超声评估下颌骨成釉细胞瘤侵袭性的初步研究

A pilot study to evaluate the invasiveness of mandible ameloblastoma on ultrasonography

目的 探索超声评估下颌骨成釉细胞瘤增殖活跃性、侵袭性的价值.方法 对19例下颌骨成釉细胞瘤行超声检查,着重观察肿瘤内血流信号及下颌骨骨皮质破坏情况,与病理结果对照分析,评估超声检查与肿瘤侵袭性的关系,并计算其敏感性和特异性.结果 15例肿瘤（79%）彩色多普勒超声示无明显血流或少量血流信号;4例血流信号丰富者中,3例病理示增殖活跃、侵袭性强.14例肿瘤（74%）声像图示患处骨皮质呈连续性;5例骨皮质呈局部中断破坏者中,3例病理示增殖活跃、侵袭性强.瘤体血供和骨皮质破坏预估肿瘤侵袭性的敏感性和特异性分别为100%、94%及100%、88%.结论 超声检查可作为下颌骨成釉细胞瘤的一种全新、有效的辅助诊断方法.观察瘤体的血供和骨皮质破坏情况,可较准确评估肿瘤的增殖活跃性和侵袭性.

Objective To evaluate and demonstrate ultrasonographic characteristics of mandibular ameloblastoma with active proliferation. Methods Nineteen subjects with ameloblastomas in the mandibles were examined with ultrasonography. In addition to sizes,internal echoes,the research was focused on blood flow of the tumors and destruction of mandibles. Ultrasonographic appearances of the tumors were compared with histopathological findings. Sensitivity and specificity of Doppler flow signals and destruction of mandibles for prediction of active tumor proliferations were calculated. Results Fifteen cases （79%）showed no or minimal flow signals on color Doppler flow imaging（CDFI）, whereas the remaining 4 lesions demonstrated abundant flow signals,in which 3 cases were confirmed histopathologically with active tumor proliferations. The sensitivity and specificity of the Doppler flow signals for prediction of active tumor proliferations were 100% and 94%, respectively. Fourteen cases （74%） showed the mandibular cortices were thin but continuous,among the remaining 5 lesions showed local cortices destruction,3 of them were confirmed histopathologically with active proliferations. The sensitivity and specificity of the destruction of cortical bone for prediction of active tumor proliferations were 100% and 88 %, respectively. Conclusions Ultrasonography can be used as a new effective supplementary diagnostic method for mandibular ameloblastomas. CDFI of tumor vascularity and destruction of cortical bone could be used to predict active tumor proliferations and invasiveness.