合格伦综合征磁共振涎腺造影图像分析

目的：分析舍格伦综合征患者的腮腺磁共振涎腺造影表现、特点及应用价值。方法：应用1．5T超导型全身磁共振扫描仪对32例舍格伦综合征患者进行磁共振涎腺造影检查，获得自旋回波磁共振涎腺造影，对其特点进行观察和总结。结果：在舍格伦综合征患者磁共振成像中可看到点状、球状、腔状及破坏性表现，少数有正常的主导管和分支导管表现；无造影检查所见主导管层状或葱皮状。结论：磁共振涎腺造影可客观、清晰地反映舍格伦综合征患者腮腺主分支导管、腺泡病变，可作为诊断舍格伦综合征的依据之一。     

颌下腺造影对肿瘤诊断价值分析

７８例颌下腺肿瘤造影诊断和术后病理分析，其中良性肿瘤４１例，恶性肿瘤３７例，主要分析肿瘤在颌下腺的主导管，分支导管，腺泡压迫侵犯的造影片表现。结果良恶性肿瘤鉴别，主要区分在恶性肿瘤管、腺泡有不同程度的破坏，造影片显示主导管中断，腺泡不同程度破坏，造影剂外溢。     

涎腺肿瘤中端粒长度及端粒酶活性测定的意义

目的：探讨端粒长度及端粒活性变化在涎腺肿瘤发生中的作用和端粒酶活性水平与涎腺肿瘤生物学行为间的关系。方法：利用TRAP法分别测定35例良性涎腺肿瘤及24例恶性涎腺肿瘤的端粒酶活性，分析其表达情况及与涎腺肿瘤生物学行为间的关系。利用Southern杂交方法测定良，恶性涎腺肿瘤及正常涎腺的端粒长度，并进行统计分析。结果：良性肿瘤端粒酶表达率为17．14％，而恶性肿瘤表达率为90％，5例有触压痛的良性涎腺肿瘤及3例有面神经受累症状的恶性涎腺肿瘤患者均为端粒酶强阳性，35例良性肿瘤中，有32例端粒酶长度是缩短的，有2例长于正常涎腺端粒长度；24例恶性肿瘤中，有15例短于正常涎腺端粒长度，有5例长于正常涎腺端粒长度，有4例处于正常涎腺端粒长度范围内，15例短于正常涎腺端粒长度的恶性涎腺肿瘤均有酶表达，而32例良性肿瘤端粒酶活性表达率为10．34％，结论：端粒缩短并激活端粒酶是涎腺肿瘤形成的重要因素，端粒酶可能会成为涎腺恶性肿瘤的一个新的肿瘤标志物，恶性涎腺肿瘤不良的生物学行为与端粒酶活性水平间有高度相关性。     

小涎腺局灶性增生的临床病理观察

目的：涎腺局灶性增生为发生于口腔小涎腺的少见病，临床常误诊为良性肿瘤或其他病变，为提高临床病理诊断水平，本文进行了总结。方法：复习628例小涎 肿瘤及瘤样病变的病理切片中，有9例属于本病。结果：9例的发生部位以腭部最多见（4／9），其次为上唇（2／9）、颊、磨牙后垫及舌各1例，临床表现增生物较小，为柔软的实性团块，与周围组织之间无明显界限。病理表现为大量粘液腺泡的聚集，腺导管基本正常，无炎症或散在少量慢性炎症细胞，偶见少量腺泡的细胞膜消失，腺泡融合，增生物与周围腺体之间无明显界限。结论：本病临床表现为缓慢增生的肿块，作为准确诊较困难，只有手术后病理检查才能确诊。     

