王 芳,王 慧,張?jiān)魄?/p>
不同類型腮腺少見腫瘤的增強(qiáng)CT表現(xiàn)特征
王芳,王慧,張?jiān)魄?/p>
目的分析腮腺少見腫瘤的增強(qiáng)CT表現(xiàn)特征,為臨床診療提供參考。方法采取回顧性研究方法,選取我院收治的70例腮腺少見腫瘤患者作為研究對(duì)象,分析不同病理學(xué)類型腫瘤在增強(qiáng)CT圖上的病變位置、大小、形態(tài)、密度以及與周圍結(jié)構(gòu)之間的關(guān)系。結(jié)果本組70例中,確診有3例軟骨肉瘤(以囊性為主且含邊緣鈣化成分的腫塊),12例肌細(xì)胞上皮瘤(多發(fā)于腮腺淺葉,少數(shù)病變可見鈣化),15例脈管瘤(密度均勻或者不均勻、突出于腮腺表面),25例基底細(xì)胞瘤(多發(fā)于腮腺淺葉、病變內(nèi)易見囊變,增強(qiáng)CT掃描可伴有增大的淋巴結(jié)),8例淋巴上皮囊腫(CT值密度比較高、囊液較為黏稠),7例腮腺脂肪瘤(脂肪密度腫塊清晰、病變內(nèi)可見纖維分隔)?;准?xì)胞瘤在術(shù)前有1例被誤診為血管瘤,與病理不符;肌細(xì)胞上皮瘤術(shù)前被誤診為多行性腺瘤,與病理不符;軟骨肉瘤在術(shù)前被誤診為神經(jīng)源性腫瘤,與病理不符。結(jié)論腮腺少見腫瘤的增強(qiáng)CT影像表現(xiàn)各有不同,需要加強(qiáng)專業(yè)技術(shù)學(xué)習(xí),以提高對(duì)其的認(rèn)識(shí)。
腮腺;少見腫瘤;增強(qiáng)CT;表現(xiàn);病理學(xué)分類
腮腺位于外耳道的前下方位置,富含豐富的脂肪,與周圍組織比較有顯著特點(diǎn),在腮腺區(qū)可以發(fā)生各種類型的腫瘤[1-2]。另外,腮腺腺體的大部分都集中在淺葉。目前對(duì)腮腺腫瘤中的肌上皮瘤、基底細(xì)胞瘤等少見腫瘤的CT診斷研究資料較少,筆者根據(jù)相關(guān)工作經(jīng)驗(yàn),選取我院收治的70例腮腺少見腫瘤患者作為研究對(duì)象,總結(jié)分析不同病理學(xué)類型腫瘤的增強(qiáng)CT表現(xiàn)特征,為臨床診療提供參考。
1.1病例資料選取我院2012年8月~2015年8月收治的70例腮腺少見腫瘤患者作為研究對(duì)象,其中男32例,女38例,年齡15.6~70.2(42.9±11.3)歲。均經(jīng)病理學(xué)檢查確診,其中軟骨肉瘤3例(4.29%),肌細(xì)胞上皮瘤12例(17.14%),脈管瘤15例(21.43%),基底細(xì)胞瘤25例(35.71%),淋巴上皮囊腫8例(11.43%),腮腺脂肪瘤7例(1.0%)。
1.2增強(qiáng)CT檢查方法采用飛利浦HD11XEEliteCT機(jī),患者取仰臥位,先平掃后增強(qiáng)掃描患者腮腺位置。采用碘苯六醇造影劑,總劑量為150 ml;掃描參數(shù):管電壓130 kV,管電流200 mA,層厚5 mm,層距5 mm。掃描后將圖像傳至PACS工作站,對(duì)其進(jìn)行三維技術(shù)重建。
1.3觀察指標(biāo)由≥2名專業(yè)影像醫(yī)師解讀圖像,觀察腫瘤在增強(qiáng)CT圖上的病變位置、大小、形態(tài)、密度以及周圍結(jié)構(gòu)之間的關(guān)系。
3例軟骨肉瘤增強(qiáng)CT表現(xiàn)特征為:內(nèi)部以囊變?yōu)橹?,左?cè)腮腺深葉見啞鈴狀囊實(shí)性占位,鈣化明顯,病變未見強(qiáng)化,增強(qiáng)CT值為18-30 HU。12例肌細(xì)胞上皮瘤中,左側(cè)8例,右側(cè)4例;4例位于腮腺深、淺葉下極,6例位于腮腺后方淺葉上極,2例位于腮腺前上級(jí)淺葉。增強(qiáng)CT表現(xiàn)中度明顯強(qiáng)化,病變常見微小囊變以及結(jié)節(jié)狀,平均病變直徑為(3.14±0.25)cm。15例脈管瘤中,左側(cè)8例,右側(cè)7例;5例位于腮腺深葉下極,3例位于腮腺前上極淺葉,7例位于腮腺腫塊淺葉蔓延。增強(qiáng)CT表現(xiàn)為橢圓腫塊,內(nèi)見鈣化灶,輕度強(qiáng)化,病變直徑為(2.65± 0.36)cm。25例基底細(xì)胞瘤中,左側(cè)12例,右側(cè)13例;5例淺葉前下極,8例淺葉后下極,6例深葉中下極,6例深淺葉交界區(qū)下極。