Lee Eun Sun, Kim Jung Hoon, Joo Ijin, Lee Jae Young, Han Joon Koo, Choi Byung Ihn
Department of Radiology, Seoul National University Hospital, Seoul, South Korea.
Department of Radiology, Cung-Ang University Hospital, 102, Heukseok-ro, Dongjak-gu, Seoul, 156-755, Korea.
Abdom Imaging. 2015 Oct;40(7):2281-92. doi: 10.1007/s00261-015-0432-x.
The purpose of this study is to evaluate the diagnostic performance of HRUS, CT, and MRI for differentiating xanthogranulomatous cholecystitis (XGC) from gallbladder (GB) cancer.
Patients with surgically proven XGC (n = 40) and GB cancer (n = 44), who had undergone at least one HRUS (n = 43), CT (n = 82), or MRI (n = 34) examination between 2000 and 2012, were included. Two radiologists retrospectively graded the likelihood of XGC or GB cancer using a 5-point confidence scale; they also assessed the imaging features. Statistical analyses were performed using ROC, ANOVA, and Fisher's exact test.
Diagnostic performance of MRI was better than HRUS for differentiating XGC from GB cancer (AUCs = 0.867 and 0.911 vs. AUCs = 0.818 and 0.86). However, HRUS showed a better performance than CT (AUCs = 0.818 and 0.86 vs. AUCs = 0.806 and 0.84) with moderate to excellent agreement (κ = 0.48-0.83). Statistically common findings for XGC included non-focal thickening, smooth GB wall, presence of intramural nodules, type I enhancement of wall, transient hepatic attenuation difference, and continuity of mucosa (p < 0.05). Co-existence of gallstones (OR = 16.5), non-focal thickening (OR = 14.7), and collapsed lumen (OR = 13.0) on HRUS, and type I enhancement on CT (OR = 3.52) were independently associated with XGC (p < 0.05).
Although MRI showed a better performance than both HRUS and CT, HRUS showed a better performance than CT. The co-existence of gallstones, non-focal thickening, and collapsed lumen on HRUS was independently associated with XGC.
本研究旨在评估高频超声（HRUS）、计算机断层扫描（CT）和磁共振成像（MRI）在鉴别黄色肉芽肿性胆囊炎（XGC）与胆囊癌方面的诊断性能。
纳入2000年至2012年间接受手术证实的XGC患者（n = 40）和胆囊癌患者（n = 44），这些患者至少接受过一次HRUS（n = 43）、CT（n = 82）或MRI（n = 34）检查。两名放射科医生使用5分置信量表对XGC或胆囊癌的可能性进行回顾性分级；他们还评估了影像学特征。使用ROC曲线、方差分析和Fisher精确检验进行统计分析。
在鉴别XGC与胆囊癌方面，MRI的诊断性能优于HRUS（曲线下面积[AUC]分别为0.867和0.911，而HRUS的AUC为0.818和0.86）。然而，HRUS的表现优于CT（AUC分别为0.818和0.86，而CT的AUC为0.806和0.84），一致性为中度至高度（κ = 0.48 - 0.83）。XGC在统计学上常见的表现包括非局灶性增厚、胆囊壁光滑、壁内结节的存在、壁的I型强化、短暂性肝实质衰减差异以及黏膜连续性（p < 0.05）。HRUS上胆结石共存（比值比[OR] = 16.5）、非局灶性增厚（OR = 14.7）和管腔塌陷（OR = 13.0），以及CT上的I型强化（OR = 3.52）与XGC独立相关（p < 0.05）。
虽然MRI的表现优于HRUS和CT，但HRUS的表现优于CT。HRUS上胆结石、非局灶性增厚和管腔塌陷的共存与XGC独立相关。
