黄色肉芽肿性胆囊炎的螺旋CT表现

目的 探讨黄色肉芽肿性胆囊炎(XGC)的螺旋CT表现及其病理基础.资料与方法 回顾性分析经手术病理证实的16例XGC患者的CT和手术病理资料,着重观察胆囊壁的厚度、胆囊壁的强化方式、胆囊壁内低密度结节、胆囊内壁黏膜线、邻近肝脏组织受累情况,胆囊内有无结石,以及胆囊周围变化.结果 16例中均见不同程度的胆囊壁增厚及壁内低密度结节,12例胆囊增大,4例胆囊缩小,12例显示胆囊内完整黏膜线,11例伴有胆囊结石或胆总管结石,10例胆囊周围炎性浸润,4例累及肝脏,3例伴有胆管不同程度扩张.结论 胆囊壁增厚、增厚的胆囊壁内低密度结节和较完整的胆囊内壁黏膜线是诊断XGC较具特征性的表现.     

黄色肉芽肿性胆囊炎的CT诊断

目的 探讨黄色肉芽肿性胆囊炎的ＣＴ表现以及与手术、病理所见的关系。方法 分析了经ＣＴ诊断胶并经手术、病理证实的９例黄色肉芽肿性胆囊炎的ＣＴ、临床及手术病理资料。观察胆囊壁厚度、壁内低密度结节、粘膜线、胆囊壁强化程度以及胆囊内有无结石,同时胆囊周围的变化。结果 ９例均见不同程度的胆囊壁增厚及壁内结节,４例显示粘膜线,３例胆囊增大,３例缩小,６例发现胆囊结石,２例侵犯肝脏,３例胆囊周围炎性浸润,３例伴     

黄色肉芽肿性胆囊炎与厚壁型胆囊癌的螺旋CT鉴别诊断

目的 比较黄色肉芽肿性胆囊炎(XGC)和厚壁型胆囊癌(GBC)的螺旋CT特点,旨在提高两者鉴别诊断中的准确率.方法 搜集临床或病理确诊的22例XGC和25例GBC的临床和螺旋CT资料进行对照研究.结果 CT征象对照中,胆囊壁内低密度结节、胆囊壁内黏膜线完整情况以及胆道梗阻情况、淋巴结肿大等差异有显著统计学意义(P =0.000,0.002,0.010,0.031),而胆囊壁最大厚度,厚壁范围、强化方式、强化程度、邻近肝脏浸润、合并胆囊、胆管结石以及周围脂肪间隙清晰征象差异无显著统计学意义(P =0.826,0.595,0.820,0.064,0.798,0.062,0.110).结论 增厚的胆囊壁内低密度结节和完整的胆囊内壁黏膜线是诊断XGC较具特征性CT表现,胆囊壁内低密度结节具有很高的敏感性和准确度,有利于两者的鉴别.     

高场MRI定性、定量鉴别黄色肉芽肿性胆囊炎和厚壁型胆囊癌

目的 分析3.0T MRI在鉴别黄色肉芽肿性胆囊炎(XGC)和厚壁型胆囊癌(GBC)中的价值.方法 回顾性分析经病理证实的XGC和厚壁型GBC患者的临床资料和MRI特征.结果 共128例患者纳入本研究,其中,XGC 53例,厚壁型GBC 75例.XGC和厚壁型GBC的壁内结节分别为44例和3例.XGC和厚壁型GBC的平...     

黄色肉芽肿性胆囊炎的CT表现

目的：探讨CT诊断黄色肉芽肿性胆囊炎的价值。材料和方法：回顾性分析5例经手术病理证实的黄色肉芽肿性胆囊炎的CT表现。结果：术前1例诊断确诊，4例误诊。胆囊不同程度增大和胆囊壁增厚5例、壁内见不规则低密度灶4例、黏膜线完整3例、胆囊结石4例和肝脏局部性受侵3例。增强扫描动脉期示“夹心饼干征”3例和环形增强3例。结论：黄色肉芽肿性胆囊炎是特殊类型的胆囊炎，胆囊壁增厚及壁内低密度灶，增强扫描动脉期呈“夹心饼干征”和环形增强，均对黄色肉芽肿性胆囊炎的诊断有重要价值。     

