胆囊结核的CT、MRI表现特点分析
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摘要
目的分析胆囊结核患者的电子计算机断层扫描(Computed Tomography,CT)、磁共振成像(Magnetic Resonance Imaging,MRI)表现特点。方法选取我院300经临床病理检查证实为胆囊结核患者纳入研究,均行CT与MRI检查,对其临床资料进行回顾性分析,总结CT、MRI表现特点。结果CT检查敏感度95.86%(278/290),特异度8 0.0 0%(8/1 0),准确性95.33%(286/300),Kappa值=0.51;MRI检查敏感度94.83%(275/290),特异度7 0.0 0%(7/1 0),准确性94.00%(282/300),Kappa值=0.41;MRI+CT检查敏感度97.93%(284/290),特异度8 0.0 0%(8/1 0),准确性97.33%(292/300),Kappa值=0.65;CT表现特点:胆囊壁增厚,并且囊内密度均匀,和邻近肝脏界清晰;经过增强扫描发现胆囊壁轻度强化;胆囊壁增厚,但是囊内密度不均匀,和邻近肝脏界模糊;经过增强扫描发现胆囊壁呈现不均匀强化,并且有分隔状强化影。MRI表现特点:胆囊区存在卵圆形异常信号,结核中央表现出短T1以及长T2信号,病灶周围环绕带状短T2与短T1信号,并且外层呈现半环状短T1以及长T2信号。结论胆囊结核在CT与MRI检查结果中具有特征性表现,CT、MRI诊断方式具有较高准确性,结合患者临床资料,可为其诊治、预后评估提供重要指导。
Objective To analyze the computed tomography(CT) and magnetic resonance imaging(MRI) manifestations of gallbladder tuberculosis. Methods 300 patients with gallbladder tuberculosis confirmed by clinical pathology were enrolled in the study. All patients were examined by CT and MRI, and their clinical data were retrospectively analyzed. CT and MRI manifestations were summarized. Results The sensitivity, specificity, accuracy and Kappa value of CT were 95.86%(278/290), 80.00%(8/10), 95.33%(286/300) and 0.51, respectively, while those of MRI were 94.83%(275/290), 70%(7/10), 94.00%(282/300) and 0.41, respectively. The sensitivity, specificity, accuracy and Kappa value of MRI+CT were 97.93%(284/290), 80.00%(8/10), 97.33%(292/300) and 0.65, respectively. The CT manifestations included thickening of the gallbladder wall, uniform density in the gallbladder, and clear boundary with the adjacent liver. Contrastenhanced scanning showed slight enhancement of the gallbladder wall, thickening of the gallbladder wall, uneven density in the gallbladder, unclear boundary with the adjacent liver, inhomogeneous enhancement of the gallbladder wall and separated enhancement shadow. MRI manifestations included oval abnormal signals in the gallbladder area, short T1 and long T2 signals in the center of the tuberculosis, lesions surrounded by short T2 and short T1 signals, and the outer layer showing semi-circular short T1 and long T2 signals. Conclusion CT and MRI manifestations of gallbladder tuberculosis are typical. The diagnostic accuracy rates of CT and MRI are high. They can provide important guidance for diagnosis and treatment and evaluation of the prognosis, combined with the clinical data.
Objective To analyze the computed tomography(CT) and magnetic resonance imaging(MRI) manifestations of gallbladder tuberculosis. Methods 300 patients with gallbladder tuberculosis confirmed by clinical pathology were enrolled in the study. All patients were examined by CT and MRI, and their clinical data were retrospectively analyzed. CT and MRI manifestations were summarized. Results The sensitivity, specificity, accuracy and Kappa value of CT were 95.86%(278/290), 80.00%(8/10), 95.33%(286/300) and 0.51, respectively, while those of MRI were 94.83%(275/290), 70%(7/10), 94.00%(282/300) and 0.41, respectively. The sensitivity, specificity, accuracy and Kappa value of MRI+CT were 97.93%(284/290), 80.00%(8/10), 97.33%(292/300) and 0.65, respectively. The CT manifestations included thickening of the gallbladder wall, uniform density in the gallbladder, and clear boundary with the adjacent liver. Contrastenhanced scanning showed slight enhancement of the gallbladder wall, thickening of the gallbladder wall, uneven density in the gallbladder, unclear boundary with the adjacent liver, inhomogeneous enhancement of the gallbladder wall and separated enhancement shadow. MRI manifestations included oval abnormal signals in the gallbladder area, short T1 and long T2 signals in the center of the tuberculosis, lesions surrounded by short T2 and short T1 signals, and the outer layer showing semi-circular short T1 and long T2 signals. Conclusion CT and MRI manifestations of gallbladder tuberculosis are typical. The diagnostic accuracy rates of CT and MRI are high. They can provide important guidance for diagnosis and treatment and evaluation of the prognosis, combined with the clinical data.
引文
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[2]董明杰,谈燚.腹腔镜胆囊切除术的手术类型研究进展[J].蚌埠医学院学报,2016,41(9):1256-1259.
[3]朱骏,朱克祥,李汛,等.胆囊癌中Bim ID1和E2F1的表达及生物学意义[J].西部医学,2016,28(2):158-161.
[4]陆鸣健.胆囊造影螺旋CT扫描在胆囊残余结石中的临床诊断价值[J].肝脏,2017,22(10):965-967.
[5]胡斌,高俊,吕进,等.肝胆结核误诊为肝门部胆管癌[J].临床误诊误治,2016,29(9):19-21.
[6]张超,陈璐,余日胜.胆囊腺瘤及其局部癌变的MRI诊断[J].临床放射学杂志,2016,35(1):85-88.
[7]陈勇军,王建,严红艳.胆囊癌腹部淋巴结转移的分布特征及CT和MR影像表现[J].医学影像学杂志,2016,26(10):1937-1939.
[8]马春波,王继民,张碧云.磁共振扩散加权成像在胆囊病变鉴别诊断中的价值[J].中国CT和MRI杂志,2017,15(11):79-81.
[9]王伟,郑田玲,马海婷等.胆囊及肝外胆管腺瘤的影像学分析[J].中国医师杂志,2017,19(8):1233-1236.
[10]王彬,罗晓,孙宝震,等.冷凝集素综合征合并胆囊结石行腹腔镜胆囊切除术1例报告[J].临床肝胆病杂志,2017,33(4):740-741.
[11]许汝娟.螺旋CT与MRCP在慢性胆囊炎临床诊断中的应用价值[J].中国CT和MRI杂志,2016,14(8):43-45.
[12]刘尼军,张华文,田延龙,等.胆囊腺瘤的MSCT表现[J].中国CT和MRI杂志,2017,15(4):96-99.
[13]胡高峰,江小华,陈红.CT和MRI对中晚期胆囊癌周围脏器侵袭和转移的诊断价值[J].检验医学,2016,31(B09):118-119.
[14]桑节峰,谷佃宝,张健,等.多层螺旋CT在胆囊结石合并胆囊炎患者腹腔镜胆囊切除术前的评估价值[J].中国CT和MRI杂志,2017,15(12):75-78.
[15]吴文芳,蔡艳,邓玲灵.胆囊结核超声误诊1例[J].临床超声医学杂志,2016,18(3):165-165.