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。     

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。     

胆囊癌的CT与B超诊断价值

目的探讨和比较CT、B超对胆囊癌的诊断价值。方法回顾分析42例经手术病理证实的胆囊癌CT、B超影像和临床资料,就其CT和B超的影像表现、强化方式、周围组织结构的关系、有无转移等进行对比分析。结果42例胆囊癌中CT诊断胆囊癌31例(占74%),B超26例(占62%)。结论CT对胆囊癌的诊断优于B超,并可对肿瘤对周围结构侵犯评估及病变的治疗方案的制定有重要价值。超声因无损伤、可反复、不同体位的检查等优点可作为胆囊病变的筛查方法。     

厚壁型胆囊癌和慢性胆囊炎的CT鉴别诊断

目的：评估CT对厚壁型胆囊癌和慢性胆囊炎的鉴别诊断价值．材料与方法：分析了经手术病理证实的36例CT检查资料。结果：厚壁型胆囊癌CT表现为胆囊定不均匀增厚，内壁凹凸不平，增强程度接近肝组织，持续时间较长。慢性胆囊炎内壁光整，增强程度明显低于肝脏，且持续时间短。结论：CT扫描对这两种疾病的鉴别诊断有一定价值．尤其是增强检查。     

Hepatic Hemangioma: Contrast-Enhancement Pattern during the Arterial and Portal Venous Phases of Spiral CT

The objective of the present study was to evaluate contrast-enhancement patterns of hepatic hemangioma according to size during hepatic arterial (30-s delay) and portal venous (65-s delay) phases of spiral computed tomography (CT). During a 10-month-period, 73 patients with 118 hemangiomas underwent two-phase spiral CT examination. The enhancement patterns of tumors were divided into four types based on the attenuation of surrounding liver parenchyma: peripherally nodular high, uniform high, iso, and low. The diameter of the tumors were <10 mm (n = 39), 11-20 mm (n = 33), and >21 mm (n = 46). Overall, the most common enhancement patterns of hemangioma were peripherally nodular high (66/118, 55. 9%) during the arterial and portal venous phases. The second most common contrast-enhancement patterns of hemangioma were uniform high (15/118, 12.7%) during the arterial and portal venous phases. In tumors smaller than 20 mm, 11 (9.3%) had low-low attenuation and two (1.7%) had iso-low attenuation during the arterial and portal venous phases, respectively. In conclusion, at two-phase spiral CT, the most common contrast-enhancement patterns of hemangioma are peripherally nodular high and/or uniform high during the arterial and portal venous phases. However, hemangiomas smaller than 2 cm may have atypical enhancing patterns including low and iso-attenuation.     

肝脏灌注异常强化在急性胆囊炎诊断中的价值

目的研究肝脏灌注异常在急性胆囊炎诊断中的价值,探讨肝脏灌注异常形成的相关因素。方法收集临床资料完整并经手术病理证实的38例急性胆囊炎病例,所有病例均行肝脏CT平扫及动脉、静脉期增强扫描。分析肝脏灌注异常的CT表现及形成的相关因素。结果 38例急性胆囊炎其中34例(89.5%)肝脏于动脉期出现半环状、斑片状、片状异常强化区,异常强化区的范围均为胆囊周围肝脏组织,静脉期肝脏异常强化区消失。结论急性胆囊炎周围肝脏的炎性泽润、充血是形成灌注异常强化的病理基础。胆囊周围肝脏灌注异常是急性胆囊炎的重要CT征象,在急性胆囊炎的诊断中具有重要价值。     

Adenomyomatosis of the gallbladder with subserosal fatty proliferation: CT findings in two cases

Adenomyomatosis of the gallbladder is frequently seen in ordinary operative specimens. Subserosal fat may proliferate in the presence of adenomyomatosis, but the amount of subserosal fat may be quite variable. Typical and atypical computed tomographic (CT) findings in two cases of adenomyomatosis with subserosal fatty proliferation of the gallbladder are presented. The thick fatty layer surrounding the thickened gallbladder wall with intramural diverticula and stones, typical of CT findings, was seen in one case, and fat interspersed in the periphery of the thickened gallbladder wall without intramural stones, atypical of CT findings, was seen in a second case.     

