常规MRI联合DWI在腮腺常见肿瘤中的诊断价值

目的:探讨常规MRI联合DWI对腮腺常见肿瘤的诊断价值。方法:回顾性分析经病理证实的62例腮腺肿瘤的MRI图像,根据其DWI图行ADC图重建,测量肿瘤的ADC值。按发病率将62例病例分成3组:多形性腺瘤、腺淋巴瘤、恶性肿瘤。多形性腺瘤31例,全部单发;腺淋巴瘤19例,9例单发,10例多发,共30个病灶;恶性肿瘤12例,3例淋巴瘤多发,其余均为单发,共18个病灶。比较分析3种肿瘤的ADC值。结果:多形性腺瘤和腺淋巴瘤多发生于腮腺浅叶(43个,70.5%),肿瘤边界多清楚,体积一般较恶性肿瘤小;恶性肿瘤位于深叶者8个(44.4%),边界清楚或不清楚,多伴有颈部淋巴结肿大(10例,83.3%)。多形性腺瘤及恶性肿瘤平均ADC值均高于腺淋巴瘤(P=0.000、0.002),且多形性腺瘤平均ADC值高于恶性肿瘤(P=0.001)。结论:腮腺肿瘤的常规MRI征象具有一定特点,联合DWI能为腮腺常见肿瘤的诊断及鉴别诊断提供更多依据。     

MRI in the diagnosis of tumors of the parotid gland]

Tumors of the parotid gland are easily depicted with magnetic resonance imaging. Their exact site, and extension in the case of a malignant tumor, are correctly predicted. The histologic nature of the lesion remains to be verified by histologic examination. MRI is invaluable for the detection of recurrent pleomorphic adenomas.     

Value of sialography in the diagnosis of parotid and submandibular gland tumors

40 patients clinically suspected of a tumor of the parotid gland, and 2 patients suspected of tumor of the glandula submandibular, were subjected to fractionated sialography at the Radiological Clinic of Münster University in the course of five years. In 31 cases (74%), the tumor was confirmed. In 11 patients (26%) no suspicion of tumour was possible even on retrospective examination of the x-ray films. Hence, the value of sialography is more in the direction of pre-operative exclusion of other types of disease, especially of stone formation. However, it is to be expected that the introduction of axial CT sialography will significantly improve the accuracy of tumour diagnosis, because this method enables examination and assessment of the glandular parenchyma besides an examination of the parotid duct.     

腮腺内表皮样囊肿的MRI及DWI表现

表皮样囊肿(epidermoid cyst,EC)是起源于外胚层组织的良性囊肿,又称表皮囊肿、表皮包涵囊肿、漏斗形囊肿、角蛋白囊肿、上皮囊肿或珍珠瘤.EC可发生在身体各处,是常见的皮肤病变,据报道EC在头颈部的发病率可达1.6%~6.9%[1],常见于口底、颏下、眼睑、额、鼻、眶外侧及耳下等部位,多位于黏膜、皮肤深处或口底诸肌之间,国内外有少数报道发生在下颌骨内、颞骨、颈深部、硬腭等部位.原发于涎腺的EC更罕见,目前仅有少数病例报道原发于颌下腺的EC[2],极少数个案报道原发于腮腺的EC[3].腮腺EC十分罕见,未在世界卫生组织(WHO)中进行分类[4],因此诊断困难,常被误诊为腮腺囊肿、肿瘤及其他囊性病变[5].手术切除是唯一治疗方法,能够获得准确的术前诊断非常重要,对患者进行相关检查必不可少.MRI具有较高的软组织分辨率,优于其他影像学检查方法.扩散加权成像(diffusion weighted imaging,DWI)是目前在活体上进行水分子扩散测量与成像的唯一方法,已广泛应用于各部位的检查,至今,国内外对腮腺EC的MRI及DWI相关报道较少.笔者对3例手术证实的腮腺EC进行回顾性分析,并对相关文献进行复习,旨在探讨该病的MRI及DWI影像表现,有助于获得准确的术前诊断.     

Value of apparent diffusion coefficient calculation in the differential diagnosis of parotid gland tumors

Background: The differential diagnosis of parotid gland tumors is often difficult with conventional magnetic resonance imaging.

Purpose: To determine whether the calculation of the apparent diffusion coefficient (ADC) is valuable for making the differential diagnosis of parotid tumors.

