發(fā)布時間：2018-02-28 20:05

  本文關(guān)鍵詞： 膽囊 擴散加權(quán)成像 原發(fā)腫瘤 膽囊炎　出處：《臨床放射學雜志》2017年10期 　論文類型：期刊論文

【摘要】：目的評價磁共振擴散加權(quán)成像(DWI)對于良惡性厚壁型膽囊病變的鑒別診斷價值。方法本研究包含了2007年11月到2014年5月在本院收治的79例良性病變[其中慢性膽囊炎25例,急性膽囊炎45例和黃色肉芽腫性膽囊炎(XGC)9例]和14例膽囊癌共93例厚壁型膽囊病變,將其按照DWI上分層表現(xiàn)、病灶形態(tài)以及是否擴散受限分成3種類型。由兩名不知道病理結(jié)果的觀察者在PACS工作站進行觀察分析記錄各自的分型結(jié)果,如有不一致時經(jīng)協(xié)商獲得一致同意。分型結(jié)果運用Fisher確切概率法進行統(tǒng)計學分析,多組間的兩兩比較采用Bonferroni校正,P0.05認為有統(tǒng)計學意義;對于良惡性病變對應DWI分型結(jié)果計算其敏感性、特異性、陽性預測值和陰性預測值。結(jié)果 93例厚壁型膽囊病變中,Ⅰ型51例,其中膽囊癌3例(5.9%),慢性膽囊炎19例(37.3%),急性膽囊炎26例(51.0%),XGC 3例(5.9%);Ⅱ型17例,其中膽囊癌0例(0.0%),慢性膽囊炎3例(17.6%),急性膽囊炎12例(70.6%),XGC 2例(11.8%);Ⅲ型25例,其中膽囊癌11例(44.0%),3例(12.0%)為慢性膽囊炎,7例(28.0%)為急性膽囊炎,4例(16.0%)為XGC。經(jīng)Fisher精確檢驗DWI分型與疾病構(gòu)成比差別有統(tǒng)計學意義(P=0.000),經(jīng)Bonferroni校正發(fā)現(xiàn)對于Ⅲ型表現(xiàn),膽囊癌與慢性膽囊炎、急性膽囊炎之間差異均有顯著性,膽囊癌與XGC之間無顯著性差異;如將Ⅲ型表現(xiàn)認為是膽囊癌,其敏感性、特異性、陽性預測值和陰性預測值分別為78.6%、82.3%、44.0%和95.6%。對于慢性膽囊炎、急性化膿性膽囊炎和慢性膽囊炎急性發(fā)作亞組病例,慢性膽囊炎以Ⅰ型表現(xiàn)為主,急性化膿性膽囊炎以Ⅱ型+Ⅲ型表現(xiàn)為主,其差異具有顯著性(P=0.0032)。結(jié)論 DWI分型結(jié)合常規(guī)MRI序列有助于良惡性厚壁型膽囊病變的鑒別,膽囊壁擴散受限一定程度反映了急性膽囊炎病變的嚴重性,并有助于鑒別急性化膿性膽囊炎和慢性膽囊炎,而對鑒別厚壁型膽囊癌與XGC幫助不大。
[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，

本文編號：1548749