增強(qiáng)CT表現(xiàn)為邊界清晰,中度明顯強(qiáng)化,內(nèi)見結(jié)節(jié)狀強(qiáng)化,病變直徑為(2.75±0.41)cm。8例淋巴上皮囊腫中,左側(cè)3例,右側(cè)5例,增強(qiáng)CT表現(xiàn)為圓形或者類圓形囊性低密度灶,病變邊界清晰,增強(qiáng)CT密度值為15~22 HU,病變直徑為(3.32±0.62)cm。7例腮腺脂肪瘤中,左側(cè)3例,右側(cè)4例,增強(qiáng)CT表現(xiàn)為腮腺內(nèi)脂肪密度腫塊影,病灶邊界清晰,內(nèi)部可見分隔,增強(qiáng)CT密度值為88~112 HU。見表1、2。
表1 腮腺少見腫瘤的病變直徑和增強(qiáng)CT值
表2 腮腺少見腫瘤的增強(qiáng)CT表現(xiàn)比較(例)
腮腺腫瘤分為良性與惡性兩種,惡性腫瘤主要以腺泡細(xì)胞癌、黏液表皮癌、轉(zhuǎn)移癌以及惡性混合瘤等為主[3-5],在臨床上的腫塊形態(tài)不規(guī)則,病灶邊界顯示也不清晰,可造成患者聽力減退、張口受限以及面部神經(jīng)麻木等癥狀;良性腫瘤以多形性腺瘤居多,對(duì)患者的主要影響是引起耳鳴、聽力障礙等[6-7]。
在本組病例中,最多的是基底細(xì)胞瘤,且有出現(xiàn)癌變的可能,好發(fā)于中老年女性?;准?xì)胞瘤的病理表現(xiàn)通常為圓形,內(nèi)見囊變及壞死。本研究結(jié)果顯示,25例基底細(xì)胞瘤中,其增強(qiáng)CT表現(xiàn)為邊界清晰、中度明顯強(qiáng)化、內(nèi)見結(jié)節(jié)狀強(qiáng)化,這與銀小輝等的研究結(jié)果一致[8-10]。25例基底細(xì)胞瘤中,有6例被誤診為多形性腺瘤,主要原因是影像科醫(yī)師的專業(yè)水平不夠高,對(duì)其認(rèn)識(shí)不足。因此,在放射診斷工作中需要仔細(xì)考慮其區(qū)別。
本組3例軟骨肉瘤增強(qiáng)CT表現(xiàn)為內(nèi)部以囊變?yōu)橹?,左?cè)腮腺深葉見啞鈴狀囊實(shí)性占位,鈣化明顯,病變未見強(qiáng)化。所以容易被誤診為神經(jīng)源性腫瘤,放射科醫(yī)師應(yīng)該對(duì)其進(jìn)行加以鑒別。
肌細(xì)胞上皮瘤好發(fā)于中年人群,根據(jù)WHO的相關(guān)規(guī)定,將肌細(xì)胞上皮瘤分為透明細(xì)胞、漿細(xì)胞以及上皮細(xì)胞等類型。肌細(xì)胞上皮瘤的增強(qiáng)CT表現(xiàn)特征為:中度明顯強(qiáng)化,病變常見微小囊變以及結(jié)節(jié)狀。本組中也出現(xiàn)過誤診為多形性腺瘤的情況,其根本原因與放射科醫(yī)師的相關(guān)認(rèn)識(shí)不足有關(guān)。
脈管瘤主要是因?yàn)橄袤w組織內(nèi)生長(zhǎng)出異常的血管而導(dǎo)致的相關(guān)疾病,其增強(qiáng)CT表現(xiàn)為橢圓腫塊,內(nèi)見鈣化灶,輕度強(qiáng)化。本組15例脈管瘤患者中,出現(xiàn)5例血管瘤,2例淋巴管瘤,且淋巴管瘤的密度比較高,究其原因與蛋白偏高有密切相關(guān)。
淋巴上皮囊腫是腮腺囊腫的一種,在顯微鏡下觀察,囊液比較濃稠,此現(xiàn)象與病變組織的炎癥有關(guān)。淋巴上皮囊腫的增強(qiáng)CT表現(xiàn)為圓形或者類圓形囊性低密度灶,病變邊界清晰。
腮腺脂肪瘤是一種比較少見的腮腺良性病癥,與遺傳或者內(nèi)分泌失調(diào)等因素密切相關(guān)。腮腺脂肪瘤的增強(qiáng)CT表現(xiàn)為腮腺內(nèi)脂肪密度腫塊影,病灶邊界清晰,內(nèi)部可見分隔。
綜上所述,增強(qiáng)CT檢查對(duì)少見腮腺腫瘤有重要的診斷價(jià)值,能夠清楚分析腫塊特征及相關(guān)性,但是,影像學(xué)專業(yè)醫(yī)師也需要加強(qiáng)學(xué)習(xí),以提高對(duì)其認(rèn)識(shí)。
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Enhanced CT features of different types of uncommon parotid tumors