Material and Methods: Thirty parotid masses in 28 patients and 24 healthy parotid glands in 12 controls were examined in this prospective study. Diffusion-weighted magnetic resonance imaging with echo-planar spin-echo sequences was used to evaluate each subject. The ADC of each tumor and each healthy parotid gland was calculated. Tumor diagnoses were confirmed by the results of histopathologic analysis.

Results: The following types of masses were identified: 11 Warthin tumors, nine pleomorphic adenomas, seven malignant tumors, one basal cell adenoma, and two benign cysts. The mean ADC value for the Warthin tumors was 0.97±0.16×10^-3 mm²/s, for the pleomorphic adenomas was 1.74±0.37×10^-3 mm²/s, for the malignant tumors was 1.04±0.35×10^-3 mm²/s, and for the normal parotid glands was 0.34±0.20×10^-3 mm²/s. The respective ADC value for the single basal cell adenoma was 1.40×10^-3 mm²/s. Statistically significant differences were identified between the subjects with pleomorphic adenoma and those with another type of parotid tumor, and between subjects with healthy parotid glands and those with a tumor.

Conclusion: Calculating the ADC appears to be useful in differentiating pleomorphic adenomas from other types of parotid gland tumors.     

DWI联合常规MR扫描对肛瘘的诊断价值

目的:评价DWI联合常规MR扫描对肛瘘的诊断价值.方法:选取20例临床怀疑肛瘘或有肛瘘手术史患者行常规MR扫描及DWI检查,比较肛瘘内、外瘘口,瘘管分支及脓肿的显示率.结果:常规MR扫描序列共显示瘘管22个、内口14个、外口22个、脓肿14个;DWI检查共显示瘘管25个、内口16个、外口23个、脓肿17个.结论:DWI...     

DWI联合Fischer评分法对乳腺良恶性肿块的鉴别

目的:探讨DWI联合Fischer评分法对乳腺良恶性肿块的鉴别诊断价值。方法:回顾性分析42例经DWI与Fis-cher评分法诊断的乳腺肿块,计算各方法的诊断敏感性、特异性、准确性。结果:恶性病灶的ADC值较良性病灶降低,但其鉴别良恶性病灶的敏感性较低。时间-信号强度曲线中的Ⅲ型曲线多考虑为恶性,但良恶性病灶均可出现Ⅱ型曲线。结论:研究显示,DWI联合Fischer评分法对乳腺良恶性病灶的鉴别诊断具有较高的敏感性和特异性,能够提高乳腺癌的诊断准确率。     

腮腺肿瘤的CT及MRI诊断及鉴别诊断

目的：探讨腮腺肿瘤的CT及MRI表现,旨在提高对腮腺肿瘤的诊断水平。方法：回顾性分析经病理证实的90例腮腺肿瘤的CT及MRI的表现。结果：90例腮腺肿瘤中,良性肿瘤74例（82.2%）,恶性肿瘤16例（17.8%）。在CT/MRI上,良性肿瘤大部分表现为位于腮腺浅叶的圆形、椭圆形软组织肿块,边缘光整,密度/信号均匀;而恶性肿瘤,大部分位于腮腺深叶或跨叶,表现为不规则形软组织肿块,边缘不清,密度/信号不均匀,侵犯周围组织并伴淋巴结转移。结论：CT和MRI检查均能对腮腺肿瘤进行有效定位,并对诊断及鉴别诊断具有一定价值。     

MRDWI序列对脑弥漫性轴索损伤的诊断价值研究

目的探讨MRI对脑弥漫性轴索损伤的的诊断价值。方法对经临床确诊的36例DAI患者行常规MRI快速自旋回波（TSE）T2WI、流动衰减反转恢复序列（FLAIR）和扩散加权成像（DWI）序列扫描,比较各序列的病灶显示率。结果DWI序列的阳性率为91．67％（33／36）,TSET2WI序列的阳性率为77．78％（28／36）,FLAIR序列的阳性率为83．33％（30／36）,DWI序列阳性率明显高于TSET2WI序列（P〈0．05）和FLAIR序列（P〈0．05）。结论应用DWI序列对急性DAI较TSETzwI和FLAIR序列有更高的敏感性。     

