腮腺肿块的螺旋CT常规与灌注成像诊断

目的 探讨螺旋CT常规及其灌注成像诊断腮腺良恶性肿块病变的价值.资料与方法对34例(39个病灶)进行常规CT扫描,其中21例(23个病灶)行CT灌注成像,对比分析良恶性肿块的影像表现.结果 常规CT扫描示良性肿块29个,恶性10个,在肿块边缘、邻近组织侵犯、邻近周围是否有肿大淋巴结方面,良、恶性肿块之间差异有统计学意义(P＜0.05);CT灌注扫描示良性肿块17个,恶性6个,灌注血流量(BF)、血容量(BV)、血管表面通透性(PS)在良、恶性肿块之间差异有统计学意义(P＜0.05).而常规CT和灌注CT扫描在病灶密度、囊变、最大径、强化值和灌注平均通过时间(MTT)方面差异均无统计学意义(P＞0.05).结论 螺旋CT常规扫描结合灌注成像可提高诊断腮腺肿块的准确性.     

腮腺病变的CT评价

目的　探讨CT对腮腺疾病的诊断价值。方法　回顾性分析 66例经病理及临床证实的腮腺病变的CT表现。结果　 62例 (94% )表现为腮腺内肿块影 ,4例 (6% )表现为腮腺弥漫性肿大。边缘清楚者 5 0例 (76% ) ,边缘不清者 16例 (2 4% )。CT诊断腮腺肿瘤的敏感性为 96% ,特异性为 5 4% ,准确性为 89% ;阳性预测值为 91% ,阴性预测值为 75 %。以病灶边缘模糊不清作为判断恶性肿瘤的预测指标 ,敏感性为 91% ,特异性为 89% ,准确性为 89% ;阳性预测值为 62 % ,阴性预测值为 98%。结论　CT易于显示腮腺内的病变 ,并能准确地定位。但对于良性肿瘤和非肿瘤性疾病的鉴别有限度 ,病灶边缘模糊不清是诊断恶性肿瘤的一个重要征象     

单发肿块型肝内胆管癌的CT强化模式分型研究

目的 总结归纳单发肿块型肝内胆管癌(IMCC)CT动态增强扫描的强化模式以及各种强化模式与病灶最大径的关系.方法 回顾性分析92例经病理证实的单发IMCC的CT平扫、动脉期、静脉期及延迟期的影像特点及其他合并征象,比较不同直径病灶的强化模式是否存在差异.结果 IMCC的CT强化模式以渐进强化型为主(83.7%),持续强化型(8.7%)及增强减退型(7.6%)比例较低.在渐进性强化型中,弥漫性强化(51.9%)所占比例最高,边缘加内部性强化(44.2%)其次,边缘性强化(3.9%)最少.最大径≤3 cm和>3 cm的肿瘤病灶强化模式无显著性差异(χ2=0.125,P=0.940).结论 单发IMCC的CT强化模式多样,以渐进强化型为主,本研究提出了一种新的强化模式分型体系.     

硬化型肝癌与肝内肿块型胆管癌的影像征象及病理学对比分析

目的 探讨硬化型肝癌(SHCC)与肝内肿块型胆管细胞癌(IMCC)的临床及影像表现的异同.方法 回顾性分析48例SHCC及97例IMCC患者的临床及CT、MRI影像表现,分析各自特征及二者间的差异.患者年龄及肿瘤直径的比较采用独立样本的t检验,率的比较采用x2检验.结果 SHCC患者发病年龄较IMCC略小(t=-2.735,P=0.007),二者肿瘤平均直径比较无明显差异(t=1.328,P=0.186),而前者更常见于病毒性肝炎患者(x2 =10.810,P=0.001).两种肿瘤发生部位均以肝脏边缘为主(x2 =2.933,P=0.087),且多伴有邻近肝包膜皱缩(x2=0.522,P=0.470),组间比较均无明显差异.两种肿瘤的CT及MRI平扫影像表现无明显差异,动态增强扫描影像表现主要分为2种类型,即典型强化和不典型强化,典型强化常见,二者间出现概率无明显差异(x2=0.028,P=0.876).两种肿瘤的不典型强化表现部分重合,但SHCC的不典型强化方式更为复杂且部分具有特征性.动态增强影像表现随肿瘤细胞和纤维间质分布、所占比例、血供情况及肿瘤出血坏死程度的不同而变化.两种肿瘤中门静脉受侵(x2 =0.358,P=0.549)及淋巴结转移(x2=0.000,P=0.982)出现的概率无明显差异,而IM-CC出现周围胆管扩张较SHCC更常见(x2=5.011,P=0.025).结论 SHCC与IMCC均为富含纤维间质的肝脏原发恶性肿瘤,二者临床及影像表现相近.充分认识二者影像表现的异同并结合临床对正确诊断及鉴别诊断具有重要意义.     

