目的 探讨炎性胆囊改变与慢性肝病胆囊改变的CT鉴别诊断要点.方法 选择经检查确诊的慢性肝病40例(慢性肝病组)、胆囊炎25例(胆囊炎组),行标准化上腹部双期CT增强扫描检查.先行平扫,然后静脉内注射碘普罗胺注射液80～100 ml,注药开始后25～35 s扫描为动脉期,60～70 s扫描为门静脉期.结果 胆囊炎组影像学改变主要为胆囊轮廓模糊、胆囊壁强化、胆汁密度增高、胆囊邻近的肝组织在动脉期出现一过性强化、囊腔或囊壁积气.慢性肝病组影像学特征为胆囊轮廓清楚、胆囊壁增厚、胆囊周围积液且无流动性,以及和基础肝病有关的特异性征象.结论 慢性肝病胆囊改变与炎性胆囊改变的CT表现不同,CT双期增强扫描有助于二者的鉴别诊断.%Objective To discuss the main features of CT differential diagnosis on cholecystic changes caused by inflammation and chronic liver disease. Methods 40 patients with definite chronic liver disease ( chronic liver disease group) and 25 patients with cholecystitis (cholecystitis group) underwent normal upper abdomen biphasic contrast enhancement with Siemens two stratum multirow spiral CT. Plain CT scan was done at first, and then 80 ～ 100 ml of iopromide was injected intraveneously. The period after 25 s to 35 s of injection was arterial phase and 60 s to 70 s was portal vein phase.Results Unclear gallbladder outline, intensive gallbladder wall, and increasing bilious density were the main imaging changes in cholecystitis group, while the main imaging changes in chronic liver disease group were clear gallbladder outline, thickening capsule wall, non-fluidity peri-gallbladder and specific signs of basic liver disease. Conclusion CT features of cholecystic changes caused by inflammation and chronic liver disease are different, and biphasic contrast enhancement of CT can present useful imaging findings for differentiation.
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