涎腺肿瘤的CT及MRI诊断

目的 探讨涎腺肿瘤的CT及MRI表现特点.方法 回顾性分析经手术及病理证实的78例涎腺肿瘤的CT及MRI影像学特征,包括病变部位、大小、形态、边界、密度或信号、与下颌后静脉或软硬腭的关系.结果 涎腺良性肿瘤51例,恶性肿瘤27例.其中腮腺肿瘤58例(良性40例,恶性18例);小涎腺肿瘤16例(良性11例,恶性5例);2例颌下腺恶性肿瘤及2例舌下腺恶性肿瘤.40例腮腺良性肿瘤中29例(72.5%)位于浅叶,小涎腺良性肿瘤全部位于硬腭.良性肿瘤形态规则,边界清晰,CT平扫密度均匀或MR平扫信号均匀,强化明显,腮腺良性肿瘤与下颌后静脉有间隔,小涎腺良性肿瘤硬腭有受压缺损.18例腮腺恶性肿瘤中12例(66.7%)位于深叶,形态不规则,边界不清晰,CT平扫密度不均匀或MR平扫信号不均匀,不均匀强化,常包绕下颌后静脉,小涎腺恶性肿瘤破坏软硬腭.结论 CT及MRI对涎腺肿瘤的诊断及鉴别诊断具有重要价值.     

DWI结合常规MRI在侵袭性纤维瘤病诊断中的应用

目的：探讨DWI结合常规MRI对侵袭性纤维瘤病的诊断价值。方法：回顾性分析经病理证实的11例侵袭性纤维瘤病（共12个病灶）的MRI表现,其中6个病灶行DWI扫描。结果：12个病灶均以等T1、稍长T2信号为主,夹杂较丰富的低信号,均呈肌肉及其筋膜间隙塑型样表现,9个病灶向相邻肌肉内蔓延形成肌束样、羽毛状强化影。行DWI扫描的6个病灶呈高信号,ADC图上信号呈等或稍高于肌肉信号。结论：侵袭性纤维瘤病的MRI表现具有一定特征。DWI结合常规MRI不仅能够提高本病的定性诊断能力,而且能够更全面细致地勾勒病灶范围及边界。     

CT灌注成像在腮腺肿瘤鉴别诊断中的临床价值

目的探讨多层螺旋CT灌注成像技术定量评价腮腺良、恶性肿瘤的血液动力学特点及其对腮腺良恶性肿瘤的鉴别诊断价值。方法53例患者共57个病变，其中良性肿瘤35例，恶性肿瘤18例，全部经术后病理证实。术前行CT灌注检查。采用Philips perfusion功能软件包获取组织的时间密度曲线（time density calve，TDC）及CT灌注参数，包括灌注量、增强峰值（PH）、达峰时间（TTP）、血容量（BV）、平均通过时间（MTT）。采用Wilcoxon符号秩和检验进行统计学处理。结果腮腺良性肿瘤的CT灌注参数的中位数及四分位间距[25％CI 75％（Q1，Q2）]分别为：灌注量73．5（18．7，113．3）ml·100g^-1·min^-1、PH 34．5（17．7，53．1）HU、TTP 20．0（13．6，34．4）S、BV 38．5（29．1，63．3）ml·100g^-1、MTT 7．6（4．5，28．7）s。腮腺恶性肿瘤的CT灌注参数分别为：灌注量135．9（101．4，195．2）ml·100g^-1·min^-1，PH 49．1（32．7，59．4）HU，TTP 12．9（11．3，14．6）s，BV 67．5（52．4，109．5）ml·100g^-1，MTT 6．0（5．1，7．6）s。统计结果显示，CT灌注参数BF、BV、TTP的中位数及四分位间距在腮腺良恶性肿瘤之间差异具有统计学意义（P值均〈0．05），而PH、及MTT之间差异无统计学意义（P〉0．05）；腺淋巴瘤、其他良性肿瘤、恶性肿瘤的TDC的差异也有统计学意义（P值均〈0．05）。结论CT灌注扫描技术对腮腺良恶性肿瘤的鉴别诊断具有一定价值。     