乳腺髓样癌的X线表现--与病理对照并与纤维腺瘤鉴别

目的　评价乳腺X线片鉴别髓样癌与纤维腺瘤以及鉴别典型髓样癌与不典型髓样癌的可能性。资料与方法　回顾性分析乳腺髓样癌 2 7例 ,纤维腺瘤 34例 ,观察X线片表现 ,并与病理进行对照。结果　乳腺髓样癌与纤维腺瘤均以无钙化的肿块常见 ,各占 78%和 74 %。髓样癌为高密度肿块 (19/2 5 ) ,纤维腺瘤多为等密度肿块 (19/2 8) ,两者有显著性差异 (P =0 .0 0 1) ;髓样癌边缘多呈浸润性或小分叶状改变 (2 3/2 5 ) ,而纤维腺瘤表现或为边缘清晰 ,或呈某一投照位置边缘清晰、而另一位置不能见肿块的特殊改变 (2 5 /2 8) ,两者有显著性差异 (P <0 .0 0 1)。 2 7例髓样癌中 ,9例为不典型髓样癌 ,典型髓样癌与不典型髓样癌在肿块形状 (P =0 .6 70 )、边缘 (P =0 .394 )及密度(P =0 .6 37)改变上无明显差异。结论　乳腺髓样癌的X线表现有一定的特征 ,与其病理基础密切相关 ,可与纤维腺瘤作出鉴别。髓样癌病理上又可分为典型髓样癌与不典型髓样癌 ,两者在X线片上无法鉴别     

腮腺间隙原发病变的CT和MRI影像诊断及鉴别诊断

目的:提高腮腺间隙原发病变影像诊断及鉴别诊断能力。方法:回顾性分析32例腮腺间隙原发病变的影像特征,包括25例良性肿瘤及肿瘤样病变,7例原发恶性肿瘤。结果:CT和MRI能显示病变累及的范围。多形性腺瘤局部含有丰富的纤维粘液样基质,在T2WI上呈高信号以及增强后明显强化。腮腺腺淋巴瘤多位于腮腺浅叶下极,表现为边界清楚的双侧或单侧多发的囊实性肿瘤,增强扫描早期明显强化。基底细胞瘤呈T1WI、T2WI低信号,增强后呈早期及延迟强化。1例血管淋巴管瘤和1例淋巴管瘤表现边界较清的弥漫性软组织肿块,具有"钻缝生长"特征。神经鞘瘤在MRI上信号不均匀,可见斑片状T2高信号,增强后不均匀明显强化。恶性肿瘤边界不清,浸润生长,T2WI呈低信号,增强后不均匀强化。其它病变缺乏影像学特征。结论:腮腺间隙原发病变有一定的临床及影像特征,术前CT和/或MRI检查,有利于病变的诊断、鉴别诊断和治疗方法的选择。     

舌病变的CT、MRI影像分析

目的 分析舌病变的CT及MRI表现,评价影像检查在舌病变诊断中的应用价值.方法 回顾性分析经手术、病理证实的28例舌病变患者资料,其中舌鳞癌20例,良性病变8例,比较分析其影像表现,并行统计学检验.结果 (1)20例舌鳞癌患者,在CT、MRI上表现为溃疡、浸润或疣型肿块影,增强扫描明显强化,与周围组织分界清;8例良性病变,除溃疡性嗜酸性肉芽肿和淋巴管瘤外,均未见肿块占位效应(x2=13.621,P=0.000).(2)MRI检查并有完整手术记录的7例舌鳞癌患者中,肿块最大径≥2 cm者6例,淋巴结转移5例,转移率为83.3％(5/6);肿块最大径＜2 cm者1例,未发现淋巴转移.结论 CT、MRI对舌良、恶性病变的鉴别诊断具有价值.     

