Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, Republic of Korea.
Clin Radiol. 2013 Oct;68(10):992-1001. doi: 10.1016/j.crad.2013.03.022. Epub 2013 Apr 25.
To evaluate the benefit of diffusion-weighted imaging (DWI) in differentiating xanthogranulomatous cholecystitis from the wall-thickening type of gallbladder cancer.
This retrospective study was approved by the institutional review board. Fourteen patients with xanthogranulomatous cholecystitis and 19 patients with the wall-thickening type of gallbladder cancer were included. Qualitative (visual diffusion restriction compared to liver parenchyma) and quantitative [apparent diffusion coefficient (ADC)] analyses were performed. Conventional MRI findings including dynamic enhancement pattern between the two groups were also analysed. Two observers independently reviewed conventional magnetic resonance imaging (MRI) images and subsequently reviewed combined conventional MRI and DWI images. Pairwise comparison of the receiver operating characteristic (ROC) curves was used to compare diagnostic performances.
In conventional MRI findings, xanthogranulomatous cholecystitis showed significant continuity of enhancing mucosal line [79% (11/14) versus 26% (5/19), p = 0.003] and intramural T2-high signal intensity [64% (9/14) versus 21% (4/19), p = 0.012] compared to the wall-thickening type of gallbladder cancer. The enhancement pattern of gallbladder cancer compared to liver parenchyma showed earlier onset than that of xanthogranulomatous cholecystitis (p = 0.001). Diffusion restriction was more frequently seen in the wall-thickening type of gallbladder cancer (68%, 13/19) than in xanthogranulomatous cholecystitis (7%, 1/14; p < 0.001). The mean ADC value of xanthogranulomatous cholecystitis was higher than that of the wall-thickening type of gallbladder cancer with statistical significance (1.637 × 10(-3) mm(2)/s versus 1.076 × 10(-3) mm(2)/s, p = 0.005). Diagnostic performance [area under ROC curve (Az)] of both observers improved significantly after additional review of DWI; Az improved from 0.737 to 0.930 (p = 0.027) for observer 1 and from 0.675 to 0.938 (p = 0.008) for observer 2.
Addition of DWI to conventional MRI improves discrimination between xanthogranulomatous cholecystitis and the wall-thickening type of gallbladder cancer.
评价弥散加权成像（DWI）在鉴别黄色肉芽肿性胆囊炎与胆囊壁增厚型胆囊癌中的作用。
本回顾性研究经机构审查委员会批准。纳入 14 例黄色肉芽肿性胆囊炎患者和 19 例胆囊壁增厚型胆囊癌患者。进行定性（与肝实质相比弥散受限）和定量[表观弥散系数（ADC）]分析。还分析了两组之间的常规 MRI 发现，包括动态增强模式。两位观察者独立地对常规磁共振成像（MRI）图像进行了评估，随后对常规 MRI 和 DWI 联合图像进行了评估。通过比较受试者工作特征（ROC）曲线的配对比较来比较诊断性能。
在常规 MRI 结果中，黄色肉芽肿性胆囊炎显示出明显的增强黏膜线连续性[79%（11/14）与 26%（5/19），p=0.003]和壁内 T2 高信号强度[64%（9/14）与 21%（4/19），p=0.012]，与胆囊壁增厚型胆囊癌相比。与肝实质相比，胆囊癌的增强模式显示出比黄色肉芽肿性胆囊炎更早的发病时间（p=0.001）。弥散受限在胆囊壁增厚型胆囊癌中更为常见（68%，13/19），而在黄色肉芽肿性胆囊炎中则较少见（7%，1/14；p<0.001）。黄色肉芽肿性胆囊炎的平均 ADC 值高于胆囊壁增厚型胆囊癌，差异具有统计学意义（1.637×10(-3)mm(2)/s 与 1.076×10(-3)mm(2)/s，p=0.005）。在两位观察者中，在额外的 DWI 检查后，诊断性能[ROC 曲线下面积（Az）]均显著提高；观察者 1 的 Az 从 0.737 提高到 0.930（p=0.027），观察者 2 的 Az 从 0.675 提高到 0.938（p=0.008）。
在常规 MRI 中加入 DWI 可提高黄色肉芽肿性胆囊炎与胆囊壁增厚型胆囊癌的鉴别能力。