胆囊癌的CT诊断及对手术指导价值分析

目的:探讨胆囊癌的CT诊断并分析其对手术指导价值。材料与方法:回顾性分析经手术病理证实的胆囊癌27例,均经螺旋CT平扫,19例经双期或三期增强扫描,层厚7mm,3mm薄层重建。结果:胆囊癌腔内肿块型3例,胆囊壁增厚型5例,浸润型9例,混合型10例。肝脏受侵犯11例,肝内转移4例,淋巴结转移10例,腹水5例,肝内外胆管扩张6例,合并胆囊炎胆结石7例,胰腺、肝曲结肠、十二指肠受累各2例,胃受累1例。结论:螺旋CT对胆囊癌的诊断、分期及指导手术有很大价值。     

原发性胆囊癌的CT分析(附30例报告)

目的 探讨原发性胆囊癌的CT表现特征。方法对30例病理证实的原发性胆囊腺癌的CT资料进行回顾性分析。结果 肿块型16例，其增强特点可用于鉴别原发性肝癌；厚壁型8例，表现为胆囊壁不规则性、非对称性增厚，区别于胆囊炎的均匀性增厚；腔内结节型6例，表现为腔内分叶状软组织结节，横径大于1.0cm，不同于胆囊息肉的表现。结论掌握原发性胆囊癌的特征性CT表现，有助于提高其诊断与鉴别诊断的准确性。     

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.     

黄色肉芽肿性胆囊炎的CT表现

目的探讨黄色肉芽肿性胆囊炎(XGC)的CT表现特点,提高对XGC的诊断水平.方法回顾性分析经手术病理证实的29例XGC的CT检查资料.结果术前诊断为胆囊癌15例,慢性结石性胆囊炎14例.29例均有不同程度的胆囊壁增厚,其中局限性胆囊壁增厚8例,弥漫性胆囊壁增厚21例;增厚的胆囊壁内见单发或多发低密度结节15例;伴发胆囊结石26例;肝-胆界面较清楚者24例,肝-胆界面不清者5例;增强后增厚的胆囊壁在动脉期仅有轻度强化,门脉期至延迟期强化逐渐明显,胆囊壁内低密度结节影强化不明显,增强后显示密度较高的黏膜线9例.结论增强后增厚的胆囊壁延迟强化,增厚的胆囊壁内低密度结节,胆囊轮廓及黏膜线的存在对本病诊断有意义.     

Spiral CT for the detection of hepatocellular carcinomas: relative value of arterial- and late-phase scanning

Background: Spiral computed tomography (CT) can image the liver during arterial and late phases of contrast and optimize the evaluation of hypervascular tumor. The objective of this study was to evaluate the relative value of arterial- and late-phase spiral CT in the detection of hepatocellular carcinomas. Methods: Fifty-eight patients with hepatocellular carcinomas underwent two-phase spiral CT examination with 10-mm collimation at 10 mm/s table speed (Siemens Somatom Plus S), and 120 mL of contrast material (36 g iodine) was injected at the rate of 3 mL/s. CT images of hepatic arterial and late phases were obtained with a 35-s and 180-s delay, respectively. Results: In 58 patients, 111 hepatocellular carcinoma lesions were seen. The arterial phase detected 93 (84%) and the late phase 75 (68%) lesions (p < 0.01). The arterial phase detected more lesions in 11 patients, and the late phase dected more in two patients and an equal number in 45 patients. If lesions larger than 2 cm are excluded, the arterial phase detected 40 (74%) and the late phase 21 (39%) of 54 lesions (p < 0.001). Conclusion: The arterial phase of spiral CT greatly improves the detection of hepatocellular carcinoma when compared with the late phase. Received: 13 April 1995/Accepted: 22 May 1995     

Gallbladder abnormalities in carcinoma of pancreatic head: findings on MR imaging

Background  Our objective is to study the gallbladder abnormalities on MR images associated with carcinoma of the pancreatic head. Methods  Thirty-six patients who had surgical resection of pancreatic head carcinoma were retrospectively analyzed regarding the appearance of the tumor and gallbladder on MR imaging performed within one month before surgery. The changes of the gallbladder wall, and the dimension of the gallbladder, cystic duct, pericholecystic region, and common bile duct (CBD) on MR imaging were noted. Results  About 92% (33/36) of patients had at least one gallbladder abnormality on MR imaging, including thickened gallbladder wall (58%), gallbladder wall striation (19%), gallbladder wall severe enhancement (44%), enlarged gallbladder (33%), gallbladder stone (19%), dilatation of cystic duct (67%), focally increased liver parenchymal enhancement adjacent to the gallbladder (19%), and pericholecystic fluid (11%). 64% of patients had dilated CBD. The diameter of the cystic duct was correlated with those of the CBD (r = 0.45, P < 0.01) and gallbladder (r = 0.56, P < 0.0001). Enlarged gallbladder, dilatation of the cystic duct, and CBD were correlated with chronic cholecystitis. Conclusion  Most patients with pancreatic head carcinoma show gallbladder abnormalities on MR imaging. Cystic duct dilatation follows CBD dilatation and is the primary cause for dilated gallbladder and chronic cholecystitis in carcinoma of pancreatic head.     

