Uchiyama Kazuhisa, Ozawa Satoru, Ueno Masaki, Hayami Shinya, Hirono Seiko, Ina Shinomi, Kawai Manabu, Tani Masaji, Yamaue Hiroki
Second Department of Surgery, Wakayama Medical University, School of Medicine, 811-1 Kimiidera, Wakayama, 641-8510, Japan.
J Hepatobiliary Pancreat Surg. 2009;16(3):333-8. doi: 10.1007/s00534-009-0067-9. Epub 2009 Mar 12.
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.
对1998年至2007年间接受手术治疗的32例经组织学确诊的黄色肉芽肿性胆囊炎（XGC）患者和21例胆囊癌患者进行回顾性分析。
所有患者术前行CT扫描。分析的CT特征包括：壁内低密度结节或条带的存在、黏膜线、壁增厚及强化方式以及胆囊内结石的存在。采用多因素逻辑回归分析对XGC患者的CT表现变量进行分析。
21例（65%）XGC患者观察到壁内低密度结节，而胆囊癌患者仅6例（29%）观察到（P<0.01）。27例（84%）XGC患者观察到黏膜线，而胆囊癌患者仅4例（19%）观察到（P<0.0001）。24例（75%）XGC患者发现胆囊结石，5例（24%）胆囊癌患者发现胆囊结石（P<0.001）。胆囊壁增厚方式（弥漫性或局灶性）及胆囊外改变的存在无显著差异。多因素逻辑回归分析显示，从CT特征来看，强化的连续黏膜线（P = 0.0013）和胆囊结石的存在（P = 0.0072）与XGC独立相关。
胆囊壁增厚时强化的连续黏膜线的CT特征，以及慢性胆囊疾病患者存在胆囊结石，高度提示XGC。因此，准确诊断XGC可能表明需要选择侵袭性较小的手术方式。
