腮腺良恶性肿瘤鉴别诊断的MRI征象分析

发布时间：2018-10-26 16:44

【摘要】：目的：分析腮腺良恶性肿瘤的MRI表现,比较用于腮腺肿瘤良恶性鉴别的MRI征象；探讨部分腮腺肿瘤的支持性MRI征象。材料与方法：回顾性分析2008年1月至2012年12月经病理证实的165例腮腺肿瘤的临床和影像学资料。一、按组织学类型分为恶性组和良性组,比较两组肿瘤之间各个评价指标的差异,分析有助于鉴别良恶性肿瘤的MRI征象。评价指标包括：病人性别、年龄、病灶部位、大小、形态、MRI信号、边界、生长方式、周围组织侵犯、骨质破坏、淋巴结浸润。二、将多形性腺瘤、腺淋巴瘤、基底细胞腺瘤、腺泡细胞癌、粘液表皮样癌、鳞癌、嗜酸细胞癌、淋巴瘤分别与其余肿瘤作比较,总结其支持性MRI征象。结果：一、用于腮腺良、恶性肿瘤鉴别诊断的MRI征象比较。下列征象良性组的出现率明显高于恶性组：T2WI高信号(P=0.004),T2WI信号均匀(P=0.023),边界清楚(增强前p=0.001、增强后P=0.000),明显强化(P=0.000),均匀强化(P=0.003)。下列征象恶性组的出现率明显高于良性组：肿瘤位于深叶(P=0.024、预告恶性准确率70%)；T2WI等信号(P=0.024、预告恶性准确率67.9%)；中度强化(P=0.000、预告恶性准确率69.7%)；边界不清(增强前)(P=0.000、预告恶性准确率72.7%),边界不清楚(增强后)(P=0.000、预告恶性准确率70.9%)；皮下组织浸润(P=0.000、预告恶性准确率87.2%)；咀嚼肌/咽旁间隙/面神经侵犯(P=0.01、预告恶性准确率76.3%)；淋巴结浸润(P=0.000、预告恶性准确率80%)；T2WI不均匀(P=0.023、预告恶性准确率41.8%)；不均匀强化(P=0.002、预告恶性准确率46.7%)。肿瘤的大小、发病年龄、性别、病灶发生于腮腺左/右叶、是否分叶、TIWI信号、T2WI低信号、轻度强化、弥漫生长/单灶/多灶、单侧/双侧、跨叶、囊变、伴有骨质破坏,P值均大于0.05,差异无统计学意义。二、不同肿瘤的支持性MR征象。多形性腺瘤：易发生于女性、边界清楚、T2WI高信号、明显强化；腺淋巴瘤：好发于男性、位于浅叶、腮腺尾部、双侧发病、多灶、强化较均匀、中度强化、边界清楚；基底细胞腺瘤：周围有低信号环、边界清楚；腺泡细胞癌：分叶,淋巴结浸润；粘液表皮样癌：分叶、边界不清、淋巴结浸润、囊变；鳞癌：分叶、皮下组织浸润、TIVI信号不均匀；嗜酸细胞癌：女性好发、易分叶、深叶。淋巴瘤：TIWI信号不均匀、中度强化,侵犯咀嚼肌间隙／咽旁浸润、弥漫生长、边界不清。上述征象在该肿瘤组的出现率明显高于其余肿瘤组(P值均小于0.05)。结论：肿瘤位于深叶、边界不清楚、T2WI等信号、中度强化、周围组织及淋巴结浸润提示腮腺恶性肿瘤。腮腺多形性腺瘤、腺淋巴瘤、基底细胞腺癌、腺泡细胞癌、粘液表皮样癌、鳞癌、嗜酸细胞癌、淋巴瘤各有相应的支持性MRI征象。
[Abstract]:Objective: to analyze the MRI features of parotid benign and malignant tumors, to compare the MRI signs used to differentiate benign and malignant parotid tumors, and to investigate the supportive MRI signs of some parotid tumors. Materials and methods: the clinical and imaging data of 165 cases of parotid tumors confirmed by pathology from January 2008 to December 2012 were analyzed retrospectively. The results were as follows: 1. According to the histological type, the malignant group and the benign group were divided into malignant group and benign group. The difference of each evaluation index between the two groups was compared, and the analysis was helpful in differentiating the MRI signs of benign and malignant tumors. The indicators included: sex, age, location, size, shape, MRI signal, boundary, growth pattern, peripheral tissue invasion, bone destruction, lymph node infiltration. Secondly, pleomorphic adenoma, basal cell adenoma, acinar cell carcinoma, mucoepidermoid carcinoma, squamous cell carcinoma, eosinophil carcinoma and lymphoma were compared with other tumors, and their supportive MRI findings were summarized. Results: first, the MRI signs for differential diagnosis of benign and malignant parotid gland were compared. The occurrence rate of the following signs in benign group was significantly higher than that in malignant group: high signal intensity in T2WI (P0. 004), homogeneous signal intensity in T2WI (P0. 023), clear boundary (p0. 001 before enhancement, P0. 000 after enhancement), obvious enhancement (P0. 000). Uniform strengthening (P0. 