Study On The Correlation Between Imaging Features And Pathology Of Xanthogranulomatous Cholecystitis

Objective:To study the correlation between Ultrasound,CT,MRI findings of xanthogranulomatous cholecystitis(XGC)and pathology,and to explore the diagnostic value of imaging.Method:The clinical and imaging data of 45 patients with XGC confirmed by operation or puncture biopsy pathology who underwent at least one Ultrasound,CT or MRI examination from January 2012 to December 2017 were collected.Among the 45 XGC patients,28 underwent ultrasound examination,42 underwent CT,and 19 underwent MR.The following imaging features were retrospectively analyzed:(1)the presence of gallbladder stones;(2)Diffuse thickening of gallbladder wall(range > 50% gallbladder circumference);(3)the maximum gallbladder wall thickness;(4)the continuity of mucosal lines(continuous or disrupted);(5)the presence of gallbladder distension;(6)the presence of intramural nodules;(7)the presence of pericholecystic fat infiltration;(8)Luminal surface enhancement(LSE)of gallbladder wall,and(9)the presence of direct invasion to the liver.The imaging characteristics of XGC were correlated with various pathological parameters.Variance analysis and Fisher exact test were used for statistical analysis.Result:In the three examinations of Ultrasound,CT and MRI,the statistically significant imaging findings of XGC include diffuse gallbladder wall thickening(Ultrasound p<0.001、CT p<0.001、MRI P=0.001),the presence of intramural nodules(Ultrasoundp<0.001、CT p<0.001、MRI p<0.001)、the continuity of mucosal lines(Ultrasound p=0.014、CT p=0.001、MRI P=0.01).In Ultrasound and CT,the statistically significant imaging findings of XGC include the adhesion and incarceration of gallstones(Ultrasound p=0.007、CT p=0.003),In CT and MRI,the statistically significant imaging findings of XGC include Luminal surface enhancement(CT p=0.017、MRI P=0.012)。 Correlation of XGC Ultrasound,CT and MR images with excised gallbladder pathology specimens.Microscopically,the thickened gallbladder wall consisted of proliferation of foamy cells and fibrous tissue with infiltration of inflammatory cells in all patients.Low-attenuation areas in the wall of XGC correlated On CT with foam and inflammatory cells or necrosis and/or abscess in XGC.Luminal surface enhancement(LSE)of gallbladder wall represented preservation of the epithelial layer.The early-enhanced areas of the liver bed on dynamic CT and MR images corresponded with accumulation of inflammatory cells and abundant fibrosis.Conclusion:The presence of intramural nodules,adhesion and incarceration of gallstones,diffuse gallbladder wall thickening,continuous mucosal line and continuous strengthening of the gallbladder wall,these five characteristics highly suggest XGC;The imaging characteristics of XGC are significantly correlated with the histopathological characteristics.Ultrasound combined with CT or MR is an ideal examination for XGC.