超声检查在IgG4相关唾液腺病变诊断中的应用

目的： 探讨IgG4相关唾液腺病变的超声声像图表现,以提高超声科医师对本病的认识。方法：经临床血清学检验及组织病理确诊（手术10例,超声引导下穿刺活检15例）,对25例IgG4相关唾液腺病变的超声声像图进行回顾性分析,包括病变腺体的形态、边界,内部回声,血流分布,腺管有无扩张,腺管内有无结石,邻近有无淋巴结肿大。对比分析14例甾体类药物治疗3个月后的超声声像图改变。结果：25例IgG4相关唾液腺病变患者平均年龄64.5岁,男女比例4∶1。病变位于下颌下腺（20例）、腮腺（5例）。超声表现：① 弥漫性改变10例（9例双侧,1例单侧）,形态饱满,腺体回声偏低,呈网格状改变,3例腺管扩张,2例伴腺管内结石,彩色多普勒显示唾液腺腺体内血管增多,血流丰富;② 局灶性改变15例（14例单侧,1例双侧）,呈不均质偏低回声“肿块”,“肿块”内血流呈放射状分布。③下颌下淋巴结病变8例,4例经穿刺确诊,4例疑似。④ 甾体类药物治疗后,肿大的唾液腺逐渐恢复,局灶性病灶逐渐变小,病变内血流分布减少。结论：认识IgG4相关唾液腺病变的超声图像表现,可以有效辅助临床诊断与治疗后随访,避免不必要的手术风险。

The value of ultrasound in diagnosis of IgG4-related sialadenitis

PURPOSE: To study the ultrasonic manifestation of IgG4-related sialadenitis, and improve sonographers’ understanding of this disease. METHODS: Based on the clinical serological test and histopathologic diagnosis, the features were evaluated by sonography in 25 cases of IgG4-related sialadenitis, including the shape and border of the gland, internal echo texture, presence and distribution of vascularity, duct dilatation, presence/absence of calculi and submandibular lymph nodes. The changes on ultrasonography in 14 patients with IgG4-related sialadenitis before and after steroid treatment were evaluated. RESULTS: There were 20 men and 5 women ranging between 42-89 years old with an average age of 64.5 years old. The sites of involvement were submandibular gland (20 cases) and parotid gland (5 cases). Of the 10 patients with diffuse involvement, the lesions showed bilateral symmetrical distribution in 9 patients and unilateral involvement in 1 patient with multiple hypoechoic lesions against a heterogeneous background. The ducts were dilated in 3 patients, and had calculus in 2 patients. Doppler sonography in all patients with diffuse involvement of the gland showed prominent intraglandular vessels. Of the 15 patients with focal involvement, 14 patients showed unilateral involvement and only one showed bilateral involvement of the submandibular gland with hypoechoic heterogeneous. The vessels showed a radial pattern within the lesions. There were definite submandibular lymph nodes involvement by IgG4-related disease in 4 of the 8 patients. After steroid treatment, the prominent sonographic feature of IgG4-related sialadenitis gradually receded. CONCLUSIONS: Sonologist must be aware of sonographic appearances in patients with IgG4-related sialadenitis, which can help correct diagnosis and treatment.