目的 探讨超声（US）、CT 及磁共振（MRI）三种影像学方法在显示胆 囊癌及其对胆囊周围结构侵犯中的价值，并对外科手术可切除性进行评价，为临 床提供参考。 方法 收集 2001 年 6 月至 2009 年 6 月河南科技大学第一附属医院经手术 病理证实的胆囊癌病例共 78 例，男 23 例，女 55 例，年龄 32~86 岁，平均年龄 57.8 岁。临床症状及体征主要有腹痛、黄疸、皮肤瘙痒、发热、纳差等。超声 检查 63 例，CT 检查 57 例，磁共振检查 42 例，CT 及磁共振检查均行平扫及增 强扫描，多层螺旋 CT 均行冠、矢状位重建；磁共振行常规轴位 T1W、T2W 平 扫，增强病例行 T1W 轴位及冠、矢状位重建，增强 VIBE 序列扫描，并做冠、 矢状位重建。 结果 （1）本组 78 例中，结节型 37 例，占 47.4%，肿块型 18 例，占 23.1%，厚壁型 23 例，占 29.5%。结节型癌灶中度至明显强化，强化较均匀，超 声可见较强且较均匀回声隆起灶，不伴声影；肿块型其轮廓不清或欠清，以周边 部强化为主，明显强化，中心部常见轻度或无明显强化低密度区，超声可见腔内 或腔外团块，回声分布不均；厚壁型胆囊壁局限性或广泛不规则增厚，明显强 化，常不均匀，内壁凹凸不平，超声可见胆囊壁不均匀增厚，隆起。（2）显示 肝脏直接侵犯的敏感度、特异度、总正确率、阳性预测值、阴性预测值分别为 68.8%、82.6%、76.9%、73.3%、79.1%；（3）显示肝脏转移的敏感度、特异 度、总正确率、阳性预测值、阴性预测值分别为 73.3%、95.2%、96.1%、 78.6%、93.8%；（4）显示胆道受侵的敏感度、特异度、总正确率、阳性预测 值、阴性预测值分别为 86.2%、87.8%、87.2%、80.6%、91.5%；（5）显示淋巴 结转移的敏感度、特异度、总正确率、阳性预测值、阴性预测值分别为 40.6%、 87.0%、67.9%、68.4%、72.7%；（6）显示胃十二指肠受侵的敏感度、特异度、 总正确率、阳性预测值、阴性预测值分别为 57.1%、68.4%、65.4%、40.0%、81.3%；（7）显示肝曲结肠受侵的敏感度、特异度、总正确率、阳性预测值、 阴性预测值分别为 57.1%、66%、62.8%、48.5%、73.3%；（8）显示网膜、腹膜 受侵的敏感度、特异度、总正确率、阳性预测值、阴性预测值分别为 28.6%、 76.0%、59.0%、40.0%、65.5%； （9）超声、CT 及磁共振对胆囊癌直接征象的 显示符合率无显著性差异；淋巴结转移检出 CT 组优于超声组；肝外胆道受侵检 出 CT 组与磁共振组效果相近；结肠肝曲受侵检出 CT 组明显优于超声组及磁共 振组。(10)根治性胆囊切除术 46 例，其中 Ι 期 8 例，Π 期 23 例，Ш 期 5 例，IV 期 10 例。姑息性胆囊切除术 16 例，其中 Ш 期 4 例，IV 期 12 例。剖腹探查术 16 例，其中 Ш 期 2 例，IV 期 14 例。 结论 超声、CT 及 MRI 三种方法对显示胆囊癌及胆囊癌对周围结构的侵犯 具有很高价值，显示胆囊癌直接征象三者符合率不存在显著性差异；超声、CT 及 MRI 显示肝脏侵犯、肝内转移、肝内外胆道受侵的准确率较高；显示淋巴结 转移、胃十二指肠受侵、肝曲结肠受侵、网膜及腹膜受侵准确率较低，但特异度 较高；显示胆道受侵 CT 与 MRI 价值相近；显示肝曲结肠受侵 CT 明显优于超声 及 MRI；超声、CT 及 MRI 对胆囊癌术前分期具有很高的准确率，能够对胆囊 癌进行较为全面的术前评估。 关 键 词：胆囊癌， 超声，体层摄影术，X 线计算机， 磁共振，手术切除 报告类型：应用研究Subject: Comparison in multi-inconography for gallbladder cancer and surgical ablation feasibility study Specialty: Medical imaging and nuclear medicine Name: Chen Wang Supervisor: Professor Gao Wan-qin ABSTRACT Objective To explore the value of ultrasonography (US), computed tomograhpy (CT) and the magnetic resonance imaging (MRI) on the demonstration of gallbladder carcinoma and its violations of the surrounding structures ,and provide a reference for the clinic by evaluating its surgical resectability. Methods 78 cases of gallbladder carcinoma confirmed by surgery and pathology were enrolled in this study , including 23 male and 55 female aging 32-86 years old with an average age of 57.8 years. All data were collected from June, 2001 to June, 2009 in the first affiliated hospital of Henan Science and Technology University . The mainly clinical symptoms and signs are abdominal pain, jaundice, itching skin, fever, anorexia, etc. Ultrasonography in 63 cases, CT examination in 57 cases, MRI examination in 42cases, CT and MRI were done by plain and enhanced scanning, Multi-slice spiral CT was done by crowned and sagittal reconstruction; MRI was done by ordinarily axial T1W, T2W plain scan, the enhanced cases were performed by axial ,crowned and sagittal T1W reconstruction, the enhanced VIBE sequence scannings were performed by crowned and sagittal reconstruction. Results (1) In 78 cases, 37 cases were tubercle type, accounting for 47.4%, 18 cases were tumor type, accounting for 23.1%, 23 cases were thick-walled type, accounting for 29.5%. The tubercle type carcinoma was more uniform, moderate to marked enhancing. Ultrasonography displayed a stronger and more homogeneous echo, the upheaval range was not accompanied by acoustic shadow ; The contour of tumor type was unclear or less clear, the peripheral was mainly and significantly