Comparison In Multi-inconography For Gallbladder Cancer And Surgical Ablation Feasibility Study

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 or extensively 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,Πperiod 23 cases,Шperiod 5 cases, IV period 10 cases. The appeasable cholecystectomy was 16 cases,Шperiod 4 cases, IV period 12 cases. The laparotomy for detecting was 6 cases,Шperiod 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. The accuracy 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 high accuracy rate on evaluating the preoperative staging of gallbladder, so that we can carry out a more comprehensively preoperative evaluation of gallbladder cancer.