MMP－9在涎腺肿瘤和炎症中的表达及意义

目的：研究MMP－9在涎腺良、恶性肿瘤组织和涎腺炎症疾病中的表达特征及临床指导意义。方法：免疫组化和明胶酶谱法检测MMP－9在涎腺良、恶性肿瘤组织、炎症组织和正常涎腺组织中的表达。结果：MMP－9在涎腺良、恶性肿瘤组织、炎症组织和正常涎腺组织中均有表达,并且在恶性肿瘤中的表达显著高于其它3组（P＜0．05）;涎腺炎症组表达又显著高于良性肿瘤组（P＜0．05）,良性肿瘤组表达显著高于正常组织（P＜0．05）。结论：MMP－9蛋白表达强度与涎腺肿瘤的恶性程度呈正相关;并且涎腺炎症组织中MMP－9表达高于涎腺良性肿瘤,说明MMP－9不仅与肿瘤的侵袭和转移相关,还有可能与肿瘤的发生存在一定的联系。     

涎腺肿瘤中Pax9基因的表达及其意义

目的:检测正常涎腺组织及涎腺肿瘤中转录因子Pax9的表达。方法:采用免疫组化SABC法,研究Pax9在正常涎腺组织、多形性腺瘤、腺淋巴瘤、基底细胞腺瘤、粘液表皮样癌和腺样囊性癌共48例中的表达情况。结果:除1例多形性腺瘤外,其余组织均表达Pax9。正常涎腺的腺泡细胞和导管内衬细胞、多形性腺瘤的上皮细胞、腺淋巴瘤的肿瘤上皮细胞和基底细胞腺瘤中Pax9弱阳性表达,差异没有显著性;而在增殖活跃的细胞如正常涎腺导管的基底细胞和恶性肿瘤细胞(粘液表皮样癌、腺样囊性癌)中表达增强,恶性肿瘤中Pax9的强阳性表达率明显增高,与正常和良性肿瘤相比具有显著差异(P<0.05)。结论:Pax9在涎腺肿瘤尤其是恶性肿瘤的发生过程中发挥重要的作用。     

肌腱抗原在涎腺恶性肿瘤中的表达及意义

目的：检测肌腱抗原（TN）在涎腺肿瘤的表达及作用。方法：应用免疫组化Envision方法检测涎腺慢性炎症8例，良性肿瘤50例。恶性肿瘤57例中TN的表达。结果：在恶性肿瘤中，TN表达强度高于良性肿瘤和慢性炎症组织，低分化组高于高分化组，淋巴结转移组高于无淋巴结转移组，有神经血管侵犯组与无神经血管侵犯组两者无明显差别。结论：在涎腺恶性肿瘤组织中，TN可能调节着涎腺肿瘤上皮细胞的黏附过程，在涎腺肿瘤的发生、发展过程中发挥作用。     

涎腺内窥镜诊断治疗慢性阻塞性涎腺炎的临床研究

目的:探讨涎腺内窥镜诊治慢性阻塞性涎腺炎的临床应用价值.方法:对30例有不明原因涎腺反复肿胀病史的患者,进行临床检查、x线平片、B超检查,对其中22例排除涎石症的患者进行涎腺造影和涎腺内窥镜检查,比较所得结果.对此22例患者应用涎腺内窥镜进行扩张狭窄导管及冲洗治疗,评价涎腺内窥镜疗效.结果:30例患者x线平片发现阳性结石8例.22例涎腺造影检查18例为慢性阻塞性涎腺炎造影表现,4例基本正常,未发现阴性结石.22例涎腺内窥镜检查导管内皆可见纤维样物质、管壁上可见充血点少数出血点、导管口及附近1cm左右较后方狭窄.22例患者导管兼有狭窄和扩张.5侧粘液栓子.1侧阴性结石.追踪观察1～8个月,平均5个月,22例患者中21例患者术后症状明显缓解(有效率95%),只有4例患者复发(复发率18%),但程度及持续时间较前明显减低.结论:涎腺内窥镜能够直接准确诊断导管内阻塞原因,是一种结合了保守疗法和手术疗法优点的有效的诊治合一的微创治疗方法.     