003). The occurrence rate of the following signs in malignant group was significantly higher than that in benign group: the tumor was located in the deep lobe (P0. 024, the accuracy of predicting malignancy was 70%), the signal of T2WI et al (P0. 024, accuracy of predicting malignancy was 67. 9%); Moderate enhancement (P0. 000, accuracy rate of predicting malignancy 69.7%), unclear boundary (before enhancement) (P0. 000, predictive accuracy of malignancy 72.7%), unclear boundary (after enhancement) (P0. 000, predictive accuracy of malignancy 70.9%); Subcutaneous tissue invasion (P0. 000, accuracy rate of predicting malignancy 87.2%), masticatory muscle / parapharyngeal space / facial nerve invasion (P0. 01, predictive accuracy of malignancy 76. 3%), lymph node invasion (P0. 000, predictive accuracy of malignancy 80%); T2WI was uneven (P0. 023, accuracy rate of predicting malignancy 41.8%) and non homogeneous enhancement (P0. 002, accuracy of predicting malignancy 46.7%). Tumor size, age, sex, lesion in left / right parotid lobe, lobulation, TIWI signal, low T2WI signal, mild enhancement, diffuse growth / single focus / multiple focus, unilateral / bilateral, translobar, cystic degeneration, accompanied by bone destruction. P > 0.05, the difference was not statistically significant. Second, supportive MR signs of different tumors. Pleomorphic adenoma was easy to occur in women, with clear boundary, high signal intensity of T2WI, obvious enhancement, and adenomatous lymphoma in male, located in superficial lobe, parotid gland tail, bilateral disease, multi-foci, homogeneous enhancement, moderate enhancement and clear boundary. Basal cell adenoma: surrounded by low signal ring with clear margin; acinar cell carcinoma: lobular, lymph node infiltration; mucoepidermoid carcinoma: lobular, unclear border, lymph node infiltration, cystic change; Squamous cell carcinoma: lobulated, subcutaneous infiltration, uneven TIVI signal; eosinophilic cell carcinoma: female, easily lobulated, deep lobes. Lymphoma: TIWI signal was uneven, moderately enhanced, invasion of masticatory muscle space / parapharyngeal infiltration, diffuse growth, unclear boundary. The occurrence rate of the above signs in the tumor group was significantly higher than that in the other tumor groups (P < 0.05). Conclusion: the tumor is located in deep lobes, with unclear boundary, T2WI signal, moderate enhancement, peripheral tissue and lymph node infiltration indicating parotid malignant tumor. Parotid pleomorphic adenoma, adenomatous lymphoma, basal cell adenocarcinoma, acinar cell carcinoma, mucoepidermoid carcinoma, squamous cell carcinoma, eosinophil carcinoma and lymphoma had corresponding supportive MRI signs.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.2;R739.8

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