Sonographic appearance of parotid glands in patients treated with intensity-modulated radiotherapy or conventional radiotherapy for nasopharyngeal carcinoma

This study aimed to investigate and compare the sonographic appearances of parotid glands in nasopharyngeal carcinoma patients treated with conventional radiotherapy (RT) or intensity-modulated radiotherapy (IMRT), and to compare them with healthy subjects. Totally 43 patients treated with conventional RT, 38 patients treated with IMRT and 58 healthy subjects were recruited and underwent parotid ultrasonography. Parotid glands were assessed for their size, echogenicity and internal architectures. The mean transverse dimension of parotid glands in patients treated with conventional RT and those treated with IMRT were significantly smaller than that in healthy subjects (p < 0.05). Parotid glands of the IMRT group tended to be hyperechoic (93%), homogenous (62%), without hypoechoic areas (64%) and with marginally-seen intra-parotid ducts (89%), which are similar to those in healthy subjects. Parotid glands in the conventional RT group tended to be hypoechoic (51%), heterogeneous (98%), with hypoechoic areas (94%) and had obviously-seen intra-parotid ducts (64%). For accurate diagnosis, post-RT changes of parotid glands should be noted in ultrasound examination of patients with previous radiotherapy. (E-mail: htmying@polyu.edu.hk)     

Diagnostic imaging of parotid gland oncocytoma: a pictorial review with emphasis on ultrasound assessment

Parotid gland oncocytoma (PGO) is a rare benign epithelial tumor that usually occurs in the elderly population. The most common clinical presentation is a painless, slow-growing, non-tender, lobulated, and mobile mass. Histologically, it is composed of monotonous sheets of epithelial cells (oncocytes) with a central scar. The cross-sectional appearance is not specific, and it overlaps with other parotid lesions. On ultrasound (US), oncocytoma appears as an ovoid, well-defined, homogeneous, and hypoechoic lesion. Cystic and hemorrhagic areas as well as intralesional fat may be observed. Doppler analysis shows intratumoral vessels, sometimes with a spoke-wheel pattern. The peak systolic flow is high (up to 100 cm/sec). Furthermore, oncocytoma is avid of FDG on a PET scan, as well as a malignant tumor. Thus, a combined clinical, imaging, and pathologic assessment is essential to establish the most accurate diagnosis and plan the best treatment. US, combined with Doppler techniques, can play an important role in suggesting the diagnosis and confirming it through percutaneous sampling. The purpose of this review is to show the imaging findings in PGO, with special emphasis on the US appearance.     

Ultrasound of the parotid gland.

Five cases of parotid gland masses were studied by ultrasound. Only retention cysts and true cysts of the parotid gland appear sonolucent at low and high gain settings. Benign and malignant tumor present as solid masses except for the Warthin's tumor which is sonolucent at lower gain settings but has a lattice of internal echoes at higher gain settings.     

超声弹性成像在腮腺弥漫性与局灶性病变中的应用进展

近年来超声弹性成像在腮腺疾病诊断中的应用逐渐增多,该技术能够定量评估腮腺组织硬度的变化,以及腮腺不同疾病的组织弹性变化。本文就超声弹性成像在腮腺弥漫性与局灶性病变中的应用进展进行综述。     

Multiparametric ultrasound evaluation of parotid gland tumors: B-mode and color Doppler in comparison and in combination with contrast-enhanced ultrasound and elastography. A case report of a misleading diagnosis

Preoperative characterization of parotid gland tumors using imaging or cytological examination (fine-needle aspiration cytology) has a strong clinical and therapeutic impact, but it is often difficult due to the tumors’ histological heterogeneity. The recent introduction of contrast-enhanced ultrasound (CEUS) and elastography, in the context of multiparametric ultrasound evaluation, contributed to improving the preoperative diagnosis of many diseases affecting the liver, breast, and thyroid, as well as other organs. However, limited evidence is available on the use and the diagnostic power of these techniques in parotid gland neoplasms. In this paper, we present a case of a parotid lesion that highlights the importance of a complete workup using multiparametric ultrasound evaluation, including CEUS and elastography, to identify malignant tumors of the parotid gland.     