超声造影在鉴别诊断腹部良恶性占位病变中的应用价值

目的探讨实时超声造影对腹部良恶性占位病变的鉴别诊断价值。方法对250例腹腔脏器占位性病变进行实时超声造影研究,其中包括肝脏良恶性肿瘤196例,胆囊癌及胆囊良性病变39例,胰腺良恶性病变15例,所有病例均经过手术或其他影像学检查方法证实。结果造影剂Sono Vue2.4ml静脉注射后,肝癌动脉相表现为整体快速增强,并在门脉相快速消退,在实质相显示为低回声;血管瘤呈周围向心性环状或结节状增强,门脉相及实质相进一步增强,持续较长时间;局灶性结节增生表现为中央扩散型快速整体增强,部分病例显示为车轮状;肝硬化增生结节的造影增强特征与肝实质一致;胆囊癌快速不均匀增强,胆囊壁连续性中断,胆囊良性病变及慢性胆囊炎胆囊壁连续;胰腺癌造影剂快速进入,消退时间早于胰腺实质,胰腺炎性肿块造影后回声与胰腺一致,或造影剂不进入。结论实时超声造影能显示肿瘤内微小血管的血流灌注情况,对腹部良恶性占位病变的定性诊断具有重要的意义。     

正常小肠螺旋CT三期扫描评价

目的　提高对正常小肠螺旋CT三期扫描影像特征的认识。方法　 80例健康患者 ,扫描前口服水。静脉注射造影剂后 ,分别于增强后 3 0s(动脉期 )、60s(静脉期 )、180s(延迟期 )行螺旋CT扫描。分别测取三期中小肠各段肠壁及系膜的CT值。结果　在同一期相中 ,小肠肠壁各段CT值差别无统计学意义 (P >0 .0 5 ) ,但在动脉期、静脉期和平衡期之间 ,有统计学意义 (P <0 .0 1)。系膜强化在各期相间均无统计学意义 (P >0 .0 5 )。结论　同一期相中 ,小肠各段的强化一致 ;不同期相间 ,小肠各段的强化有显著差别 ,系膜的强化在各期相间均无变化     

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。     

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双期扫描诊断伴肝硬化的小肝癌的探讨

目的：探讨螺旋CT双期增强扫描诊断伴肝硬化的小肝癌的价值。方法：14例伴肝硬化的小肝癌患手术及病理发现小肝癌病灶21个（直径≤3cm),回顾性分析螺旋CT双期增强扫描的结果,比较小肝癌在动脉期和门脉期内强化类型,检出率及诊断正确率,结果：动脉期检出率为85．7％（18／21）,门脉期有71．4％（15／21）,66．7％小肝癌动脉期为均一高密度,门脉期定性正确率为52．4％,联合动脉期和静脉期后,其检出率和定性正确率分别增加至90．5％和80．9％。结论：动脉期扫描明显增加小肝癌的检出,两期结合能提高检出率及定性正确率。     

Diagnostic accuracy of ultrasound in acute cholecystitis

This work attempts to assess the diagnostic accuracy of ultrasound for acute cholecystitis in 98 clinically suspected patients from the emergency unit in whom at least 3 of 6 relevant criteria are present. Gallbladder distention to 5 cm or more transversely or in the anterior-posterior axis (criterion 1) was present in 64 patients; thickening of the gallbladder wall of at least 5 mm (criterion 2) in 95; cholelithiasis (criterion 3) in 86; sonolucent halo in the gallbladder wall (criterion 4) in 40; sonolucent fluid band surrounding the gallbladder (criterion 5) in 27; and intraluminal echogenic mass with no posterior acoustic shadow (criterion 6) in 35. A diagnostic accuracy index, corrected for chance, was statistically and clinically more relevant with 3 as the minimum number of criteria for the ultrasonic diagnosis of acute cholecystitis.     

Computed tomographic evaluation of gallbladder disease

Evaluation of gallbladder diseases by computed tomography (CT) is limited compared with ultrasonographic evaluation. However, CT can bring about excellent information in advanced carcinoma of the gallbladder, severe and complicated cholecystitis, porcelain gallbladder, and indication for dissolution of gallbladder stones. Unique findings are also available in emphysematous cholecystitis, xanthogranulomatous cholecystitis, stones with gas (Mercedez-Benz sign), limy bile, and enhancement in acute cholecystitis. Combined use of CT and ultrasound apparently increase the accuracy of diagnosis in carcinoma and cholecystitis. This article is composed of sections on carcinoma, cholecystitis, stone, bile in the gallbladder, calcification, gas and fat, and miscellaneous topics including polypoid lesions, adenomyomatosis, hydrops, and wall thickening.