磁共振扩散加权成像鉴别良恶性厚壁型胆囊病变

发布时间：2018-02-28 20:05

  本文关键词： 胆囊 扩散加权成像 原发肿瘤 胆囊炎　出处：《临床放射学杂志》2017年10期 　论文类型：期刊论文

【摘要】：目的评价磁共振扩散加权成像(DWI)对于良恶性厚壁型胆囊病变的鉴别诊断价值。方法本研究包含了2007年11月到2014年5月在本院收治的79例良性病变[其中慢性胆囊炎25例,急性胆囊炎45例和黄色肉芽肿性胆囊炎(XGC)9例]和14例胆囊癌共93例厚壁型胆囊病变,将其按照DWI上分层表现、病灶形态以及是否扩散受限分成3种类型。由两名不知道病理结果的观察者在PACS工作站进行观察分析记录各自的分型结果,如有不一致时经协商获得一致同意。分型结果运用Fisher确切概率法进行统计学分析,多组间的两两比较采用Bonferroni校正,P0.05认为有统计学意义;对于良恶性病变对应DWI分型结果计算其敏感性、特异性、阳性预测值和阴性预测值。结果 93例厚壁型胆囊病变中,Ⅰ型51例,其中胆囊癌3例(5.9%),慢性胆囊炎19例(37.3%),急性胆囊炎26例(51.0%),XGC 3例(5.9%);Ⅱ型17例,其中胆囊癌0例(0.0%),慢性胆囊炎3例(17.6%),急性胆囊炎12例(70.6%),XGC 2例(11.8%);Ⅲ型25例,其中胆囊癌11例(44.0%),3例(12.0%)为慢性胆囊炎,7例(28.0%)为急性胆囊炎,4例(16.0%)为XGC。经Fisher精确检验DWI分型与疾病构成比差别有统计学意义(P=0.000),经Bonferroni校正发现对于Ⅲ型表现,胆囊癌与慢性胆囊炎、急性胆囊炎之间差异均有显著性,胆囊癌与XGC之间无显著性差异;如将Ⅲ型表现认为是胆囊癌,其敏感性、特异性、阳性预测值和阴性预测值分别为78.6%、82.3%、44.0%和95.6%。对于慢性胆囊炎、急性化脓性胆囊炎和慢性胆囊炎急性发作亚组病例,慢性胆囊炎以Ⅰ型表现为主,急性化脓性胆囊炎以Ⅱ型+Ⅲ型表现为主,其差异具有显著性(P=0.0032)。结论 DWI分型结合常规MRI序列有助于良恶性厚壁型胆囊病变的鉴别,胆囊壁扩散受限一定程度反映了急性胆囊炎病变的严重性,并有助于鉴别急性化脓性胆囊炎和慢性胆囊炎,而对鉴别厚壁型胆囊癌与XGC帮助不大。
[Abstract]:Objective to evaluate the value of diffusion-weighted Mr imaging (DWI) in the differential diagnosis of benign and malignant thick-walled cholecystopathy. Methods from November 2007 to May 2014, 79 cases of benign lesions [including 25 cases of chronic cholecystitis] were studied. In 45 cases of acute cholecystitis and 9 cases of xanthogranulomatous cholecystitis (XGC) and 14 cases of gallbladder carcinoma, 93 cases of thick-walled cholecystitis were performed according to DWI stratification. The morphology of the lesion and whether the diffusion was limited were divided into three types. Two observers who did not know the pathological results were observed and analyzed on the PACS workstation to record their classification results. If there is inconsistency, consensus is obtained through negotiation. The results of classification are statistically analyzed by Fisher exact probability method, and the comparison between groups is considered statistically significant by Bonferroni correction (P0.05). The sensitivity, specificity, positive predictive value and negative predictive value were calculated for benign and malignant lesions corresponding to DWI classification. Among them, gallbladder carcinoma in 3 cases, chronic cholecystitis in 19 cases, chronic cholecystitis in 19 cases, acute cholecystitis in 26 cases, acute cholecystitis in 26 cases, acute cholecystitis in 26 cases, XGC in 3 cases, type 鈪，

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