腮腺导管损伤的诊断与治疗

目的回顾性研究分析17例腮腺导管损伤患者的临床资料。方法对17例腮腺导管损伤患者的性别、年龄、致伤原因、部位、临床表现、辅助检查、治疗方法、预后等进行统计分析。结果腮腺导管患者中男性多于女性,好发于20～29岁,其中以嚼肌区居多,致伤原因以刀砍伤最为常见。涎腺造影检查可以明确损伤的部位及损伤程度。腮腺导管损伤一般采用导管吻合术可以达到治疗之目的。结论腮腺导管损伤通过及时的诊断与正确的治疗,可以较好的恢复腮腺的功能。     

腮腺腺淋巴瘤的MRI表现(附30例分析)

目的 探讨腮腺腺淋巴瘤的MRI表现,旨在提高对本病的认识.方法 回顾性分析经手术病理证实的30例腮腺腺淋巴瘤患者的临床及MRI表现.结果 30例腮腺腺淋巴瘤患者中,男25例,女5例,年龄19～82岁(平均56岁),50岁以上21例(70.0%);有吸烟史23例(76.7%).30例腮腺腺淋巴瘤共发现45个肿瘤(其中单侧单发23例,单侧多发3例,双侧多发4例),其中35个(77.8%)肿瘤位于腮腺后下方.肿瘤一般呈圆形、椭圆形或分叶状软组织肿块,边缘光整;T1WI呈低信号,T2WI及压脂T2WI呈低、高混杂信号,囊变区呈明显长T1、长T2信号,增强后表现为早期轻中度强化.结论 腮腺腺淋巴瘤有一定的临床和影像特点;术前MR检查,不但可对肿瘤进行术前准确定位和发现多发病灶,而且有利于肿瘤的诊断、鉴别诊断和治疗方法的选择.     

腮腺多形性低度恶性腺癌1例报道并文献复习

目的探讨多形性低度恶性腺癌(小叶性或终末导管癌)的临床病理特点、诊断及鉴别诊断。方法通过光镜和免疫组化，对1例腮腺多形性低度恶性腺癌进行病理组织学观察。结果多形性低度恶性腺癌细胞形态较单一，但组织结构具有多样性。上皮膜抗原(EMA)呈阳性。结论这是一种不常见的肿瘤，多发于小涎腺，尤其是腭部，腮腺少见。尽管其具有浸润性生物学行为，但仍属于低度恶性肿瘤。彻底切除病变，可防止肿瘤复发。     

Ultrasound Histogram Assessment of Parotid Gland Injury Following Head-and-Neck Radiotherapy: A Feasibility Study

Xerostomia (dry mouth), resulting from radiation damage to the parotid glands, is one of the most common and distressing side effects of head-and-neck cancer radiotherapy. A noninvasive, objective imaging method to assess parotid injury is lacking, but much needed in the clinic. Therefore, we investigated echo histograms to quantitatively evaluate the morphologic and microstructural integrity of the parotid glands. Six sonographic features were derived from the echo-intensity histograms to assess the echogenicity, homogeneity and heterogeneity of the parotid gland: (1) peak intensity value (I_peak), (2) −3-dB intensity width (W_3-dB), (3) the low (<50% I_peak) intensity width (W_low), (4) the high (>50% I_peak) intensity width (W_high), (5) the area of low intensity (A_low) and (6) the area of high intensity (A_high). In this pilot study, 12 post-radiotherapy patients and seven healthy volunteers were enrolled. Significant differences (p < 0.05) were observed in four sonographic features between 24 irradiated and 14 normal parotid glands. In summary, we developed a family of sonographic features derived from echo histograms and demonstrated the feasibility of quantitative evaluation of radiation-induced parotid-gland injury.     

正常成人腮腺及颌下腺实时剪切波弹性成像的研究

目的:探讨实时剪切波弹性成像(Shear wave elastography,SWE)检测腮腺及颌下腺硬度的可行性,建立正常成人杨氏模量的参考值范围.方法:对820名健康成人进行腮腺及颌下腺实时剪切波弹性成像检查,比较左右两侧及不同性别、年龄组之间杨氏模量值的差异.结果:左右两侧腮腺及颌下腺杨氏模量值差异均无统计学意义(P＞0.05).不同性别间腮腺杨氏模量值差异有统计学意义(P＜0.05);不同性别间颌下腺杨氏模量值差异无统计学意义(P＞0.05).不同年龄组的腮腺及颌下腺杨氏模量值差异均无统计学意义(P＞0.05).结论:实时剪切波弹性成像可用于评估腮腺及颌下腺的硬度,为疾病的鉴别诊断提供有价值的信息.     