关键CT征象对黄色肉芽肿性胆囊炎与胆囊癌的鉴别诊断效能研究

目的 探讨关键CT征象对鉴别黄色肉芽肿性胆囊炎(Xanthogranulomatous cholecystitis,XGC)与胆囊癌(Gallbladder carcinoma,GBCA)的诊断效能,为二者的鉴别诊断提供客观依据。方法 选取89例经组织病理学证实的XGC和GBCA患者的平扫+三期增强CT图像特征。统计方法通过Fisher精确检验、独立样本t检验分析,对差异有统计学意义的统计指标绘制受试者工作特征(receiver operating characteristic,ROC)曲线,分别评价各指标的诊断效能,以约登指数最大为原则确定ROC曲线下面积(area Undercurve,AUC)。结果 胆囊壁增厚类型、黏膜线连续性、壁内低密度结节、胆囊结石、邻近肝实质动脉期一过性强化差异有统计学意义(P <0.05),其敏感性与特异性、AUC值分别为:75.8%、70.4%、0.73; 72.7%、75.0%、0.74; 78.8%、76.8%、0.78; 69.7%、62.5%、0.66; 63.6%、65.3%、0.64;多因素逻辑回归分析显示,胆囊壁增厚类型、黏膜线连续...     

黄色肉芽肿性胆囊炎的影像学表现研究

目的 探讨超声造影对诊断黄色肉芽肿性胆囊炎(xanthogranulomatous cholecystitis,XGC)的价值.方法 选取术前行常规超声及超声造影检查的XGC 14例,同时行增强CT检查的9例,分析图像特点,总结其特征表现.结果14例病灶胆囊壁均增厚,13例伴囊腔内结石,1例伴胆总管结石.超声造影4例病...     

黄色肉芽肿性胆囊炎的特征性影像表现及文献复习

目的探讨黄色肉芽肿性胆囊炎(XGC)的特征性影像表现及诊断要点。方法分析1例XGC病人的增强CT表现及临床病理特征,并复习相关文献。结果 CT平扫及增强检查示胆囊轮廓毛糙,胆囊壁弥漫性增厚,腔内可见环形高密度影,与周围肝实质分界欠清,增强后胆囊壁呈明显分层样强化,邻近肝实质于动脉期呈一过性强化。病理诊断为黄色肉芽肿性胆囊炎。结论黄色肉芽肿性胆囊炎表现具有一定特征,包括胆囊壁增厚,胆囊壁呈"三明治"样或"夹心饼干"样强化、黏膜线多连续、胆囊壁内结节、胆囊或胆管结石等,有助于本病的诊断及鉴别诊断。     

黄色肉芽肿性胆囊炎影像学表现及其病理学基础

目的 探讨黄色肉芽肿性胆囊炎(XGC)的CT与MRI表现及其病理学基础.方法 回顾经手术及病理证实的27例XGC患者影像学资料,27例行CT检查,其中20例行MRI检查.分析CT及MRI影像学表现特征,并与病理结果对照分析.结果 胆囊扩大(CT 93％、MR90％),所有患者(100％)均有胆囊壁增厚.局限性增厚(CT 37％、MR 50％),广泛性增厚(CT 63％、MR 50％).增强扫描见增厚胆囊壁内多发低密度(或信号)结节(CT74％、MR 100％),壁内强化结节(CT 18.5％、MR 15％)胆囊结石(CT 74％、MR 100％).肝脏及胆囊间隙不清(CT74％、MRI90％),胆囊内见点状气体(CT7％ MRI 0％).增强扫描胆囊黏膜线连续(CT 44％、MRI 60％),中断(CT56％、MRI 40％),术前准确诊断XGC(CT 67％、MRI75％),误诊为胆囊癌(CT 26％、MRI 15％).结论 胆囊壁广泛或局限增厚,增强扫描增厚胆囊壁呈“三明治征”或“夹心饼干征”、囊壁内见强化和/或低密度(信号)结节,黏膜线连续或部分中断可能为XGC特征性CT及MRI表现,有助于该病的准确诊断.     

黄色肉芽肿性胆囊炎32例临床病理分析

目的探讨黄色肉芽肿性胆囊炎(XGC)临床病理特点。方法对1 426例腹腔镜切除胆囊标本中,经病理确诊的32例XGC结合文献做回顾性分析。结果32例XGC临床表现缺乏特异性。大体观察胆囊壁不同程度增厚,切面常见淡黄色大小不等的结节或斑块,有的有蒂呈息肉样隆起。镜下见胆囊壁的正常结构受到破坏,代之以特征性黄色肉芽肿性结构,由大量泡沫样细胞、急慢性炎细胞、成纤维细胞、异物巨细胞及Touton细胞等组成。结论XGC是一种良性而有破坏性的特殊类型胆囊炎,临床诊断困难,确诊有赖于病理诊断。     

Radiology-Pathology Conference: Xanthogranulomatous cholecystitis

We report the radiology and pathology of a patient with xanthogranulomatous cholecystitis (XC) and review the literature on this unusual condition.     