腮腺病变的CT诊断

目的探讨腮腺良、恶性病变的CT特点。方法回顾性分析52例经手术病理及临床证实的腮腺病变的CT表现,其中良性肿瘤29例,恶性肿瘤13例,结核4例,慢性腮腺炎6例。结果52例中,48例表现为腮腺内或腮腺区肿块,良性肿瘤形态规则,边界清楚,占82.8%(24/29);恶性肿瘤形态不规则,边界模糊不清,占76.9%(10/13);腮腺结核表现为密度不均、边界较模糊的结节或肿物,并有结节样钙化和腮腺周围淋巴结肿大,病灶及肿大淋巴结均呈环形强化;4例弥漫性炎症表现为一侧或双侧腮腺弥漫性肿大,密度增高;2例为局限炎症,呈形态不规则肿块状,边界不清。结论CT扫描对腮腺病变定位敏感性为100%,对各类腮腺病变的定性诊断有重要价值,增强扫描可提高其定性诊断率。     

双能减影和常规DR对肺结节或肿块检出能力的比较

目的:比较双能减影和常规DR对肺结节或肿块检出的能力.方法:对经CT证实的50例患者共104个肺结节或肿块(PNM)行双能减影(DES)和常规数字X线减影(CDR)检查.评价DES和CDR对PNM的检出能力,并用配对卡方检验进行差异显著性分析.结果:对于CT证实全部PNM,DES和CDR的检出率分别为67.3%(70/104)和52.9%(55/104).两者差异有极显著性意义(X2=9.33,P＜0.01).对于最大径＞1 cm的PNM.DES和CDR的检出率分别为91.5%(43/47)和89.4%(42/47),两者差异无显著性意义(X2=1,P＞0.05).对于最大径≤1 cm的PNM,DES和CDR的检出率分别为47.4%(27/57)和22.8%(13/57),两者差异有极显著性意义(X2=8.45,P＜0.01).结论:DES对PNM的检出能力优于CDR.     

腮腺良恶性肿瘤的CT鉴别诊断

目的:探讨CT对腮腺良恶性肿瘤的鉴别诊断价值.方法:回顾性分析20例经手术病理证实的腮腺肿瘤的CT表现,其中良性肿瘤16例,恶性肿瘤4例.结果:本组中CT术前诊断符合率为90%.良性肿瘤的主要CT表现为边界清楚15例(94%),平均大小为8 cm3;位于浅叶10例(63%),深叶1例(6%),5例同时累及深、浅叶;钙化1例(6%),囊变3例(19%),头颈部淋巴结增大2例(13%).恶性肿瘤中边界清楚1例(1/4),平均大小为13 cm3;1例(1/4)位于浅叶,2例(2/4)位于深叶,1例同时累及深、浅叶;头颈部淋巴结增大3例(3/4).结论:腮腺肿瘤的CT表现有一定特征性,CT对良恶性腮腺肿瘤的鉴别诊断有一定价值.     

