超声造影对腮腺多形性腺瘤与腺淋巴瘤的鉴别诊断价值

目的分析腮腺多形性腺瘤与腺淋巴瘤的超声造影特征及超声造影参数差异,探讨超声造影在腮腺多形性腺瘤与腺淋巴瘤鉴别诊断中的价值。方法25例腮腺多形性腺瘤患者为多形性腺瘤组,34例腺淋巴瘤患者为腺淋巴瘤组,均行超声造影检查。记录2组造影特征;对2组肿块进行时间-强度曲线分析,获得定量分析参数包括达峰时间、峰值强度、峰值半降时间、曲线下面积;绘制ROC曲线,评价峰值强度、峰值半降时间鉴别诊断腮腺多形性腺瘤与腺淋巴瘤的效能。结果腮腺多形性腺瘤超声造影表现为"等进等退等增强",腺淋巴瘤超声造影表现为"等进慢退高增强";多形性腺瘤组增强边界清晰、有增强环、增强后肿块范围增大比率(80.00%、72.00%、16.00%)与腺淋巴瘤组(89.19%、83.78%、10.81%)比较差异均无统计学意义(P>0.05)。多形性腺瘤组峰值强度(11.73±4.86)dB]、曲线下面积(1906.11±212.14)dB.s]低于腺淋巴瘤组(19.59±3.42)dB、(4247.84±418.75)dB.s](P<0.05),峰值半降时间(38.99±7.13)s]短于腺淋巴瘤组(57.92±7.34)s](P<0.05),达峰时间(16.10±2.39)s]与腺淋巴瘤组(16.41±2.38)s]比较差异无统计学意义(P>0.05)。ROC曲线分析结果显示,峰值半降时间以48.17 s为最佳截断值,鉴别诊断腮腺多形性腺瘤与腺淋巴瘤的AUC为0.96(95%CI:0.92~1.00,P<0.001),灵敏度为89.2%,特异度为88.0%;峰值强度以13.89 dB为最佳截断值,鉴别诊断腮腺多形性腺瘤与腺淋巴瘤的AUC为0.88(95%CI:0.80~0.97,P<0.001),灵敏度为97.3%,特异度为64.0%。结论腮腺多形性腺瘤与腺淋巴瘤具有不同的超声造影特征,超声造影参数中峰值半降时间、峰值强度在二者的鉴别诊断中有较高价值。

Value of contrast-enhanced ultrasound to the differential diagnosis of parotid gland pleomorphic adenoma and adenolymphoma

Objective To investigate the value of contrast-enhanced ultrasound(CEUS)to the differential diagnosis of parotid gland pleomorphic adenoma(PA)and adenolymphoma(AL)by analyzing their CEUS features and CEUS parameter differences.Methods CEUS was performed in 25 patients with PA(PA group)and 34 patients with AL(AL group).The CEUS features were recorded.The time-intensity curve(TIC)was analyzed in two groups to obtain time to peak(TTP),peak intensity(PI),time from peak to one half(TFP)and area under the curve(AUC).ROC was drawn to assess the efficacies of PI and TFP on the differential diagnosis of PA and AL.Results CEUS showed"identical in,identical out and identical enhancement"in PA group,and"identical in,slow out and hyper-enhancement"in AL group.There were no significant differences between two groups in the enhancement boundary,enhancement ring and the size of the mass after enhancement(80.00%vs.89.19%,72.00%vs.83.78%,16.00%vs.10.81%)(P>0.05).The PI and AUC were lower in PA group((11.73±4.86)dB,(1906.11±212.14)dB.s)than those in AL group((19.59±3.42)dB,(4247.84±418.75)dB.s),TFP was shorter in PA group((38.99±7.13)s)than that in AL group((57.92±7.34)s)(P<0.05),and TTP showed no significant difference between two groups((16.10±2.39)s vs.(16.41±2.38)s)(P>0.05).ROC analysis showed that when the optimal cut-off value of TFP was 48.17 s,the AUC for differential diagnosis of PA and AL was 0.96(95%CI:0.92-1.00,P<0.001),the sensitivity was 89.2%,and the specificity was 88.0%;when the optimal cut-off value of PI was 13.89 dB,the AUC was 0.88(95%CI:0.80-0.97,P<0.001),the sensitivity was 97.3%,and the specificity was 64.0%.Conclusion PA and AL have different CEUS features.TFP and PI have high diagnostic efficacies on the differential diagnosis of PA and AL.