Cha So Yeon, Kim Young Kon, Min Ji Hye, Lee Jisun, Cha Dong Ik, Lee Soon Jin
Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Clin Imaging. 2019 Mar-Apr;54:63-70. doi: 10.1016/j.clinimag.2018.12.001. Epub 2018 Dec 4.
Magnetic resonance imaging (MRI) is a reliable imaging tool for evaluating gallbladder carcinoma, but it is costly and time-consuming.
To compare noncontrast MRI with multidetector row CT (MDCT) and gadoxetic acid-enhanced whole MRI in distinguishing gallbladder carcinoma from benign disease.
101 patients (36 with gallbladder carcinoma and 65 with benign disease) with mild focal gallbladder wall thickening were included. Two radiologists reviewed the MDCT and MRI to determine the differential features between malignancy and benignity. Then, the diagnostic performance of MDCT and MRI (T1-, T2- and diffusion-weighted images) with and without gadoxetic acid enhancement in the diagnosis of gallbladder carcinoma was evaluated.
The benign group more often showed T2 necklace sign or T2 hyperintensity within the thickened wall (P < 0.0001) and T1 hyperintensity within the wall or gallbladder lumen (P = 0.0002). Meanwhile, malignancy more frequently showed T2 moderate hyperintensity of the thickened wall, papillary appearance, and diffusion restriction (all P < 0.0001). There were significant differences in sensitivity (79.2% vs 98.6% for observer 1; 84.7% vs 100% for observer 2) and specificity (80.7% vs 96.9%; 79.2% vs 95.4%) between the MDCT and noncontrast MRI (P < 0.05). We found similar diagnostic values between the noncontrast MRI and whole MRI (P = 0.479-1.000) for both observers.
Noncontrast MRI could be a useful alternative to gadoxetic acid-enhanced MRI in the diagnosis of gallbladder carcinoma that presents as mild gallbladder wall thickening on MDCT.
磁共振成像（MRI）是评估胆囊癌的可靠成像工具，但成本高且耗时。
比较非增强MRI与多排螺旋CT（MDCT）及钆塞酸增强全腹部MRI在鉴别胆囊癌与良性疾病方面的差异。
纳入101例胆囊壁轻度局限性增厚的患者（36例胆囊癌患者和65例良性疾病患者）。两名放射科医生对MDCT和MRI进行评估，以确定恶性与良性病变之间的鉴别特征。然后，评估MDCT及MRI（T1加权、T2加权和扩散加权成像）在有无钆塞酸增强情况下对胆囊癌的诊断性能。
良性组更常表现为增厚壁内的T2项链征或T2高信号（P<0.0001）以及壁内或胆囊腔内的T1高信号（P=0.0002）。同时，恶性病变更常表现为增厚壁的T2中度高信号、乳头状外观和扩散受限（所有P<0.0001）。MDCT与非增强MRI之间在敏感度（观察者1为79.2%对98.6%；观察者2为84.7%对100%）和特异度（80.7%对96.9%；79.2%对95.4%）方面存在显著差异（P<0.05）。对于两名观察者，我们发现非增强MRI与全腹部MRI之间在诊断价值上相似（P=0.479至1.000）。
在诊断MDCT表现为胆囊壁轻度增厚的胆囊癌时，非增强MRI可作为钆塞酸增强MRI的有用替代方法。