MRI对合并子宫内膜病变的卵巢肿瘤的诊断价值

目的探讨MRI对合并子宫内膜病变的卵巢肿瘤的诊断价值。方法回顾性分析27例经病理证实的合并子宫内膜病变的卵巢肿瘤患者的临床特征及MRI表现。结果27例卵巢肿瘤患者中,卵巢颗粒细胞瘤6例,其中2例(2/6)合并子宫内膜增生,3例(3/6)合并子宫内膜息肉,1例(1/6)合并子宫内膜浆液性癌;卵泡膜纤维瘤15例,其中9例(9/15)合并子宫内膜增生,5例(5/15)合并子宫内膜息肉,1例(1/15)合并子宫内膜浆液性癌;卵巢子宫内膜样癌6例,其中2例(2/6)合并子宫内膜增生,4例(4/6)合并子宫内膜样癌。27例患者卵巢肿瘤的MRI特点卵巢颗粒细胞瘤表现为附件区囊实性占位,具有海绵样外观;卵泡膜纤维瘤T1WI及T2WI常呈等低信号;卵巢子宫内膜样癌常表现为盆腔内体积较大的带有壁结节的囊实性肿块,增强扫描表现为“火焰征”。结论卵巢颗粒细胞瘤、卵泡膜纤维瘤及卵巢子宫内膜样癌均可同时合并子宫内膜病变,它们的MRI表现具有一定特征性,当MRI检查发现卵巢肿瘤与子宫内膜病变并存时,根据其影像特点,能够作出较明确的诊断。     

磁共振弥散加权成像联合CTA对基底动脉尖综合征(TOBS)的诊断价值

目的:总结MRI弥散加权成像(DWI)序列对基底动脉尖综合征的诊断价值,运用CTA技术探寻TOBS的发病原因。方法:回顾性分析26列TOBS患者的常规MRI和DWI影像资料以及21例TOBS患者的椎-基底动脉CTA表现,对比不同MR序列对病灶的发现率及病灶的分布范围,分析椎-基动脉血管结构有否病变。结果:梗塞灶呈多发性分布于双侧丘脑、中脑、小脑、枕叶及颞叶内侧,26例TOBS患者DWI共发现183个病灶,远较T2WI发现的136个病灶为多(134.6%),其中呈对称性分布者21例(80.8%),另5例(19.2%)呈单侧分布。21例行CTA检查患者中14例(66.7%)有椎基底动脉形态异常,其中2例基底动脉瘤,3例椎动脉瘤,7例椎-基底动脉壁存在粥样硬化斑。结论:弥散加权成像(DW)是早期诊断TOBS的最敏感影像检查技术,CTA可追溯TOBS的部分栓塞原因,两者结合可加强TOBS的病因诊断。     

Vascular lesions of parotid gland in adult patients: diagnosis with high-resolution ultrasound and MRI

Three adult patients with rare vascular lesions in the parotid gland including pseudoaneurysm, arteriovenous fistula and haemangioma are discussed. All patients presented with non-specific unilateral parotid mass. In all cases high-resolution ultrasound and MRI allowed accurate diagnosis and delineation of the extent of lesion. Conventional angiogram was utilized for planning definitive surgical or endovascular treatment.     

Value of diffusion tensor imaging in differentiating malignant from benign parotid gland tumors

PurposeTo evaluate whether diffusion tensor imaging (DTI) can be used to differentiate malignant parotid gland tumors from the benign ones.Materials and methodsThe study population comprised 59 parotid gland tumors (24 Warthin’s tumors, 19 pleomorphic adenomas, seven other benign tumors, and nine malignant tumors). Single-shot echo-planar DTI was performed with motion-probing gradients along 30 noncollinear directions (b = 1000 s/mm²) at 3.0 T. Apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values for benign and malignant tumors were compared using the Mann–Whitney U test. Receiver-operating characteristic (ROC) curve analysis was performed to assess the ability of the ADC and FA values to differentiate malignant tumors from the benign ones.ResultsADC values showed no significant difference between malignant (0.93 ± 0.21 × 10⁻³ mm²/s) and benign tumors (1.19 ± 0.50 × 10⁻³ mm²/s) (p = 0.225). FA values of malignant tumors were significantly higher than those of benign tumors (0.26 ± 0.06 vs. 0.17 ± 0.05, p < 0.001). The area under the ROC curve of FA was significantly greater than that under the curve of ADC (0.884 vs. 0.628, p = 0.010).ConclusionsDTI, particularly FA, can help differentiate malignant parotid gland tumors from the benign ones.     