涎腺内镜诊治慢性阻塞性下颌下腺炎14例报道

目的：评价涎腺镜在诊断和治疗慢性阻塞性下颌下腺炎中的价值。方法：对14例临床诊断为慢性阻塞性下颌下腺炎的患者进行涎腺镜检查．了解导管壁和导管内的表现，并同时通过涎腺镜进行相应的治疗，包括液电碎石术、钳取术和套石篮取石术、导管清扫扩张术．将结石或黏液栓子取出。结果：14例患者涎腺镜诊断的阻塞原因分别是：阳性结石10例、阴性结石1例，黏液栓子1例，管壁严重增生2例(其中1例结石嵌入)。11例患者成功应用治疗性涎腺镜取出结石或去除黏液栓子，导管扩张灌洗后阻塞症状消失；3例治疗失败，原因主要为导管增生、结石嵌入。术后无明显并发症发生。结论：涎腺镜能直观地了解涎腺导管内的病变表现，明确导管阻塞原因，并可同时进行相应的治疗，为慢性阻塞性下颌下腺炎的诊断和治疗提供了新的有效方法。     

涎腺恶性肿瘤肿瘤相关物质检测的临床意义

目的探讨血清肿瘤相关物质(TSGF)的检测对涎腺恶性肿瘤诊断的意义。方法以免疫组化法检测82例涎腺恶性肿瘤患者血清的TSGF,并以63例良性肿瘤和51例非肿瘤患者作对照。结果恶性肿瘤患者血清中TSGF水平与非肿瘤组、良性肿瘤组相比差异均有显著性(P<0.01);不同类别恶性肿留患者血清TSGF水平相比差异无显著性(P>0.05);在良性肿瘤与非肿瘤患者之间,差异亦无显著性(P>0.05)。结论血清TSGF检测对于鉴别涎腺肿瘤的良、恶性有一定的参考价值。     

CT sialography and conventional sialography in the investigation of parotid masses

In a 3-year period computed tomography (CT), both plain and in combination with sialography, and conventional sialography were used in 59 patients who had or were suspected of having salivary gland tumors, with special regard to attenuation in different tumors and the tumor borders. The diagnostic information obtained with CT sialography and conventional sialography was evaluated. The most valuable advantage of parotid CT sialography is the possibility of demonstrating the tumor and its actual size and relationship to the surrounding structures. The differentiation between benign and malignant tumors must be based mainly on clinical investigation and fine-needle biopsy. Conventional sialography may be an important complement to CT sialography because of its ability to illustrate the morphology of the finest ducts.     

腮腺造影用于腮腺疾病的诊断112例分析

目的探讨腮腺造影对腮腺疾病的诊断价值。方法回顾性分析112例139个腺体的腮腺造影影像学特征及诊断结果。结果舍格伦综合征38例、儿童复发性腮腺炎27例、慢性阻塞性腮腺炎29例,其影像学表现符合其各自的特征性表现而得到确诊,良性肥大8例中的2例结合B超检查确诊,腮腺肿瘤10例中有2例结合B超检查定性。结论腮腺造影对腮腺非肿瘤性疾病有诊断价值,腮腺肿瘤应结合病史、化验并配合高频超声等其他手段提高诊断准确率。     

The value of sialography in the differential diagnosis of parotid masses

Sialographic manifestations of 82 patients with parotid masses were studied to determine the value of sialography in the differential diagnosis. Multiple filling defects indicate metastatic tumor, tuberculosis and sarcoidosis. The occurrence of calcification suggests tuberculosis or sarcoidosis. The parotid cyst may show the sialographic appearance similar to that of adenolymphoma. The appearance of adenitis of parotid lymph nodes may be similar to that of malignant tumor when the inflammation extends into the parenchyma. Sometimes the appearance of eosinophilic lymphatic granuloma may be similar to that of malignant tumor, but the former is more extensive. The displacement of entire gland suggests extrinsic lesion. Although the displacement of branch ducts may occur in the hypertrophy of parotid, there is no defect in acinar filling. At times it is not easy to differentiate the parotid masses by sialography alone Case histories, results of laboratory and other examines, such as gray scale ultrasound, should be combined to improve the diagnosis.     

