胆囊脏面穿孔CT与MRI的表现特征

目的探讨胆囊脏面穿孔CT与MRI表现特征。资料与方法回顾性分析16例经手术病理证实或经多种影像检查确诊的胆囊脏面穿孔患者的多层螺旋CT(MDCT)与MRI表现,并结合临床情况进行综合分析。结果胆囊脏面穿孔的CT与MRI表现包括胆囊壁异常、胆囊脏面穿孔所致肝脏异常和胆囊周围及右上腹腔异常。胆囊壁异常包括胆囊壁局部缺损或突出正常轮廓外,壁呈分层状。肝脏异常表现为肝脓肿或胆汁瘤形成,胆囊床周围肝实质动脉期异常强化。胆囊周围及上腹腔异常包括胆囊窝及右上腹腔包裹性积液,胃窦、十二指肠、结肠肝曲、右半横结肠壁及邻近肠系膜肿胀。结论MDCT和MRI能够准确、全面地反映胆囊脏面穿孔的大体病理特征、累及范围和程度,为准确诊断和选择合理的治疗方案提供可靠的影像学信息。     

穿孔性阑尾炎与非穿孔性阑尾炎的CT鉴别诊断

目的:评价多排螺旋CT对穿孔性与非穿孔性阑尾炎的鉴别诊断价值.方法:搜集手术及病理证实的急性阑尾炎151例,并按照手术及病理结果分为穿孔组(66例)和非穿孔组(85例),总结分析其CT表现,并比较穿孔性与非穿孔性阑尾炎的CT表现.结果:阑尾腔外粪石、阑尾腔外气体、阑尾周围脓肿、阑尾壁局限性强化缺损对诊断阑尾炎穿孔有很高的特异性(P＜0.05),为诊断阑尾炎穿孔的特异性征象;阑尾周围炎、盆腔炎改变在穿孔组发现频率也明显高于非穿孔组(P＜0.05),穿孔组阑尾直径明显大于非穿孔组(P＜0.05),对诊断阑尾炎穿孔有一定价值;阑尾位置、阑尾腔内粪石、阑尾腔内气体、阑尾周围淋巴结肿大在两组中无明显差异(P＞0.05).结论:CT是诊断穿孔性阑尾炎有效、快速的方法,其中阑尾腔外粪石、阑尾腔外气体、阑尾壁局限性强化缺损、阑尾周围脓肿为诊断穿孔性阑尾炎较为特异的CT征象,阑尾周围炎、盆腔炎改变、阑尾直径增大对于诊断阑尾炎穿孔有一定价值.     

增强MSCT对胆囊穿孔的诊断价值

目的探讨术前增强MSCT对胆囊穿孔的诊断价值。方法回顾性分析25例经手术或穿刺确诊为胆囊穿孔患者的术前增强MSCT图像,总结其各种影像学表现。结果术前腹部增强MSCT横断位直接清晰显示胆囊壁局部薄弱、连续性中断11例(44%),2例经冠状位重建后清晰显示破裂口,另1例胆囊内及壁外多发气肿,2例胆囊内及壁外、膈下见气液平面,提示胆囊穿孔;2例胆囊壁不规则,局部模糊不清,肝周包裹性积液或腹腔大量积液,怀疑胆囊穿孔。胆囊体积增大13例,胆囊萎缩5例;合并有胆囊结石11例,无胆囊结石14例;弥漫性腹膜炎16例,胆囊窝积液18例,肝包膜下包裹性积液4例,肝实质受累7例,形成肝脓肿2例,胆囊十二指肠瘘3例,小肠梗阻4例。故术前增强MSCT明确诊断胆囊穿孔16例(64%),可疑诊断2例,未能在术前作出诊断7例。结论胆囊穿孔的影像学表现多种多样,增强MSCT可显示其各种直接及间接征象,对胆囊穿孔有明确诊断及重要的提示作用。     

胆囊癌的CT诊断及鉴别诊断(附33例报道)

目的:探讨胆囊癌的CT表现及鉴别诊断.方法:33例经手术病理证实的胆囊癌,对其CT表现进行观察分析.结果:胆囊癌以老年女性多见,临床表现为黄疸及腹部肿块、纳差.CT表现:胆囊区肿块,密度不均,胆囊腔缩小或消失;胆囊壁增厚,呈局限性或弥漫性不规则增厚;胆囊腔内软组织块影;合并胆结石;肝内外胆管扩张;肝脏直接受侵范;肝脏转移,侵犯腹壁,合并腹水.增强扫描可见病灶中度及明显强化.病灶周围及邻近器官侵犯、淋巴结转移更有助于诊断.结论:仔细观察胆囊及其周围结构、邻近器官改变,旨在提高胆囊癌的诊断正确率.     

