CT灌注成像与细针穿刺细胞学检查在涎腺肿瘤诊断中的应用

Application of CT perfusion imaging and fine needle aspiration cytology in diagnosis of salivary gland tumors

目的:探讨CT灌注成像与细针穿刺细胞学检查对涎腺肿瘤良恶性的鉴别诊断价值。方法:36例涎腺肿瘤(腮腺26例,下颌下腺8例,舌下腺1例,腭部1例)患者,术前均行细针穿刺细胞学检查和CT灌注扫描,并取得相应的灌注参数:血流量(blood flow,BF),血容量(blood volume,BV),平均通过时间(mean transit time,MTT)和表面渗透性(permeability surface,PS),所有涎腺肿瘤术后均行病理检查。结果:36例患者中,最终病理确诊为涎腺恶性肿瘤者13例,细针穿刺细胞学检查对恶性肿瘤检测的敏感性为84.6%(11/13),特异性为95.7%(22/23),符合率为91.7%(33/36)。CT灌注成像恶性肿瘤组BF、BV、PS值均高于良性肿瘤组(P<0.05),而2组之间的MTT参数则无统计学差异(P>0.05)。其诊断恶性肿瘤的敏感性为92.3%(12/13),特异性为86.9%(20/23),符合率为88.9%(32/36)。细针穿刺细胞学检查假阴性的涎腺恶性肿瘤可通过CT灌注成像检查得到正确诊断。结论:CT灌注成像能提供涎腺肿瘤微循环灌注方面的信息,有利于肿瘤良恶性的鉴别,与细针穿刺细胞学检查并联应用,能够明显提高涎腺肿瘤诊断的准确性。

Objective： To analyze the value of fine needle aspiration cytology and CT perfilsion imaging in differential diagnosis of benign and malignant salivary, gland tumors. Methods： Perfusion CT and fine needle aspiration cytology were performed in 36 patients of salivary gland tumors（26 cases in parotid gland, 8 cases in submandibular, 1 case in sublingual gland and 1 case in pars palatalis） and perfusion parameters, including ： blood flow（ BF）, blood volume （ BV ）, mean transit time （ MTF）, permeability surface （PS）. Pathological diagnosis was performed on all salivary gland tumors. Results： 13 cases of 36 patients eventually were diagnosed as malignant salivary gland tumors. The sensitivity, specificity and accordance rate for malignancy of fine needle aspiration cytology were 84.6% （ 11/13 ）, 95.7% （22/23） and 91.7% （ 33/36）, respectively. The values of BF, BV and PS of the malignant tumors were higher than those of benign tumors significantly（P 〈0.05）. However, the MTF values showed no significant differenee between be- nign and malignant tumors（ P 〉 0.05 ）. The sensitivity, specificity, and accordance rate for malignancy of CT perfusion were 92.3% （ 12/13 ）, 86.9% （20/23） and 88.9% （32/36）, respectively. The negative cases of fine needle aspiration cytology can be correctly identified as malignant by CT perfusion imaging. Conclusion： CT perfusion inmging can provide salivary gland tumors with information of microcirculation perfusion. It contributes to the identification of benign and malignant tumors. Paralled with fine needle aspiration cytology can greatly improve the accuracy of salivary gland tumors.