CT在腮腺肿块性病变的诊断与鉴别诊断中的价值

Value of CT in diagnosis and differential diagnosis of parotid masses

目的:探讨CT对腮腺肿块性病变的诊断与鉴别诊断价值,提高术前定性诊断准确性。方法:回顾性分析经手术病理证实的52例原发性腮腺肿块性病变,所有病例均行平扫,其中39例行CT增强扫描,将CT诊断结果与病理结果进行对照研究。结果:35例良性肿瘤CT表现为圆形或类圆形边界清楚肿块22例,浅分叶13例,多形性腺瘤病灶内密度较均匀,腺淋巴瘤(6/9)易出现囊性变;14例恶性肿瘤CT表现为分叶状或不规则肿块影,边界毛糙模糊,其内密度欠均匀,发生坏死囊变(7/14),与邻近咬肌及胸锁乳突肌分界欠清楚(8/14);3例嗜酸性淋巴肉芽肿CT表现为单侧或双侧腮腺浅叶弥漫性增大,并颌下和颈部淋巴结大。CT均能对52例腮腺肿瘤准确定位,多数病变CT能准确定性,但对低度恶性肿瘤与良性肿瘤,囊变淋巴瘤与淋巴上皮癌,深叶嗜酸性腺瘤与恶性肿瘤难以鉴别。结论:肿块的形态、边缘、内部低密度灶分布以及与邻近咬肌及胸锁乳突肌分界情况是腮腺良恶性肿瘤的重要鉴别点,CT对大多数腮腺良、恶性肿瘤能做出正确诊断。

Objective： To evaluate CT in diagnosis and differential diagnosis of parotid masses, and elevate the preoperative diagnostic accuracy. Methods.. The data of 52 patients with parotid masses confirmed by operation and pathology was analyzed retrospectively, 39 cases with both plain and contrast scanning, others with only plain scanning. Results： In 35 benign tumors, 22 were circular and well-circumscribed, 13 were mutilobar; Pleomorphism adenomatosis were homogenerous density, and adenolymphoma （6/9） were inclined to be cystic. 14 malignant tumors were lobulated or irregular, inhomogenerous density, ob scure boundary , opt to be cystic and necrosis（ 7/14）, intermingled with surrounding masseter and sternocleidomastoid（8/14） ; 3 cases with eosinophilic lymphogranuloma shows diffuse augmentation of unilateral or bilateral parotid, subrnaxillares and neck lymphadenectasis were also found. It was easy for CT to localize the parotid lesions accurately in 52 cases ,also it was easy for CT to confirm the character of most lesions, but it was hard to differentiate the low-grade malignant tumor form benign tumor, cystic lyrnphoma from lymphepithelioma, eosinophilic adenoma from malignant tumor. Conclusion： The shape, borderline,internal low density tissue and the association of masseter and sternocleidomastoid are differential key points between bengin and malignant parotid tumor. CT can accurately diagnose the benign and malignant parotid tumor.