胆囊癌18例CT诊断分析

目的探讨胆囊癌的CT表现,旨在提高胆囊癌的诊断水平。方法回顾性分析经病理证实的18例胆囊癌的CT表现。结果胆囊壁增厚型3例,腔内结节型6例,肿块型9例,合并肝脏及其他脏器受侵、肝脏及淋巴结转移、肝内外胆管扩张、胆囊结石等间接征象。结论 CT在胆囊癌的诊断与鉴别诊断中有重要的作用,但存在一定的局限性;细心分析胆囊及其周围的结构、器官的改变,有助提高胆囊癌的CT诊断水平。     

胆囊穿孔的MRI表现

目的：通过对胆囊穿孔的MRI表现进行分析,提高对该病的认识。方法：回顾性分析15例经手术证实的胆囊穿孔的MRI图像,总结其MRI征象。结果：胆囊穿孔最常见的MRI直接征象为胆囊壁连续性局部中断,胆囊壁的不规则增厚;主要的间接征象为穿孔处、胆囊周围积液与脓肿形成,以及T₂WI、DWI的异常高信号。结论：MRI对胆囊穿孔的诊断及显示邻近组织的受累有明显优势,能为临床诊断及手术治疗提供影像学依据。     

螺旋CT等诊断急性坏疽性胆囊炎并发亚急性胆囊穿孔价值研究

目的：探讨螺旋CT联合超敏C反应蛋白对急性坏疽性胆囊炎并发亚急性胆囊穿孔的诊断价值。方法：对经病理学检查确诊为急性坏疽性胆囊炎并发亚急性胆囊穿孔38例的CT表现和超敏C反应蛋白水平进行回顾性分析。结果：螺旋CT联合超敏c反应蛋白术前诊断为亚急性胆囊穿孔32例,诊断准确度为84．2％。急性坏疽性胆囊炎并亚急性胆囊穿孔CT表现初期为胆囊体积增大,胆囊壁增厚,部分可见双边征,胆囊内胆汁密度升高,胆囊周围筋膜反应性增厚;后期为胆囊体积减小,胆囊壁局部缺损,胆囊周围脓肿形成,少量胆囊周围积气、腹腔积气,少量腹腔积液等。超敏c反应蛋白表现为,初期显著升高（最高者〉39mg／L）;后期升高幅度显著降低（均〈18mg／L）。结论：螺旋CT联合超敏C反应蛋白诊断急性坏疽性胆囊炎并发亚急性胆囊穿孔诊断准确度较高。     

黄色肉芽肿性胆囊炎多层螺旋CT表现及误诊分析

目的 探讨黄色肉芽肿性胆囊炎(XGC)的多层螺旋CT表现,以期提高XGC的诊断水平.方法 收集经手术病理证实的38例XGC病例,回顾性分析其CT影像表现,观察胆囊壁的厚度及范围、胆囊壁内有无低密度结节、胆囊内壁黏膜线连续性、胆道系统有无结石、胆管梗阻情况、邻近组织受累情况.结果 38例均有胆囊壁增厚,其中弥漫性增厚36例,局限性增厚2例.17例可见胆囊壁内低密度结节或低密度带,21例胆囊壁未见明显低密度结节.32例显示完整黏膜线,6例显示黏膜线中断.33例胆道系统结石,5例胆道系统内未见阳性结石.8例合并肝内外胆管扩张,2例仅有胆总管扩张.累及肝脏10例,累及胃肠道10例,累及胆总管1例,余病例与周围组织未见明显粘连.CT误诊19例,其中术前诊断胆囊癌8例,慢性胆囊炎11例.结论 XGC的CT增强扫描增厚的胆囊壁内低密度结节或低密度带在其诊断和鉴别诊断中有重要的价值.     