Reliability of ultrasonography and sialography in the diagnosis of sjögren's syndrome

Objectives. The purpose of this study was to evaluate quantitatively observer performance with ultrasonography and sialography in the diagnosis of parotid gland involvement of Sjögren's syndrome.Study design. Sixty-four parotid gland sialograms and 65 ultrasonograms were prepared for observer performance experiments. They included both modalities in 24 Sjögren's syndrome and 19 nonspecific parotitis cases, 21 normal parotid gland sialograms, and 22 normal ultrasonograms in healthy volunteers. The images were randomly sequenced and presented to five observers who were asked to describe several findings and finally to determine the imaging diagnosis by ranking the abnormal features and the diagnosis on a five-point-rating scale. Observer performance was evaluated on the basis of the reliability of findings interpreted and the diagnostic accuracy of each modality from observers' rating scores.Results. The diagnostic accuracy of sialography was very high, nearly perfect. The diagnostic accuracy of ultrasonography was lower than that of sialography; resulting from the lower incidence of characteristic findings in the disease groups and lower sensitivity on ultrasonography. In the differentiation of Sjögren's syndrome from the normal, however, the diagnostic accuracy of ultrasonography increased to 80% for all cases, and up to nearly 90% in the advanced sialographic stages.Conclusion. Ultrasonography is useful for the diagnosis of Sjögren's syndrome in the advanced stages. Taking the noninvasiveness of this technique into account, we recommend first applying ultrasonography to the diagnosis of Sjögren's syndrome and performing sialography when no positive findings are detected on ultrasonography.     

The value of sialography in the diagnosis of parotid tumors

Sialographic manifestations of 442 patients with primary parotid tumors, 336 benign and 106 malignant, were studied. The sialographic appearance were divided into five types: benign, aggressive benign, low-grade malignant, malignant, and adenolymphoma. The overall corresponding rate between roentgenographic and histologic diagnosis was 81.9%, benign tumors was 89.3, malignant tumors 58.5%, and adenolymphoma 88.9%. Irregular-arrangement, dilation and narrow of branch ducts were the characteristics of adenolymphoma. Extension of main duct, smooth defect of posterior border of mandibular ramus, posterior displace of styloid process, and filling defect of branch ducts and acini in the pterygomandibular space were seen in deep lobe parotid tumors. The causes of mistaken, and the value of sialography were discussed.     

涎腺疾病导管系统的磁共振水成像研究

目的应用磁共振水成像术(MRH)衍生的磁共振涎管成像术(MRS)对涎腺病变导管系统变化进行观察。方法对33例涎腺病变患者进行MRS,采用4种序列显示腮腺导管系统,然后给患者含服维生素C,分别于3min和10min后再次扫描,比较腮腺导管系统的显示效果。结果IR-FSE序列较FSE腮腺导管显示效果明显提高(P<0.05),服药后腮腺导管显示效果有一定的提高(P>0.05)。结论MRS对腮腺导管系统显像良好,具有简单、无创、安全等优点,能提供全面、立体的腮腺病变信息。     

Virtual endoscopic view of salivary gland ducts using MR sialography data from three dimension fast asymmetric spin-echo (3D-FASE) sequences: a preliminary study

OBJECTIVES: We performed magnetic resonance (MR) sialography of parotid gland and/or submandibular gland ducts using three-dimensional fast asymmetric spin-echo (3D-FASE) sequencing. The objective was to make three-dimensional (3D) reconstruction images and virtual endoscopic views of the parotid gland ducts using MR sialography data sets of 3D-FASE sequences. METHODS: We reviewed the MR sialography data sets with 3D-FASE sequencing of 10 control volunteers and six patients. Three-dimensional reconstruction images and virtual endoscopic views of the parotid gland and/or submandibular gland ducts were generated with maximum intensity projection (MIP), shaded surface display (SSD), and volume rendering techniques (VRT). RESULTS: The main parotid gland and/or submandibular gland ducts, large branches within the glands, and small branches were fairly well defined in a very short acquisition time on MR sialographic images with 3D-FASE sequencing in nine of the 10 healthy volunteers. The 3D-reconstruction images of the parotid gland ducts and/or submandibular gland ducts showed the entire length of the branch paths and complete images from all angles, and the virtual endoscopic views showed the endoluminal tracts of the main ducts and the large branches in nine. In the patient with Sjogren's syndrome, chronic sialoadenitis, and salivary calculi in the Wharton ducts, the MR sialographic images showed diffuse areas of punctate high signal intensity, dilatation of Stensen's duct, or stones of Wharton's duct, respectively. Furthermore, the 3D-reconstruction images of the salivary gland ducts showed the stenoses and stones in the branch paths and complete images from all angles, and the virtual endoscopic views showed the stenoses and stones in the endoluminal tracts of the main and large branches. CONCLUSIONS: Our initial experience showed that virtual MR endoscopy could be performed to observe the endoluminal tracts of parotid and submandibular glands. The clinical use of the virtual MR endoscopy for salivary gland ducts has not been established yet. Future applications of the 3D-reconstruction images and virtual endoscopic views using MR sialography data sets of 3D-FASE sequences are very attractive and further expansion of this field is expected.     