黄色肉芽肿性肾盂肾炎的CT诊断和鉴别诊断

目的 探讨黄色肉芽肿性肾盂肾炎（XGPN）的CT表现及其与肾癌和肾脓肿的鉴别诊断。材料与方法 XGPN 5例,肾癌15例,肾脓肿12例,前两组病例经手术病理证实,后一组经手术或临床资料证实。32例均于平归后再行增强扫描,回顾性分析三者的CT表现及其不同点。结果 （1）XGPN的CT表现为肾实质内的囊／囊实性占位,增强后实性部分强化;多合并结石（3例）和肾周受累（4例）;患肾不同程度功能减退（3例）。（2）3例XGPN和12例肾脓肿增强后边界清晰,呈缓慢强化;肾癌组9例边界清晰,增强早期一过性显著强化;XGPN和肾脓肿与肾癌的肾周受累有显著性差异;XGPN与脓肿的囊腔和囊性肾癌不同;4例肾癌（26％）有钙化,3例（20％）肾周有赘状突起／结节,6例（40％）有转移。结论 CT对XGPN的诊断和鉴别诊断有一定价值。     

脊索瘤的C T、MR I表现及其误诊分析

目的：探讨脊索瘤的CT、MRI表现及分析其误诊原因。方法回顾性分析18例脊索瘤 CT、MRI 图像,对术前诊断错误者进行影像分析及总结。结果术前12例诊断正确,6例误诊。颅底部9例,骶尾部8例,颈椎1例。CT与 MRI显示病灶呈圆形或类圆形12例,不规则形6例;14例边界清楚,4例边界不清。CT见膨胀性溶骨性骨质破坏,肿块呈不均匀等密度或稍低密度;9例病灶内或周边见点片状钙化或残存骨质。MRI示病灶呈等稍低T1 WI、高T2 WI信号;CT及 MRI增强后肿块呈不均匀轻中度强化。结论脊索瘤具有一定的CT、MRI特征,CT与 MRI结合对脊索瘤的定位、定量、定性诊断具有重要的价值。     

Xanthogranulomatous cholecystitis: Diagnostic performance of CT to differentiate from gallbladder cancer

Purpose

To retrospectively evaluate CT findings of xanthogranulomatous cholecystitis (XGC) and to measure diagnostic performance for distinguishing it from gallbladder (GB) cancer.

Methods and materials

Our institutional review board approved this retrospective study. Three blinded radiologists, first independently and then in consensus, retrospectively evaluated postcontrast CT images of 35 patients with histopathologically proved XGC and GB cancer, all of whom subsequently had cholecystectomy. These included 18 patients with XGC (13 male, 5 female; age range, 35-84, mean 63 years) and 17 with GB cancer (6 male, 11 female; age range, 45-95, mean 69). Differences in CT findings between XGC and GB cancer and diagnostic performances for each CT finding were calculated. Sensitivity, specificity, and accuracy were calculated for each radiologist and observer performance was also determined by receiver-operating-characteristic curve analysis.

Results

Five CT findings showed significant differences between XGC and GB cancer. Sensitivity, specificity, and accuracy of each finding for the differentiation of XGC were 89%, 65%, 77% with diffuse GB wall thickening, 67%, 82%, 74% with a continuous mucosal line, 61%, 71%, 66% with intra-mural hypo-attenuated nodules, 72%, 77%, 74% with absence of macroscopic hepatic invasion, and 67%, 71%, 69% with absence of intra-hepatic bile duct dilatation, respectively. When at least three of these five CT findings were observed in combination, sensitivity, specificity, and accuracy were 83%, 100% and 91%, respectively. Sensitivities, specificities and Az values for the differentiation of XGC from GB cancer were 83%, 88%, 0.94 for reader 1, 78%, 88%, 0.93 for reader 2, and 78%, 82%, 0.84 for reader 3.

Conclusions

The combination of three of the five CT findings that are common with XGC can provide excellent accuracy for the differentiation of XGC and GB cancer.     

CT and MR features of xanthogranulomatous cholecystitis: An analysis of consecutive 49 cases

Objective

To study the CT and MR features of xanthogranulomatous cholecystitis (XGC).

Materials and methods

49 patients had pathologically confirmed XGC. All patients underwent contrast enhanced CT, and 10 patients had additional plain MRI. The CT and MRI results were retrospectively analyzed.

