Etiological Evaluation Of Patients With Cholecystolithiasis With Inflammatory Thickening Of Gallbladder Wall By MRI

Objective To investigate the value of MRI in diagnosis of diffuse inflammatory edema of gallbladder wall in patients with cholecystolithiasis in order to guide clinical surgical treatment or conservative treatment.Methods The inpatients who performed upper abdominal discomfort in The 2nd Hospital of NingBo between January 2016 and January 2017 were collected and divided into two groups:139 patients with acute cholecystitis and 67.patients with viral hepatitis combined with cholecystolithiasis.The differences of various imaging signs in standardized upper abdominal MRI examination was analyzed.Results All kinds of imaging signs had statistical differences among groups,including stone location(P=0.000<0.05),continuity of gallbladder mucosa(P = 0.000<0.05),short diameter of gallbladder cavity(P = 0.000<0.05),exudation of perigallbladder space(P =0.000<0.05),edema of intrahepatic portal area(P = 0.000<0.05),hilar lymph node(P=0.000<0.05).There was no statistical difference in the thickness of gallbladder wall(P= 0.138>0.05),but the statistical difference in the type of thickened gallbladder wall was showed by stratification analysis(P = 0.000<0.05).In addition,following stratification analysis,the background of liver parenchyma and the extent of edema in intrahepatic catchment area had significant statistical differences(P=0.000<0.05).The imaging signs of non-gallbladder neck duct stones and gallbladder wall concentric thickening support the diagnosis of viral hepatitis combined with gallstone.The discontinuity of gallbladder mucosa and the exudation of perigallbladder space strongly support the diagnosis of acute cholecystitis of gallstone.In the case of diffuse edema of gallbladder wall with cholecystolithiasis without liver cirrhosis background and edema in intrahepatic portal area,calculous cholecystitis should be firstly considered.Conclusion The routine upper abdominal MRI examination plays an important role in assessing the etiology of gallbladder wall diffuse edema thickening in patients with gallstone,Especially,the location of gallstone,the concentric edema of gallbladder wall,the continuity of gallbladder mucous membrane and the perigallbladder space exudation are the main distinguishing points.These MR imaging signs should be read in details to provide important reference for the choice of clinical treatment.