磁共振腮腺导管成像术对慢性阻塞性腮腺炎的诊断价值

目的 评价磁共振腮腺导管成像术(MRS)对慢性阻塞性嘿腺炎（COP）的诊断价值：方法：18例患者在经X线腮腺造影检查，确诊为慢性阻塞性腮腺炎后，再行磁共振检查。磁共振检查采用重T2加权序列TR=4000ms．TE=250ms)及快速自旋回波水成像技术并做最大信号强度投影(MIP)处理，获得腮腺导管的成像图像(MRS)，比较X线腮腺造影和MRS对慢性阻塞性腮腺炎的诊断准确率。结果：MRS可显示哩腺的主导管和一级分支导管．对COP的定性诊断准确率为94．4％(17/18)，定位诊断准确率达100%(17/17)。结论：MRS可成功地用于腮腺的导管系统检查，具有无创性特点，在慢性阻塞性腮腺炎的诊断中，有望取代部分创伤性憾腺造影检查。     

腮腺导管磁共振成像研究

目的　探讨磁共振腮腺导管成像术用于诊断腮腺疾病的可行性 ,并筛选出可获得最佳显示效果的扫描序列。方法　采用 4种不同的扫描序列 ,对 2 3例腮腺疾病患者 (病变组 )及 5名健康志愿者 (对照组 )行磁共振腮腺导管成像。首次扫描后 ,患者含化VitC 2 0 0mg ,于含药后 3、10min再次扫描 ,将所获图像按腮腺导管及其分支显示效果分级 ,比较各扫描序列及服药前后的显示效果。并依据图像对疾病定性诊断 ,将诊断结果与术后病理诊断结果比较。结果　磁共振腮腺导管成像能清楚地显示腮腺主导管、叶间导管、小叶间导管及小叶内导管 ,清楚显示导管有无狭窄、扩张、导管中断及破坏的情况 ,对疾病定性诊断的准确率为 95 6 %。扫描序列中 ,以IR FSE序列的显示效果最佳 ,与FSE比较 ,效果明显提高 (P <0 0 5 )。含服VitC并不显著提高显示效果 (P >0 0 5 )。结论　磁共振腮腺导管成像能清晰显示腮腺导管及其病理改变 ,对腮腺疾病的定性诊断准确率高于普通腮腺造影术。其中IR FSE脂肪抑制序列的显示效果最好 ,可作为腮腺导管X线造影的替代方法应用于临床     

Combined diagnosis of parotid masses

Computed tomography (CT), ultrasonography, sialography, and 99mTc scintigraphy were applied before operation to 108 patients with parotid masses. The results of each technique and the combined study of them were compared with the pathological diagnosis. Ultrasonography was found to be a very effective diagnostic aid in determining the presence of space-occupying lesion in the parotid. CT was the best technique to provide adequately reliable informations regarding the location of the tumor and the relationship between tumor and surrounding tissues. For diagnosing the nature of tumors, ultrasonography combined with sialography was reliable. 99mTc scintigraphy was better than other techniques in diagnosis of adenolymphoma. The diagnostic accuracy of combined diagnosis (90.7%) was higher than those of ultrasonography (83%), CT (80.5%), sialography (79%), and 99mTc scintigraphy (13.9%) alone. The advantage of combined diagnosis was particularly obvious for the diagnosis of low-grade malignant tumors.