螺旋CT对急性阑尾炎的诊断价值

目的：探讨螺旋CT对急性阑尾炎的诊断价值。方法：搜集CT提示或诊断为阑尾炎并经手术病理证实的34例患者，回顾性分析其CT征象。结果：15例CT表现为阑尾增粗，壁增厚；26例表现为右下腹或盆腔炎性改变（如周围脂肪密度增高、肠周积液、蜂窝织炎、脓肿、腔外气体、淋巴结肿大、相邻肠管增厚、阑尾结石或粪石）；6例盲肠末端有局限性增厚；4例右侧腰大肌影模糊。结论：CT诊断急性阑尾炎有独到之处，能为临床合理治疗提供帮助。     

螺旋CT在消化道穿孔中的诊断价值

目的：分析CT在消化道穿孔中的诊断价值。方法回顾性分析51例经手术证实的消化道穿孔病例,术前行立位腹部平片检查者41例,腹部CT扫描者51例,比较两种检查方法在消化道穿孔中的诊断价值。结果41例X线片检出游离气体26例,CT检出50例,CT检出率高于普通X线检查（P＜0．05）。CT显示腹内游离气体呈新月状或小气泡影（50例）,胃肠穿孔处周围局限性积液或蜂窝织炎（34例）,阑尾周围脓肿（3例）,肠梗阻（5例）,胃肠壁增厚（25例）,胃肠壁肿块（2例）,胃肠壁缺损（4例）,腹水（30例）。CT对穿孔病因的诊断符合率为68．6％（35/51）,对穿孔部位的诊断符合率为88．2％（45/51）。结论螺旋CT诊断胃肠道穿孔是一种有效的检查方法,且对穿孔部位和病因的诊断也具有重要价值。     

胃肠道穿孔的CT诊断

目的:分析胃肠道穿孔的CT征象,提高CT对胃肠道穿孔诊断的准确性。方法:分析53例经手术病理证实为胃肠道穿孔的CT征象。对有无腹腔游离气体、腹腔积液、腹膜炎及胃肠道壁的改变进行观察、分析。结果:53例胃肠道穿孔的主要CT征象:腹腔内游离气体(71.7%),腹腔积液(84.9%),腹膜炎改变(60.3%),脓肿(7.5%),胃肠道壁的改变(56.6%)。53例中,CT诊断为胃肠道穿孔48例(90.6%),对穿孔部位的诊断符合率为67.9%,对穿孔病因诊断符合率为58.4%。结论:CT平扫能清晰显示胃肠道穿孔的主要征象,结合临床综合分析,有助于提高CT诊断胃肠道穿孔的准确性,包括穿孔部位和病因的诊断。     

Personal experience in 71 consecutive patients with acute cholecystitis

PURPOSE: Acute cholecystitis is one of the most frequent abdominal inflammatory processes. If untreated or misdiagnosed it can result in severe complications such as gallbladder rupture, abscesses, or peritonitis. We retrospectively reviewed a series of 71 consecutive patients with surgical confirmation of acute cholecystitis and now compare the results of the diagnostic techniques we used preoperatively. MATERIAL AND METHODS: Over 16 months, 71 consecutive patients (42 women and 29 men; age range: 34-84 years, mean: 58) with acute abdominal pain were operated on for acute cholecystitis at Cardarelli Hospital, Naples. Abdominal plain film was performed in 65 of 71 cases, abdominal US in 69 and abdominal CT in 6. On abdominal plain films, we retrospectively searched the following signs: densities projected over the gallbladder, linear calcifications in gallbladder walls, gallbladder enlargement, focal gas collections within the gallbladder, and air-fluid levels in the gallbladder lumen. On US images we looked for: gallbladder wall thickening (> 3 mm), intraluminal content in the gallbladder, pericholecystic fluid, US Murphy's sign, and gallbladder distension. On CT images, we investigated: gallbladder distension, wall thickening, intraluminal content, pericholecystic fluid, and inflammatory changes in pericholecystic fat. Associated complications of cholecystitis were also searched on all images. RESULTS: On plain abdominal films we found densities projected over the gallbladder (16.9%) and linear calcifications in the gallbladder wall (4.6%). Abdominal US demonstrated gallbladder wall thickening (56.5%), one or more gallstone(s) (85.5%), pericholecystic fluid (14.5%), gallbladder distension (46.4%), and US Murphy's sign (39.1%). Abdominal CT showed gallbladder wall thickening (83.3%), gallbladder distension (66.6%), pericholecystic fluid (66.6%), gallstones (50%), inflammatory changes in pericholecystic fat (33.3%), and increased bile density (> 20 HU) (33.3%). CONCLUSIONS: US appears to be the most useful imaging technique in patients with suspected acute cholecystitis, for both screening and final diagnosis. CT plays a limited role in the early assessment of these patients, but can be a useful tool in diagnosing acute cholecystitis in patients with questionable physical findings or in investigating related complications.     