Diagnostic value of FDG PET and salivary gland scintigraphy for parotid tumors

PURPOSE: The purpose of this study was to examine the diagnostic value of the combination of F-18 fluorodeoxyglucose (FDG) PET and Tc-99m pertechnetate salivary gland scintigraphy in parotid tumors. MATERIALS AND METHODS: Seventy-two patients with benign parotid gland tumors (n = 52), malignant parotid tumors (n = 12), and inflammation (n = 8) underwent both FDG PET and salivary gland scintigraphy within 1 week, and 66 of the patients also underwent gallium scintigraphy. All patients were negative on their first fine-needle aspiration (FNA). RESULTS: Malignant parotid tumors showed significantly higher FDG uptake (standard uptake values [SUVs]) than both benign tumors and inflammation, except in Warthin's tumor (5.82 +/- 3.95 vs. 2.07 +/- 1.33; P <0.01). Although the SUV values of Warthin's tumor and malignant parotid tumors overlapped somewhat, Warthin's tumor did demonstrate increased radiotracer uptake, and it was reliably distinguished from other parotid gland tumors by the use of salivary gland scintigraphy. Considering a SUV value >3 as being positive for malignancy and excluding Warthin's tumor on the basis of salivary gland scintigraphy, sensitivity and specificity of FDG PET were 75% and 80%, respectively. These results were superior to those of gallium scintigraphy (58% and 72%, respectively). CONCLUSIONS: Although the diagnostic value of FDG PET in the differentiation of malignant from benign parotid gland tumors was limited because of the high FDG uptake in some benign tumors, and particularly pleomorphic adenomas, combining salivary gland scintigraphy with FDG PET may help to negate this drawback, and this combination may be a more promising approach for differentiation of various parotid gland tumors in patients compared with nondiagnostic needle aspiration.     

腮腺多形性腺瘤与沃辛瘤MRI表现对照分析

目的:探讨磁共振成像检查对腮腺多形性腺瘤与沃辛瘤的鉴别诊断价值。方法:回顾分析经病理证实的8例腮腺多形性腺瘤及10例腮腺沃辛瘤的磁共振成像检查表现,并作统计学处理。结果:腮腺多形性腺瘤为单侧腮腺单发病灶(8/8),沃辛瘤可单侧单发(5/10),亦可双侧或多发(5/10)(P<0.05);沃辛瘤多位于腮腺浅叶(13/17),腮腺多形性腺瘤可位于浅叶(6/8),亦可位于深叶或占据深浅叶(2/8)(P<0.05);多形性腺瘤在T2WI中以高信号多见(5/8),沃辛瘤以等信号或低信号为主(17/17)(P<0.05);性别分布上腮腺多形性腺瘤女性多见(6/8),沃辛瘤男性多见(7/10)(P<0.05);年龄分布上沃辛瘤为50岁以上者多见(6/10),多形性腺瘤中50岁以上与50岁以下者分布相近,各为4例(P<0.01)。结论:磁共振成像检查的特征表现和临床资料相结合对腮腺多形性腺瘤与沃辛瘤可正确诊断。     

3.0T MR动脉自旋标记对腮腺肿瘤的鉴别诊断价值

目的:初步探讨3.0T磁共振动脉自旋标记技术(ASL)对腮腺肿瘤的鉴别诊断价值。方法:前瞻性搜集2017年3月-2020年1月因腮腺肿物于本院就诊及治疗的患者作为研究对象,所有研究对象均行常规MR平扫及ASL扫描,测量ASL序列图像上肿瘤组织的肿瘤血流量(TBF),并将计算出的标准化肿瘤血流量(nTBF)与病理结果进行对比分析。结果:本研究总共纳入45例经术后病理证实的腮腺肿瘤患者。其中良性肿瘤28例,包括腺淋巴瘤14例,多形性腺瘤14例;恶性肿瘤共17例。测量并经计算得出腺淋巴瘤、多形性腺瘤、恶性腮腺肿瘤的nTBF分别为:3.71±1.65、0.89±0.25、1.55±0.60。腺淋巴瘤的nTBF明显高于多形性腺瘤(P<0.01)和恶性肿瘤(P<0.01),但是多形性腺瘤和恶性肿瘤的nTBF差异无统计学意义(P=0.073)。ASL能将腮腺腺淋巴瘤从多形性腺瘤及恶性肿瘤中鉴别出来,但是无法鉴别多形性腺瘤与恶性肿瘤。ASL诊断腮腺腺淋巴瘤的ROC曲线下面积为0.935,nTBF的诊断阈值为2.03,诊断腺淋巴瘤的敏感度和特异度分别为92.9%、93.5%。结论:3.0T MR ASL技术可以无创地、定量地评价腮腺肿瘤的TBF,并对腺淋巴瘤的诊断和鉴别诊断具有较高的价值。     