腮腺结节性筋膜炎2例报道并文献复习

目的 探讨腮腺结节性筋膜炎的临床病理学特征及其鉴别诊断。方法 对2例发生在腮腺内的结节性筋膜炎进行光镜观察和免疫组化标记。结果 2例均表现为右耳下生长迅速的无痛性肿块。镜检病变周界相对清楚，均由增生的梭形细胞组成，呈不规则或交叉的短条束状排列，背景疏松，黏液水肿样。其中1例冷冻切片下酷似肉瘤。免疫组化标记显示增生的梭形细胞Vim、α-SMA和MSA( )，CK、S-100和CFAP(-)。结论 原发于腮腺内的结节性筋膜炎十分罕见，尽管在临床病理学方面与发生在其他部位的结节性筋膜炎并无差异，但易误诊为各种类型的肉瘤，尤其是在细胞丰富并可见到较多核分裂象时，尤应注意。     

Superficial soft-tissue lymphoma: sonographic appearance and early survival

We evaluated superficial soft-tissue lymphomas on high-resolution ultrasonography (HRUS) in 43 patients (17 women, 26 men; mean, 59.7 y; range, 12 to 90 y), with 1- to 97-month follow-up. Clinical presentations, tumor location and morphology, echogenicity on HRUS and color-encoding grades on Doppler ultrasonography (CDUS) were assessed. Clinical presentations did not significantly differ with tumor location or morphology. Types of lymphoma did not significantly differ in echogenicity, although most were hypoechogenic. On CDUS, most lymphomas were hypervascular, but grades did not significantly depend on the type of tumor. On Kaplan-Meier analysis with log-rank testing, survival did not differ by age (divided at 65 y), sex, tumor location or size (cut-off, 5 cm), CDUS grade or pathology. Survival was significantly related to clinical presentation (p < 0.0095) and tumor morphology (p < 0.0354). HRUS and CDUS were good modalities to detect the masses and provided important pretreatment information.     

Three‐dimensional cultures of mouse submandibular and parotid glands: a comparative study

Freshly isolated salivary cells can be plated on an extracellular matrix, such as growth factor‐reduced Matrigel (GFR‐MG), to induce the formation of three‐dimensional (3D) structures. Cells grown on GFR‐MG are able to form round structures with hollow lumina, capable of sustaining amylase expression. In contrast, cells grown on plastic do not exhibit these features. Our recent studies have used mouse parotid gland (PG) cells, grown on different extracellular matrices, as a model for acinar formation. However, PG cells were not able to respond to the secretory agonist carbachol beyond 5 days and did not sustain polarity over time, regardless of the substratum. An alternative option relies in the use of mouse submandibular glands (SMG), which are more anatomically accessible and yield a larger number of cells. We compared SMG and PG cell clusters (partially dissociated glands) for their ability to form hollow round structures, sustain amylase and maintain secretory function when grown on GFR‐MG. The results were as follows: (a) SMG cell clusters formed more organized and larger structures than PG cell clusters; (b) both SMG and PG cell clusters maintained α‐amylase expression over time; (c) SMG cell clusters maintained agonist‐induced secretory responses over time; and (d) SMG cell clusters maintained secretory granules and cell–cell junctions. These results indicate that mouse SMG cell clusters are more amenable for the development of a bioengineered salivary gland than PG cell clusters, as they form more organized and functional structures. Copyright © 2014 John Wiley & Sons, Ltd.     

多层螺旋CT在腮腺良性肿瘤中的诊断价值(附84例分析)

目的回顾分析84例经病理证实的腮腺良性肿瘤MSCT扫描影像特征,探讨MSCT在腮腺良性肿瘤中的诊断价值。方法搜集84例经手术病理证实的腮腺良性肿瘤的MSCT检查资料,所有病例术前均进行CT平扫和双期增强扫描。影像评价:病灶数目、位置,密度、双期增强程度和方式;静脉期与动脉期相比,增强动态变化程度:增高、无变化、减低和混合型,双期增强方式:均匀、不均匀,是否存在不强化的囊变坏死区。结果单发混合瘤40例;腺淋巴瘤29例(6例多发,2例为双侧多发病灶);基底细胞瘤10例(1例为单侧两个病灶);肌上皮瘤5例。肿瘤平扫都表现为大小约1~5cm的边界清楚的软组织密度肿块,部分病例有囊变。增强方式显著不同:腮腺混合瘤动脉期无强化或轻度强化,静脉期呈轻度强化,较动脉期略明显,CT值约升高20Hu;腮腺腺淋巴瘤绝大多数病灶位于浅叶后下极,动脉期显著强化,静脉期呈轻度强化,较动脉期明显减低;腮腺基底细胞瘤动脉期和静脉期均有较显著强化,两者无显著差别,CT值约升高40Hu;腮腺肌上皮瘤动脉期和静脉期均有轻度强化,两者无显著差别,CT值约升高20Hu。结论不同类型的腮腺良性肿瘤的CT平扫和增强表现具有一定的特征性,CT增强检查对于肿瘤的定性诊断有更大帮助。     

