Xanthogranulomatous cholecystitis: the use of preoperative CT findings to differentiate it from gallbladder carcinoma
Xanthogranulomatous cholecystitis: the use of preoperative CT findings to differentiate it from gallbladder carcinoma
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DOI：
10.1007/s00534-009-0067-9
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发表时间：
2009-05-01
期刊：
影响因子：
--
通讯作者：
Yamaue, Hiroki
中科院分区：
文献类型：
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作者：
Uchiyama, Kazuhisa;Ozawa, Satoru;Yamaue, Hiroki
回顾性分析了1998年至2007年间32例组织学证实的黄色肉芽肿性胆囊炎（XGC）和21例胆囊癌手术治疗的患者。所有患者术前均行CT扫描。CT表现为：有无壁内低强度结节或带，粘膜线，壁增厚和增强的模式，胆囊内有无结石。采用多变量logistic回归分析XGC CT表现的变量。XGC患者中有21例（65%）可见壁内低衰减结节，胆囊癌患者中仅有6例（29%）可见壁内低衰减结节（P < 0.01）。在27例XGC患者（84%）和4例胆囊癌患者（19%）中观察到粘膜线（P < 0.0001）。XGC患者有24例（75%）出现胆结石，胆囊癌患者有5例（24%）出现胆结石（P < 0.001）。胆囊壁增厚的类型（弥漫性或局灶性）和胆囊外改变的存在无显著差异。多因素logistic回归分析显示，CT表现增强的连续粘膜线（P = 0.0013）和胆结石的存在（P = 0.0072）与XGC独立相关。慢性胆囊疾病患者胆囊壁增厚，连续粘膜线增强，伴胆囊结石，高度提示XGC。因此，对XGC的准确诊断可能提示需要选择一种侵袭性较小的手术方法。
A retrospective analysis was performed on 32 patients with histologically confirmed xanthogranulomatous cholecystitis (XGC) and 21 patients with gallbladder carcinoma who underwent surgical treatment between 1998 and 2007.All patients underwent preoperative CT scanning. The CT features analyzed were: the presence of intramural hypoattenuated nodules or bands, mucosal line, the patterns of wall thickening and enhancement, and the presence of stones in the gallbladder. The variables of the CT findings with XGC were analyzed using multivariate logistic regression analysis.Intramural hypoattenuated nodules were observed in 21 patients (65%) with XGC, but in only six patients (29%) with gallbladder carcinoma (P < 0.01). The mucosal line was observed in 27 patients (84%) with XGC and in only four patients (19%) with gallbladder carcinoma (P < 0.0001). Gallstones were noted in 24 patients (75%) with XGC and five patients (24%) with gallbladder carcinoma (P < 0.001). There was no significant difference in the pattern of gallbladder wall thickening (diffuse or focal) and the presence of changes outside the gallbladder. Multivariate logistic regression analysis revealed from the CT features that the enhanced continuous mucosal line (P = 0.0013) and the presence of gallstones (P = 0.0072) were independently correlated with XGC.CT features of the enhanced continuous mucosal line in a thickened gallbladder wall, together with gallstones in a patient with chronic gallbladder disease, are highly suggestive of XGC. Accurate diagnosis of XGC may therefore indicate the need to select a less aggressive surgical approach.