及误诊为胆囊其他疾病的胆囊癌的超声影像学特点。结果26例胆囊癌中超声诊断18例（69．2％）,漏误诊8例（30．8％）。胆囊癌的超声影像学表现分成4种类型：①囊壁局部或弥漫性增厚型11例（42．3％）;②肿块型6例（23．1％）;③乳头结节型8例（30．8％）;（9胆囊增大型1例（3．8％）。结论原发性胆囊癌超声表现多样化,易诊断为胆囊其他疾病,细致观察胆囊声像图,综合应用二维超声与彩色多普勒超声检查,有助于提高对早期诊断胆囊癌的诊断率。     

超声造影在胆囊癌诊断中的应用价值

目的 探讨超声造影对胆囊癌的诊断价值.方法 回顾分析经手术病理证实的24例胆囊癌的超声造影表现.结果 胆囊癌的超声造影具有一定的强化特点,24例胆囊癌均可见造影增强,病灶较常规超声显影清晰,采用时间-强度曲线分析可以发现病变部位曲线上升支较为陡直,病变峰值强度高于同水平面上相邻肝组织.10例厚壁型胆囊癌中9例胆囊壁快速明显强化,1例胆囊壁在整个造影过程中呈弱增强,增厚的胆囊壁内可见增粗扭曲的血管;8例肿块型胆囊癌快速整体不均匀增强;6例结节型胆囊癌结节内可见造影剂快速进入,不均匀增强.5例胆囊癌伴肝转移造影后检出更多的转移病灶.结论 超声造影强化特征对胆囊癌的诊断有重要的价值,有助于提高胆囊癌的诊断水平.     

胆囊癌肝侵犯的CT诊断及临床价值

目的：探讨胆囊癌肝侵犯的CT诊断及临床价值。方法：回顾性分析经手术、病理证实的17例胆囊癌肝侵犯CT资料。结果：肿块型11例,腔内型2例,厚壁型4例。侵犯肝左内叶5例,肝右叶前段3例,同时侵犯肝左内叶及右叶前段9例。5例侵犯深度〈2cm,12例侵犯深度〉2cm。CT表现为胆囊窝脂肪间隙消失,邻近胆囊窝的肝脏组织内出现不规则形低密度影,边界模糊,胆囊癌肿与肝脏组织分界不清,增强后肝内病灶不规则强化。结论：CT对胆囊癌肝侵犯的诊断及I临床分期、治疗方案的选择具有重要价值。     

Gallbladder carcinoma and chronic cholecystitis: differentiation with two-phase spiral CT

The objective of the present study was to determine whether an analysis of two-phase spiral computed tomographic (CT) features provides a sound basis for the differential diagnosis between gallbladder carcinoma and chronic cholecystitis. Eighty-two patients, 35 with gallbladder carcinoma and 47 with chronic cholecystitis, underwent two-phase spiral CT. We reviewed the two-phase spiral CT features of thickness and enhancement pattern of the gallbladder wall seen during the arterial and venous phases. Mean wall thicknesses were 12.6 mm in the gallbladder carcinoma group and 6.9 mm in the chronic cholecystitis group. The common enhancement patterns seen in gallbladder carcinoma were (a) a highly enhanced thick inner wall layer during the arterial phase that showed isoattenuation with the adjacent hepatic parenchyma during the venous phase (16 of 35, 45.7%) and (b) a highly enhanced thick inner wall layer during both phases (eight of 35, 22.9%). The most common enhancement pattern of chronic cholecystitis was isoattenuation of the thin inner wall layer during both phases (42 of 47, 89.4%). In conclusion, awareness of the wall thickening and enhancement patterns in gallbladder carcinoma and chronic cholecystitis on two-phase spiral CT appears to be valuable in differentiating these two different disease entities.