enhanced, the center showed a mildly or unobviously enhanced low-density area, ultrasonography demonstrated the clumps inside or outside the cavity with uneven distribution of the echo; The capsule of thick-walled gallbladder was limitedly orextensively irregular thickening with obvious enhancing, often uneven, the internal wall was non-uniform, ultrasonography demonstrated the capsule of gallbladder was uneven thickening with upheaval . (2) The sensitivity, the specificity, the total accuracy, the positive predictive value and the negative predictive value of the liver’s direct violation are 68.8%, 82.6%, 76.9%, 73.3% and 79.1% respectively; (3) The sensitivity, the specificity, the total accuracy, the positive predictive value and the negative predictive value of the liver metastasis are 73.3%, 95.2%, 96.1%, 78.6% and 93.8% respectively; (4)The sensitivity, the specificity, the total accuracy, the positive predictive value and the negative predictive value of the inside and outside violations of the bile duct are 86.2%, 87.8%, 87.2%, 80.6% and 91.5% respectively; (5) The sensitivity, the specificity, the total accuracy, the positive predictive value and the negative predictive value of the lymph node metastasis are 40.6%, 87.0%, 67.9%, 68.4% and 72.7% respectively; (6) The sensitivity, the specificity, the total accuracy, the positive predictive value and the negative predictive value of the gastroduodenal violation are 57.1%, 68.4%, 65.4%, 40.0% and 81.3% respectively; (7)The sensitivity, the specificity, the total accuracy, the positive predictive value and the negative predictive value of the violation of hepatic flexure colon are 57.1%, 66%, 62.8%, 48.5% and 73.3% respectively; (8) The sensitivity, the specificity, the total accuracy, the positive predictive value and the negative predictive value of the violation of omentum and peritoneum ,the values are 28.6%, 76.0%, 59.0%, 40.0% and 65.5% respectively; (9) The direct signs of Ultrasonography, CT and MRI on displaying the gallbladder carcinoma are no significant difference; CT group is better than Ultrasonography group on detecting the metastasis of lymph node; The effect of CT group and MRI group is similar on detecting the invasion of extrahepatic bile duct; CT group is superior to MRI group on detecting the invasion of hepatic flexure colon . (10) The radical cholecystectomy was 46 cases,I period 8 cases, Π period 23 cases, Ш period 5 cases, IV period 10 cases. The appeasable cholecystectomy was 16 cases, Ш period 4 cases, IV period 12 cases. The laparotomy for detecting was 6 cases, Ш period 2 cases, IV period 14 cases. Conclusions Ultrasonography, CT and MRI have high value on diagnosing gallbladder cancer and it offends surroundings, there is no significant difference among the three methods on displaying the direct signs of gallbladder carcinoma. Theaccuracy of the violation of the liver , the intrahepatic metastasis and the violation of extrahepatic bile duct displayed by Ultrasound CT and MRI is higher; The specificity of the lymph node metastasis, the gastroduodenal violation, the violation of hepatic flexure colon and the violation of omentum and peritoneum showed by CT and MRI is higher, while the accuracy is lower; The effect of CT and MRI is similar on revealing the invasion of extrahepatic bile duct; CT is superior to MRI on revealing the invasion of hepatic flexure colon; Ultrasonography, CT and MRI have a hi