Bilateral and multifocal Warthin's tumors of parotid glands: PET/CT imaging

Unilateral hypermetabolic lesion of parotid gland demonstrated on PET/CT imaging may originate from a large spectrum of benign or malignant processes, such as adenoma, Warthin's tumor, oncocytic neoplasm, lymphoma, and primary or secondary malignancy of the gland. Bilateral and multifocal parotid gland disease is less common but possible because of the known characteristics of Warthin's tumors. The authors present such a case that was incidentally documented during PET/CT evaluation of solitary pulmonary nodule.     

腮腺原发恶性肿瘤的CT表现

目的：分析腮腺各类型原发恶性肿瘤的CT表现，了解其影像学特点，资料与方法。分析经手术及病理证实的腮腺原发恶性肿瘤19例，包括粘液表皮样癌8例，腺泡细胞癌及腺癌各3例，鳞状细胞癌及恶性混合瘤各2例，腺样囊性癌1例。结果：临床有面神经受累症状者7例，其中6例肿瘤侵及深，浅二叶。19例中，5例肿物呈圆形或椭圆形，14例呈不规则形；6例边缘清楚，13例边缘不清楚并伴有不同程度的周围结构受侵。17例行增强扫描，肿瘤均有不同程度的强化，其中10例明显强化。肿瘤密度均匀2例，不均匀15例，内部有不同形态的低密度区，其中4例中央有大片低密度坏死，9例合并有颈部淋巴结肿大。结论：面神经受累症状为腮腺恶性肿瘤的临床特点，如肿瘤侵及深，浅二叶时诊断更为可靠；肿物边缘不规则，边界不清楚，明显强化，内部密度不均匀以及颈部淋巴结肿大为腮腺原发恶性肿瘤的影像学特点。     

腮腺多形性腺瘤的CT表现

目的 分析腮腺多形性腺瘤的CT表现，了解其影像特点。资料与方法 分析经手术及病理证实的腮腺多形性腺瘤18例，包括原发良性多形性腺瘤12例，复发4例（其中1例与原发多形性腺瘤重叠），恶性多形性腺瘤3例。结果 12例良性多形性腺瘤中，8例呈圆形或椭圆形，4例呈多结节分叶形，12例肿物均边缘清楚，但密度不均匀，内部有不同形态的低密度区。4例复发肿瘤均为多发，呈多结节、多环形各2例。3例恶性混合瘤肿物轮廓均不规则，边界不清楚，密度不均匀，均可见大片坏死区。结论 边界清楚，肿物内部有不同形态的低密度区为腮腺良性多形性腺瘤的CT特点。肿瘤的边界不清楚，有大片坏死区应考虑恶性多形性腺瘤的可能性，长期腮腺肿物的病史，近期迅速增大有助于诊断。     

Malignant parotid tumors: clinical use of MR imaging and histologic correlation.

Magnetic resonance (MR) imaging was performed in 116 patients in whom a parotid mass lesion was clinically suspected. Eighty-six patients had benign disease. The 30 patients in whom a malignant tumor was found were further evaluated. To determine which features are characteristic of malignant parotid tumors, spin-echo T1- and T2-weighted images of malignant lesions in the parotid gland were compared with those of benign disease. In our series, tumor margins, homogeneity, or signal intensity were not discriminative factors to correctly predict benign or malignant disease. Infiltration into deep structures (eg, the parapharyngeal space, muscles, and bone) was observed only in malignant tumors. Infiltration into subcutaneous fat was noticed in malignant as well as in inflammatory disease. No statistically significant correlation was found between tumor grade and MR imaging features in malignant disease. MR imaging is useful in delineating malignant tumors but is unreliable in correctly predicting the histologic nature of a mass lesion in the parotid gland.     

