Bozer Ahmet, Durgun Nagihan
Department of Radiology, Izmir City Hospital, Izmir, Turkey.
Arch Iran Med. 2024 Dec 1;27(12):674-682. doi: 10.34172/aim.31710.
Xanthogranulomatous cholecystitis (XGC) is a rare, chronic gallbladder inflammation often mistaken for gallbladder cancer (GBC) on imaging. Accurate differentiation is vital for appropriate treatment. This study aims to enhance computed tomography (CT) scan diagnostic accuracy for distinguishing XGC from GBC.
This retrospective study included patients diagnosed with XGC and GBC between 2014 and 2023. CT images of 70 patients (16 GBC, 54 XGC) were reviewed. Radiologists assessed CT parameters: gallbladder wall thickening, intramural hypoattenuating nodules, enhancement characteristics, mucosal line continuity, pericholecystic fat stranding, presence of stones, bile duct dilatation, hepatic invasion, invasion to adjacent structures, and lymph node size.
Among 70 patients, there were 38 males (54%) and 32 females (46%), with a median age of 62 years. GBC patients were significantly older (median age 72 years) compared to XGC patients (60 years) (=0.001). Diffuse gallbladder wall thickening was more frequent in XGC (70%) than GBC (12.5%) (<0.001). Continuous mucosal lines and intramural hypoattenuating nodules were more common in XGC (<0.001 and =0.010, respectively). Intrahepatic bile duct dilatation and invasion to adjacent structures were significantly linked with GBC (<0.001 and =0.043). Lymph nodes with a short axis>8 mm indicated GBC (<0.001), with a cutoff providing 71.4% sensitivity and 84% specificity (AUC: 0.843, <0.001). CT showed 75% sensitivity (95% CI: 48-93%), 74% specificity (95% CI: 60%-85%), and 74% accuracy (95% CI: 62%-84%).
CT imaging can effectively differentiate XGC from GBC, and larger studies can further improve diagnostic accuracy.
黄色肉芽肿性胆囊炎（XGC）是一种罕见的慢性胆囊炎症，在影像学上常被误诊为胆囊癌（GBC）。准确鉴别对于恰当治疗至关重要。本研究旨在提高计算机断层扫描（CT）对区分XGC与GBC的诊断准确性。
这项回顾性研究纳入了2014年至2023年间诊断为XGC和GBC的患者。对70例患者（16例GBC，54例XGC）的CT图像进行了回顾。放射科医生评估了CT参数：胆囊壁增厚、壁内低密度结节、强化特征、黏膜线连续性、胆囊周围脂肪条索、结石存在情况、胆管扩张、肝脏侵犯、对相邻结构的侵犯以及淋巴结大小。
70例患者中，男性38例（54%），女性32例（46%），中位年龄为62岁。与XGC患者（60岁）相比，GBC患者年龄显著更大（中位年龄72岁）（P=0.001）。弥漫性胆囊壁增厚在XGC中（70%）比GBC中（12.5%）更常见（P<0.001）。连续的黏膜线和壁内低密度结节在XGC中更常见（分别为P<0.001和P=0.010）。肝内胆管扩张和对相邻结构的侵犯与GBC显著相关（P<0.001和P=0.043）。短轴>8mm的淋巴结提示GBC（P<0.001），截断值的敏感性为71.4%，特异性为84%（AUC：0.843，P<0.001）。CT的敏感性为75%（95%CI：48-93%），特异性为74%（95%CI：60%-85%），准确性为74%（95%CI：62%-84%）。
CT成像能够有效区分XGC与GBC，更大规模的研究可进一步提高诊断准确性。
