胆囊腺肌增生症的CT检查技术和表现

目的：描述胆囊腺肌增生症的CT表现,特别是多期增强扫描和口服胆囊对比剂后的CT表现特点,提高对本病CT表现的认识。方法：经手术病理证实的11例胆囊腺肌增生症,其中男5例,女6例。年龄38－56岁,平均43岁。检查采用CT平扫、动态增强、多期增强扫描技术和口服胆囊对比剂后CT扫描技术。结果;11例中CT术前诊断胆囊腺肌增生症7例,其中,弥漫型3例,节段型1例,基底型3例;误诊为慢性胆囊炎2例,胆囊癌1例,CT未见异常1例。CT表现为胆囊壁弥漫或局限性增厚,内外壁较光整,肝胆交界清晰。增强特点为动脉期病变区的黏膜及部分黏膜下明显强化,在门脉期和延迟期,强化沿黏膜面向浆膜面扩展,全层均匀或不均匀显著强化。特征性CT表现为口服胆囊对比剂后胆囊内Rokitansky-Aschoff窦充盈对比剂,服脂肪餐后显示“光环征”。结论：口服胆囊对比剂后CT检查对胆囊腺肌增生症有定性诊断价值,CT多期扫描对胆囊腺肌增生症有较高的诊断准确性,二者结合对胆囊壁增厚性病变的和鉴别诊断有较高的价值。

Computed tomographic methods and findings in adenomyomatosis of the gallbladder

Objective To describe the characteristic CT imaging of adenomyomatosis of gallbladder and to improve the diagnostic knowledge of the disease. Methods Eleven (5 males and 6 females, mean age = 43 years) patients with adenomyomatosis of gallbladder (4 diffuse, 2 segmental, and 5 fundal) confirmed by histopathology and performed by CT examination including plain, dynamic or multiphase enhancement and / or oral cholegraphic agent were reviewed. Results Correct diagnosis was made in 7 of 11 patients(3 diffuse, 1 segmental, and 3 fundal). CT findings included segmental or diffuse gallbladder wall thickening in the involved area, associated with well defined and regular borders at both of the inner and outer layers. Significant CT findings of this entity were marked enhancement of wall layers during triphase contrast CT scanning, especially at delayed scans. Rokitansky Aschoff sinuses were clearly shown by CT, presenting as characteristic "aureola " sign, when performed with application of a cholegraphic agent. Conclusion Understanding the CT findings and using the optimal methods, we can use CT scan as a valuable method to help make the diagnosis in most cases of adenomyomatosis.