螺旋CT对腮腺恶性肿瘤的诊断价值

目的:分析腮腺恶性肿瘤的CT表现,以及MPR后处理图像对提高诊断率的价值。方法:分析经我院于术病理证实的腮腺原发恶性肿瘤2 2例,包括粘液表皮样癌9例,腺癌及鳞状细胞癌各4例,腺泡细胞癌3例,恶性混合瘤2例。结果:2 2例中肿物呈圆形及椭圆形8例,不规则形14例,边缘清楚9例(在MPR图像上总能发现边缘毛糙、周围脂肪受侵) ,边缘不清楚13例,肿瘤有不同程度的向周围组织浸润。增强扫描显示肿瘤均有不同程度的强化,其中18例明显强化,薄环状强化伴中央大片低密度坏死5例,肿块呈不规则型强化17例。颈部淋巴结转移11例。临床表现有面神经受累9例,其中6例横断位上下颌后静脉增强扫描显示不清;3例下颌后静脉较清晰可见,但在MPR图像上显示受压变形、移位。结论:面神经受累为腮腺恶性肿瘤的临床特点,肿块边缘不规则、边界不清、有明显强化、内部密度不均匀以及颈部淋巴结肿大为原发腮腺恶性肿瘤影像学特点。     

Warthin's tumor of parotid gland on Tc-99m pertechnetate scintigraphy with lemon juice stimulation: Tc-99m uptake, size, and pathologic correlation

The aim of this study was to evaluate the usefulness of technetium-99m (Tc-99m) pertechnetate scintigraphy with lemon juice stimulation in the diagnosis of Warthin's tumor and its correlation with Tc-99m uptake, tumor size, and histologic subtype. Tc-99m pertechnetate scintigraphy before and after lemon juice stimulation and pathologic specimens of 34 Warthin's tumors and 47 non-Warthin's lesions were retrospectively evaluated. Tc-99m uptake of Warthin's tumors before and after stimulation was visually graded as follows: absent; indeterminate; low grade; definite; and strong. Tumor size was defined as maximum diameter of the tumor measured from the surgical specimen. Warthin's tumors were classified into three histologic subtypes according to the ratio of epithelial and lymphoid stromal components: predominant epithelial; intermediate; and low-grade epithelial types. Eighteen of 34 (53%) Warthin's tumors and one benign lymphoepithelial cyst showed higher uptake than that of the normal parotid gland on Tc-99m scintigraphy before lemon juice stimulation. Thirty-two of the 34 (94%) Warthin's tumors, one benign lymphoepithelial cyst, one pleomorphic adenoma, and one oncocytoma revealed higher uptake than that of the normal parotid gland on Tc-99m scintigraphy after lemon juice stimulation. The mean size was 37 mm in strong uptake Warthin's tumors, 24 mm in definite uptake tumors, 19 mm in low-grade uptake tumors, and 12 mm in low-grade uptake tumors excluding those tumors with large cystic component. There was a significant correlation between tumor size and degree of Tc-99m uptake after lemon juice stimulation. However, there was no correlation between histologic subtype and Tc-99m uptake, and histologic subtype and tumor size in Warthin's tumors. Our study concludes that Tc-99m pertechnetate scintigraphy with lemon juice stimulation is useful for the detection and diagnosis of Warthin's tumor. The degree of uptake in Warthin's tumor on Tc-99m scintigraphy with lemon juice stimulation depends mainly on tumor size and the presence of large cystic component in it.     

腮腺基底细胞腺瘤的CT与MRI表现

目的:探讨腮腺基底细胞腺瘤(BCA)的CT和MRI表现。方法:回顾性分析10例腮腺BCA的CT和MRI表现。10例中男3例,女7例;右侧腮腺4例,左侧6例。结果:10例肿瘤均为单发,肿瘤最长径平均为2.4cm。10例肿瘤中不规则形或深分叶状2例,圆形或类圆形8例;边缘均光滑清楚。MRI检查2例,表现为长T1、短T2信号实性肿块,伴稍低信号包膜,增强扫描后病灶呈均匀明显强化。CT检查8例:6例呈实性,2例呈囊实性、内有大片液化囊变,实性部分明显强化。结论:腮腺BCA的CT和MRI表现有一定特征,结合临床,有助于本病的诊断和鉴别诊断。