腮腺腺淋巴瘤的临床、病理及CT表现

目的 探讨腮腺腺淋巴瘤(Warthin's瘤)的临床、病理及CT表现.方法 回顾性分析经术后病理证实的24例腮腺Warthin's瘤的临床、病理及CT资料.结果 24例患者,男22例,女2例;单发16例,多发8例,共38个病灶,其中31个(81.6％)病灶位于腮腺后下象限.病灶多呈高密度圆形、椭圆形结节或肿块,边缘光整,密度均匀或欠均匀,增强后34个病灶中2个轻度强化,5个中度强化,27个明显强化;17个均匀强化,17个不均匀强化(直径＞2 cm),且10个伴贴边血管征.结论 符合腮腺Warthin's瘤的发病年龄、性别、部位及影像学表现的患者,诊断时应首先考虑Warthin瘤的可能.     

Osteoradionecrosis of the mandible and mastoiditis after radiotherapy for parotid mucoepidermoid carcinoma

Osteoradionecrosis of the mandible in conjunction with mastoiditis is an extremely rare occurrence following irradiation of salivary gland malignancy in the orofacial region. We report one such case of a patient who presented to us with trismus, jaw pain, and ear discharge. Imaging of the jaws revealed classical features of osteoradionecrosis and mastoiditis. This case is important because presenting features like trismus and dental infection led us to investigative procedures that revealed extensive bone involvement including mastoiditis. Trismus progressively increased over a period of 8 years. In this case, we would like to emphasize the importance of good oral hygiene in the postradiotherapy stage for head and neck cancer.     

干燥综合征的腮腺和颌下腺损害特点分析

目的：通过比较干燥综合征组和正常对照组进行放射性核素显像的定量参数差异,观察干燥综合征患者的腮腺和颌下腺损害的各自特点。方法：38例干燥综合征患者均符合2002年干燥综合征国际分类（诊断）标准,对照组14例,所有病例按常规行唾液腺动态显像,并计算获得3项摄取功能参数：4min摄取比值（UR4）、15min摄取比值（UR15）、摄取速率（UV）;3项排泄功能参数：最大排泄量（MS）、酸刺激后腺体计数下降到最低所需的时间（Tmin）和1min内排泄速率（SV1min）,将两组定量参数进行t检验和Mann-Whitney U检验。结果：干燥综合征组腮腺不显影或显影不清楚的比例为2/38,干燥综合征组腮腺功能参数SV1min、UR15明显减低。颌下腺不显影或显影不清楚的例数为14/38,干燥综合征组颌下腺功能参数包括：UR4、UR15、UV、MS、SV1min均较对照组明显减低。结论：干燥综合征患者的腮腺与颌下腺功能损害并不是完全一致的。颌下腺损害更加常见,摄取和排泌量及速度均减低。腮腺仅高峰摄取比值和早期排泌速率明显减低,摄取速率和排泄量可表现正常。     

CT诊断腮腺基底细胞腺瘤1例

患者男,56岁,发现左侧腮腺区无痛性肿块2个月。查体:面神经功能无异常。左侧腮腺区轻度隆起,可扪及直径约2cm肿物,无明显压痛。彩超:左侧腮腺内见约1.4cm×2.7cm囊实性肿物,边界清晰,其后缘可见星点状血流信号。CT:平扫示左侧腮腺肿大,密度略不均匀,腮腺深叶界限不清的囊实性病灶(图1A);增强扫描动脉期病灶实质部分无明显强化,囊壁呈环形轻度不均匀强化(图1B);静脉期病灶实质部分轻度强化,     

The sonographic appearance and contrast enhancement of puncture needles

Investigations on the ultrasonic appearance of puncture needles in vitro and in vivo are reported. The images from the waterbath phantom correspond closely to those seen in the human body. The surfaces of smooth puncture needles reflect the ultrasonic beam so that, in most cases, the shaft is not visible. Surface roughnesses and small air bubbles enhance echogenicity and contrast of such needles. These roughnesses or inhomogeneities may be extraluminal or intraluminal. The phenomenon of the needle tip echo and its modifications are interpreted as physical and technical artifacts.