双语病例 | Porcelain gallbladder 瓷胆囊

病例选自《Mayo Clinic Body MRI Case Review》

双语学影像授权发布

History

65-year-oldwoman with rectal cancer and indeterminate hepatic lesions on CT

患者65岁，直肠癌病史。CT怀疑肝脏占位。

Fig 3.3.1：

Fig 3.3.2：

Fig 3.3.3：

Imaging Findings

Coronal SSFSE (Figure 3.3.1) and axial FSE T2-weighted(Figure 3.3.2) images demonstrate low signal intensity in the gallbladder fundus, with a markedly hypointense rim. Coronal reformatted image from contrast-enhanced CT (Figure 3.3.3) shows diffuse calcification of the gallbladder fundus corresponding to the hypointense rim on MRI.

冠状位SSFSE序列及横断位FSE T2WI序列示胆囊底部低信号，周边见明显低信号环。

增强CT冠状位重建图像，胆囊底部MRI低信号环对应位置显示为胆囊壁广泛钙化。

Diagnosis

Porcelain gallbladder

瓷胆囊

Comment

Porcelain gallbladder is used to describe diffuse calcification of the gallbladder wall and has long been thought to constitute a significant risk factor for gallbladder carcinoma. For that reason, prophylactichas been advocated for patients with porcelain gallbladder, whether or not they have symptoms.This thinking was based largely on papers published in the 1960s, one of which reported a 61% incidence of gallbladder carcinoma in patients with porcelain gallbladder. This association has been called into question more recently; 2 larger studies published in 2001 showed much lower incidences of 0% and 5%, respectively. The explanation for the large discrepancies is not clear but likely has to do with the rapid proliferation of US and CT and the subsequent detection of gallbladder calcification as an incidental finding leading to cholecystectomy. It also is possible that the epidemiology of gallbladder carcinoma is changing.

瓷胆囊是指胆囊壁弥漫性钙化，该病一直被认为是胆囊癌的高风险因素，因此，瓷胆囊患者无论有没有症状。都十分推崇预防性胆囊切除术。这一想法是由于上世纪60年代的大宗病例的报道，认为61%的胆囊癌与瓷胆囊有关。最近几年也有两者相关性的研究，但结果低得多，2001年的两项研究得出的两者相关性分别为0%和5%。这种巨大差异的解释尚不完全清楚，可能与超声、CT的逐渐广泛应用有关，很多患者偶然发现患有瓷胆囊，随后就进行了胆囊切除手术。另外，也可能与胆囊癌的流行病学逐渐改变有关。

Whatever the case,the finding of porcelain gallbladder should still be reported, but without the dire prognostic implications once ascribed to it. MRI is well known as the test of choice if you don’t want to see calcification, but calcification can sometimes be appreciated by the careful observer, generally as a nonenhancing, hypointense structure onboth T1- and T2-weightedimages. This case illustrates this principle: The gallbladder wall is hypointense in the fundus, corresponding to the calcification on CT. It should be noted that this is not universally true but probably is the more common presentation.

无论什么情况下，瓷胆囊的影像学表现都值得我们去学习，而曾经归咎于它的很差的预后则不用过多的纠结。如果我们不是特别需要关注钙化，MRI是一个检查的选择，但有经验的观察者仍能够发现胆囊壁钙化的征象，比如增强扫描无强化、T1WI和T2WI均为低信号。

本病例很好地很好地说明了这一原则：胆囊底部呈低信号，对应CT上的钙化灶。需要注意的是，这一原则大多数情况下都适用，但并非绝对。

Porcelain gallbladder is strongly associated with chronic inflammation and the presence of gallstones(60%-100%), and the ongoing inflammatory process is thought to be responsible for mucosal dysplasia and eventual calcification.

瓷胆囊与胆囊慢性炎症密切相关，并且约60%-100%可见胆囊结石。而且这种慢性炎症的过程可能与粘膜发育异常有关，并最终形成钙化。