Urgent MRI with MR cholangiopancreatography (MRCP) of acute cholecystitis and related complications: diagnostic role and spectrum of imaging findings

Acute cholecystitis, which is usually associated with gallstones, is one of the commonest surgical causes of emergency hospital admission and may be further complicated by mural necrosis, perforation, and abscess formation. Magnetic resonance imaging (MRI) is increasingly available in the emergency setting. Technically improved equipment and faster acquisition protocols allow excellent tissue contrast and MRI is now an attractive modality for imaging acute abdominal disorders. The use of MRI with MR cholangiopancreatography in the emergency setting provides rapid, noninvasive, and confident diagnosis or exclusion of acute cholecystitis and of coexistent choledocholithiasis. To familiarize the reader with these cross-sectional imaging appearances, this paper reviews MRI findings consistent with uncomplicated cholecystitis. These include gallbladder distension, intraluminal sludge and gallstones, impacted stones obstructing the gallbladder neck or cystic duct, thickening of the gallbladder wall, abnormal signal intensity and edematous stratification, and pericholecystic and perihepatic fluid, plus increased enhancement of the gallbladder wall and adjacent liver parenchyma when intravenous paramagnetic contrast is used. Furthermore, MRI allows prompt detection and comprehensive visualization and characterization of cholecystitis-related complications such as gangrene, perforation, pericholecystic abscess, and intrahepatic fistulization. Some previous literature reports, and our experience, suggest that, when available, MRI should be recommended to provide prompt and efficient triage of patients with suspected cholecystitis and inconclusive clinical, laboratory, and sonographic findings. It facilitates appropriate therapeutic planning, including the timing of surgery (emergency or delayed), approach (laparoscopic or laparotomic), and need for preoperative or intraoperative removal of stone(s) in the common bile duct.     

CT findings in acute gangrenous cholecystitis.

OBJECTIVE: The purpose of this study was to determine the CT findings in acute gangrenous cholecystitis. MATERIALS AND METHODS: Four observers retrospectively reviewed CT scans in 75 patients (23 with acute gangrenous cholecystitis, 25 with acute non-gangrenous cholecystitis, and 27 without cholecystitis). The following findings were evaluated: distention, mural thickening, wall enhancement, irregular wall, wall striation, intraluminal membranes, pericholecystic inflammation, gallstones, pericholecystic fluid, enhancement of liver parenchyma, pericholecystic abscess, and gas in the wall or lumen. Sensitivity and specificity of CT for gangrenous cholecystitis and for each finding were calculated. Two reviewers in consensus measured gallbladder dimension and wall thickness. Logistic regression models were used to predict gangrenous versus non-gangrenous cholecystitis. RESULTS: Sensitivity, specificity, and accuracy of CT for acute cholecystitis were 91.7%, 99.1%, and 94.3%, respectively, and for acute gangrenous cholecystitis were 29.3%, 96.0%, and 64.1%, respectively. Findings with the highest specificity for gangrenous cholecystitis were gas in the wall or lumen (100%), intraluminal membranes (99.5%), irregular or absent wall (97.6%), and abscess (96.6%). The difference between the mean gallbladder wall thickness and the short-axis dimension for the two groups with cholecystitis was statistically significant. In three patients with gangrenous cholecystitis, no mural enhancement was seen. Pericholecystic fluid also achieved statistical significance for the diagnosis of gangrene. Multivariate logistic regression analysis showed that the overall accuracy of CT for gangrenous cholecystitis was 86.7%. CONCLUSION: CT findings most specific for acute gangrenous cholecystitis are gas in the wall or lumen, intraluminal membranes, irregular wall, and pericholecystic abscess. Gangrenous cholecystitis is associated with a lack of mural enhancement, pericholecystic fluid, and a greater degree of gallbladder distention and wall thickening.     