Results

On CT, all patients had thickening of gallbladder wall, with 87.8% cases showed diffuse thickening. 85.7% cases had intramural hypo-attenuated nodules in the thickened wall. Continuous mucosal line and luminal surface enhancement were noted in 79.6% and 85.7% cases, respectively. Gallbladder stones were seen in 69.4% patients. The coexistence of the above 5 CT features was seen in 40% cases, and 80% cases had the coexistence of ≥4 features. Diffused gallbladder wall thickening in XGC is more likely to have disrupted mucosal line, and XGC with disrupted mucosal line is more likely to be associated with liver infiltration. In 60% patients the inflammatory process extended beyond gallbladder, with the interface between gallbladder and liver and/or the surrounding fat blurred. 40% cases had an early enhancement of liver parenchyma. Infiltration to other surrounding tissues included bowel (n = 3), stomach (n = 2), and abdominal wall (n = 1). On MR images, 7 of 9 intramural nodules in 7 subjects with T1-weighted dual echo MR images showed higher signal intensity on in-phase images than out-of-phase images.

Conclusion

Coexisting of diffuse gallbladder wall thickening, hypo-attenuated intramural nodules, continuous mucosal line, luminal surface enhancement, and gallbladder stone highly suggest XGC. XGC frequently infiltrate liver and surrounding fat. Chemical-shift MRI helps classifying intramural nodules in the gallbladder wall.     

肺肉瘤样癌的CT 诊断及误诊分析

目的：探讨肺肉瘤样癌的C T表现特征。方法回顾性分析14例经病理证实肺肉瘤样癌C T 资料,并与病理结果进行对照分析。结果14例中12例为单发,2例为多发,中央型4例,周围型10例,病变平扫呈软组织密度,12例呈不均匀强化,内部有囊变坏死区,10例患侧胸膜肥厚,免疫组织化学14例均表达CK （＋）,Vim （＋）。结论肺肉瘤样癌CT表现具有一定特征性,CT检查有助于肺肉瘤样癌的定位定性及明确肿瘤与周围组织结构的关系,为手术方案提供可靠的影像学依据。免疫组织化学CK和Vim对肺肉瘤样癌的诊断有决定性作用。     

甲状腺未分化癌的 CT 特点

目的：总结甲状腺未分化癌的 CT 特点。方法回顾性分析12例经手术或活检病理证实的甲状腺未分化癌的 CT 表现。结果单发病灶11例(91.7%),表现为低密度肿物伴条带状、絮状或斑片状高密度区。11例(91.7%)为轻~中度强化。8例(66.7%)可见粗大钙化灶,其中4例为不完整环状或蛋壳状钙化。11例(91.7%)侵犯周围结构：气管6例(50%),食管4例(33.3%),带状肌7例(58.3%),喉2例(16.7%),血管6例(50%)。5例(41.7%)出现颈内静脉瘤栓。10例(83.3%)病理证实淋巴结转移,强化形式为3种类型：较均匀轻度强化4例(40%)、轻度强化伴内部小片状低密度区7例(70%)、轻度环形强化伴内部无强化低密度区7例(70%)。结论甲状腺未分化癌的 CT 特点包括低密度肿物,内部或边缘絮状或斑片状高密度区,粗大钙化灶,轻度强化。常见侵犯周围结构及淋巴结坏死。     

胆囊癌CT误诊分析

目的　分析胆囊癌CT误诊原因 ,以提高诊断正确率。方法　搜集经手术病理证实的胆囊癌病例 43例 ,均行CT扫描 ,其中误诊 2 3例。与手术结果对照 ,分析误诊原因。结果　 2 3例误诊中 ,诊断为急慢性胆囊炎 5例 ,胆囊息肉 1例 ,肝门区胆管癌 2例 ,胆管癌 1例 ,胆总管下端、壶腹部占位 3例 ,胰头癌 5例 ,胆总管炎症 1例 ,梗阻性黄疸 2例 ,胆囊肿大 2例 ,结肠癌 1例。结论　明确胆囊癌的CT征象及其转移途径 ,可以避免误诊 ,提高诊断正确率。     

黄色肉芽肿性胆囊炎的CT表现

目的探讨CT对黄色肉芽肿性胆囊炎的诊断价值。方法回顾性分析4例经手术病理证实的黄色肉芽肿性胆囊炎的CT表现，分析其影像学特点。结果术前1例确诊，3例误诊。3例胆囊有不同程度的增大，4例胆囊壁均有增厚，壁厚在4—30mm之间，内均可见形态不规则的低密度灶。2例黏膜线完整，其中1例胆囊颈结石嵌顿，1例胆总管结石，1例胆囊内积气合并肝脏浸润。增强后动脉期的“夹心饼干征”2例，环形强化1例。结论增强后动脉期的“夹心饼干征”和环形强化，对黄色肉芽肿性胆囊炎的诊断有重要价值。