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Lymphatic Nodal Spreading of Gallbladder CarcinomaCT and MR Imaging Features

ObjectiveTo investigate the CT and MR imaging features and distribution characteristics of lymphatic nodal involvement in patients with gallbladder carcinoma. MethodsThirtyseven histopathologically proven cases of gallbladder carcinoma with regional lymphatic nodal enlargement in upper abdomen were included into the study. The lymph nodal short diameter of equal to or larger than 10 mm was used as the criteria for positive lymphadenopathy. Thirtyone cases underwent contrastenhanced spiral CT scanning, 6 cases had MR imaging studies. CT and MR images were jointly evaluated by three radiologists with especial attention to the size and location of enlarged lymph nodes in upper abdomen.ResultsThe enlarged lymph nodes were observed in four anatomic locations in the upper abdominal region. ①The retroportal and retropancreatic group in which lymph nodes were located along the cystic duct and common bile duct, in the portocaval space and behind the pancreatic head. ②The celiac group in which enlarged nodes distributed along the common hepatic artery and surrounded the celiac trunk. ③The mesenteric group in which lymph nodes assembled at the mesenteric root and around the superior mesenteric vessels. ④The abdominal aorta group in which lymph nodes scattered at the left side of abdominal aorta and in the aortocaval space at the level of the left renal vein. The spiral CT visualization rates for the above 4 groups of lymphadenopathy were 89.1%(33/37), 78.3%(29/37), 29.8%(11/37) and 51.3%(19/37) respectively.ConclusionCT and MR can clearly depict the four location sites of lymphadenopathy in patients with gallbladder carcinoma, which closely reflects the three major lymphatic spreading pathways of gallbladder carcinoma, namely, the cholecystoretropancreatic, cholecystoceliac and cholecystomesenteric routes.