Wang Fang1,Wang Hui1,Zhang Yunqing21.Zhidan People's Hospital,Yan'an,Shaanxi,717500,China;2.Yan'an University Affiliated Hospital,Yan'an,Shaanxi,716000,China
ObjectiveTo analyze the enhanced CT features of uncommon parotid tumors to provide reference for clinical diagnosis and treatment.MethodsA total of 70 patients with uncommon parotid tumors admitted to our hospital were review to analyze the location,size,shape and density of lesions of different pathological types of tumors on enhanced CT image and the their relation with surrounding structures.ResultsAmong the 70 cases,there were three cases of confirmed hondrosarcoma(mainly cystic lumps with components with peripheral calcification),12 cases of myocyte epithelioma(mostly on superficial parotid lobe,with calcification visible on a few lesions),15 cases of vascular tumor(with uniform or non-uniform density and protruding from the protid surface),25 cases of basal cell tumor(mostly on superficial parotid lobe,obvious cystic change within lesions,and enlarged lymph nodes in the enhance CT image),8 cases of lymphatic epithelial cyst(high density in CT image and sticky cyst fluid)and 7 cases of protid lipomyoma(clear fat density and lumps,and visible hyperdensity in lesions).Before the operation,one case of basal cell tumor was misdiagnosed as hemangioma,which was not in conformity with pathological findings;myocyte epithelioma as superficial multiform adenoma,which was not in conformity with pathological findings;and hondrosarcoma as neurogenic tumor,which was not in conformity with pathological findings.ConclusionThe manifestations of uncommon protid tumors in enhanced CT image are different.Therefore,professional technological learning shall be enhanced to improve the understanding of such manifestations.
parotid;uncommon tumors;enhanced CT;manifestation;pathological classification
R 730.4
A
1004-0188(2016)08-0899-03
10.3969/j.issn.1004-0188.2016.08.026
717500陜西延安,延安市志丹縣人民醫(yī)院(王芳,王慧);延安大學(xué)附屬醫(yī)院(張?jiān)魄澹?/p>
(2016-01-25)