СОВРЕМЕННЫЕ МЕТОДЫ ВИЗУАЛИЗАЦИИ ЗАБОЛЕВАНИЙ ЖЕЛЧНОГО ПУЗЫРЯ
Ключевые слова:
Холестериновый полип, Аденома желчного пузыря, Аденомиоматоз, Холецистит, Ксантоматозный холецистит, Рак желчного пузыря, Методы визуализацииАннотация
Доброкачественные заболевания желчного пузыря обычно проявляются наличием внутриполостных образований и локальным или диффузным утолщением стенки. Внутриполостные образования желчного пузыря включают желчные камни, холестериновые полипы, аденомы или билиарный осадок. Также необходимо исключить полиповидную форму рака желчного пузыря. Размер полипа, ширина ножки и интенсивность контрастного усиления при контрастной ультрасонографии, а также степень ограничения диффузии могут помочь в дифференциации холестериновых полипов и аденом от рака желчного пузыря. Локальное утолщение стенки желчного пузыря в основном связано с сегментарным или очаговым аденомиоматозом, хотя инфильтративный рак может проявляться аналогично. Идентификация синусов Рокитанского-Ашгоффа является ключевой для диагностики аденомиоматоза. Слоистая структура, степень усиления контраста и целостность стенки являются важными признаками визуализации, которые помогают отличить доброкачественное утолщение от рака желчного пузыря. Высокочастотная ультрасонография особенно полезна для анализа слоистости стенки желчного пузыря. Диффузное утолщение стенки часто наблюдается при воспалительных процессах желчного пузыря. Тем не менее важно проверять наличие сопутствующего рака в случаях острого холецистита. Ультразвук сам по себе ограничен в оценке сложных форм холецистита и часто требует дополнительной компьютерной томографии. При хроническом холецистите сохранение двухслойной структуры стенки и слабое усиление стенки являются диагностическими признаками для исключения злокачественного процесса. Магнитно-резонансная томография в сочетании с диффузионно-взвешенной визуализацией помогает дифференцировать ксантоматозный холецистит от рака желчного пузыря, выявляя наличие жировой ткани и степень ограничения диффузии. Такие различия требуют знания типичных признаков визуализации различных заболеваний желчного пузыря и понимания ролей различных методов визуализации в его оценке.
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