Computed tomography in acute cholecystitis

It has been our experience that acute cholecystitis can frequently be diagnosed on the basis of computed tomography (CT) alone, without the need for further confirmatory studies. This capability has not been emphasized in the radiologic or surgical literature.Retrospective review of CT scans performed in patients with the initial diagnosis of acute abdomen or sepsis due to abdominal source yielded 29 patients in whom a retrospective CT diagnosis of acute cholecystitis was made when all three of the following findings were present: gallbladder wall thickening (>3 mm), gallbladder distention, and pericholecystic abnormality (either fluid or abnormal fat).Pathologic or surgical follow-up was available in 22 of 29 patients. In 20 of 22 (91%) patients who underwent surgery, there was a pathologic or surgical diagnosis of acute cholecystitis. There were two falsepositive diagnoses: one patient with chronic cholecystitis and one patient with adenocarcinoma of the neck of the gallbladder.A confident diagnosis of acute cholecystitis can be made on CT scan in the appropriate clinical setting when all three of these criteria are met: gallbladder distention, gallbladder wall thickening, and pericholecystic abnormality. If one of these criteria is not met or is equivocal, biliary scintigraphy or ultrasonography may be needed to confirm the diagnosis.     

Gallbladder blunt trauma: comparison between radiologic and anatomo-surgical findings

PURPOSE: To assess the diagnostic accuracy and the possible role of ultrasonography (US) and Computed Tomography (CT) in a small group of patients who had a blunt abdominal trauma involving the gallbladder. MATERIAL AND METHODS: We retrospectively reviewed the US and CT findings of five patients with surgically confirmed post-traumatic gallbladder injury. The whole series consisted of 196 consecutive patients submitted to laparotomy for blunt abdominal trauma in the past 7 years. The following US and CT findings were considered at least suggestive of a possible post-traumatic gallbladder injury: pericholecystic fluid collection, ill-defined wall margin, collapsed lumen, high intraluminal density. RESULTS: At surgery, the following findings were observed: gallbladder hematoma (1 case), acute colecystitis (1 cases), gallbladder tear (3 cases), gallbladder tear associated with post-traumatic hepatic injuries (2 cases), duodenal tear (2 cases), hemoperitoneum alone (2 cases), hemoperitoneum associated with choleperitoneum (1 case), choleperitoneum alone (1 case). The US and CT findings were pericholecystic fluid collections (4 cases), ill-defined gallbladder wall margins (3 cases), collapsed lumen with intraluminal high density (1 case) and free intraperitoneal fluid collections (4 cases). They were suggestive of a possible post-traumatic gallbladder injury in all the five patients. CONCLUSIONS: The radiologic findings of our five patients were suggestive of a gallbladder damage but did not permit to distinguish minor from major injuries, the latter requiring surgical treatment. US proves to be a useful screening tool which can also help timing surgery in these patients. CT confirmed the US suspicions and also permitted accurate assessment of associated post-traumatic injuries to the liver and duodenum. Nevertheless, the clinical presentation was the most important factor as to the therapeutic management of these blunt abdominal trauma patients.     

Postchemoembolization liver abscess: findings on hepatobiliary scintigraphy

We describe a 41-year-old man with a 1-week history of nausea and vomiting 1 month after chemoembolization of a liver metastasis. The patient subsequently became febrile and developed right upper quadrant abdominal and midback pain. Findings of initial laboratory and imaging studies (a noncontrast computed tomographic [CT] scan and ultrasound) were not remarkable. Hepatobiliary scintigraphy, performed to rule out cholecystitis, revealed an abnormal area in the right lobe of the liver consistent with a focal bile leak into an abscess cavity. The patient was subsequently treated for liver abscess. In conclusion, hepatobiliary scintigraphy should be considered as a first-line test in the work-up of patients whenever a postchemoembolization complication is considered likely.