Diagnosis of tumors of the parotid gland with anti-CEA immunoscintigraphy

Twenty-nine consecutive patients with a palpable unilateral tumor in the parotid gland region had scintigraphy 22-28 hr after they were injected with 111In-labeled monoclonal anti-carcinoembryonic antigen (CEA) antibody (F023C5). Two patients were imaged at 48 hr also, and one patient was imaged additionally with single-photon emission CT. Twenty-seven of the patients had surgery within 2-3 weeks. The serum CEA concentrations were normal in 27 of 29 patients. Immunoglobulin G human anti-murine-antibody concentrations were elevated in three of 20 patients. Ten patients had scintigraphic findings suggesting a malignant tumor, six of them had histologically proved malignant tumors. The tumors associated with positive immunoscintigrams were stained immunohistochemically with anti-CEA, and four of the malignant tumors were positive in immunohistochemical staining. The results suggest that nonspecific anti-CEA-antibody imaging is helpful in predicting the presence of a malignant tumor in the parotid area. The radioantibody method could provide useful clinical information that has a high negative predictive value.     

干燥综合征的腮腺MRI表现

目的探讨干燥综合征患者的腮腺MRI表现。方法对7例临床确诊为干燥综合征的患者行3.0TMRI检查,MRI扫描序列包括平扫轴位T1WI、T2脂肪抑制序列、冠状位及腮腺导管水成像序列,对各采集图像进行分析。结果7例患者双侧腮腺均有不同程度肿大,与正常腮腺MRI信号对比,7例患者的腮腺T1WI均表现为信号减低,并见弥漫分布大小不等点状、结节状低信号影,T2WI表现为腮腺信号增高,伴有弥漫分布的点状、结节状高信号影,T2WI冠状位压脂序列除能显示腮腺形态、信号改变外,另外能很好显示颈部淋巴结增大情况,本组7例均出现颈部多发淋巴结肿大,于T2WI压脂序列上呈较高信号。腮腺水成像显示,本组中1例表现为双侧腮腺主导管、分支导管管腔串珠状扩张及末梢导管球囊状扩张,6例仅表现为末梢导管点状、球囊状扩张,而主导管及分支导管形态正常。结论 MRI能很好的显示干燥综合征的腮腺形态和信号的改变,腮腺导管水成像是利用唾液天然对比剂功能而进行的一种无创性涎管造影检查,能很直观反映腮腺各级导管扩张的情况,从而能帮助临床对患者腮腺唾液的分泌及排空功能做一个很好的评估。     

DWI联合MRI动态增强扫描对子宫内膜癌术前分期的诊断价值

目的：探讨DWI联合MRI动态增强扫描（DCE-MRI）判断子宫内膜癌肌层浸润深度及术前分期的准确性,为合理选择手术方式及预后评估提供依据。方法：选择54例子宫内膜癌作为观察对象,通过DWI联合DCE-MRI表现区分肌层浸润深度及临床分期,并与术后病理结果进行对照。结果：54例经DWI联合DCE-MRI发现47例肌层浸润,诊断准确率为95.9%（47/49）,其中30例浅肌层浸润,诊断准确率为96.8%,17例深肌层浸润,诊断准确率为94.4%,2例误判均为低判。DWI联合DCE-MRI诊断深肌层浸润的敏感度为94.4%（17/18）,特异度为96.8%（30/31）;经DWI联合DCE-MRI,51例术前分期明确,准确率为94.4%（51/54）,3例误判中2例低判,1例高判,与术后病理结果一致性较好（χ²=3.085,P=0.079,K=0.92）。结论：DWI联合DCE-MRI能够较好地判断子宫内膜肌层的浸润深度及病理分期,具有较高的诊断敏感度和特异度,对子宫内膜癌患者的病情评估具有非常重要的价值,可为手术方式的选择及预后判断提供可靠依据。     

腮腺Warthin瘤的多层螺旋CT表现

目的 探讨腮腺Warthin瘤的多层螺旋CT表现特点.方法 搜集手术及病理证实的腮腺Warthin瘤16例,分析其部位、数目、大小、形态、边界、密度、强化特征.结果 16例共见21个病灶,左侧9个、右侧12个;浅叶18个,后下象限16个;病灶呈圆形或类圆形,平均直径2.5 cm;囊变14个;边界清楚19个;动态增强扫描病变显示为对比剂“快进快出”13例,3例显示延迟强化,5例见微血管征;同侧腮腺炎性反应1例,同侧颈部淋巴结肿大1例.结论 密切结合腮腺Warthin瘤临床表现特点及在多层螺旋CT表现,可对该病做出正确的诊断.