腮腺深叶及毗邻间隙肿瘤CT定位诊断分析

Positioning diagnosis analysis of tumor in the deep parotid and related spaces with CT

目的探讨依据腮腺深叶及毗邻间隙(the deep parotid and related spaces,DPRS)解剖学标志对CT准确定位该区肿瘤的价值及临床意义。方法依据"U"线界定腮腺深、浅叶,依据二腹肌后腹、翼内肌、腮腺床移位方向、脂肪间隔存在与否及咽旁间隙(parapharyngeal spaces,PS)变形特点和移位方向确定DPRS肿瘤起源。由3位不知手术结果的高年资医生就38例病理证实的DPRS肿瘤作回顾性定位分析。所有病例均作CT平扫及增强检查。结果 38例DPRS肿瘤术前26例(68.4%)定位准确,定位错误的12例中4例腮腺深叶间隙(deep parotid spaces,DPS)肿瘤误PS肿瘤,5例颈动脉间隙(carotidspaces,CS)肿瘤误PS肿瘤,2例PS肿瘤误CS肿瘤,1例PS肿瘤误黏膜间隙肿瘤。依据解剖标志回顾分析35例(92.1%)定位准确,准确率显著高于术前(t=4.16,P<0.05)。定位错误的3例中1例DPS肿瘤误PS肿瘤,CS与PS肿瘤相互定位错误各1例。结论依据解剖标志明显提高DPRS肿瘤CT定位准确率,对制定正确的手术方案具有重要意义。

Objective To explore the value and clinical significance of the CT in accurate location of tumor in the deep parotid and related spaces （DPRS） according to anatomical marks. Methods Parotid depth leaf was defined according to U line, and the origin of tumor in DPRS was determined according to the displacement of the posterior belly of digastric muscle, medial pterygoid muscle and pa- rotid bed, fat interval existence and the deformation characteristics and shifting direction of parapharyngeal spaces （PS）. Positioning a- nalysis of 38 DPRS tumors was made by three experienced radiologists retrospectively. All cases underwent unenhanced and enhanced CT scanning. Rusults 26 cases of the 38 cases（68.4% ） were precisely located. Other 12 cases were located wrongly, 4 DPS （ deep parotid spaces） tumors were misdiagnosed as PS tumor, 5 CS （carotid spaces ） tumor were wrongly diagnosed as PS tumor, and 2 PS tumor were misdiagnosed as mucosal tumors. 35 cases （92.1% ） were rightly located according to anatomical landmarks retrospective- ly, and its accuracy was significantly higher than that before operation（ t = 4.16,P 〈 0.05 ）. In the 3 misdiagnosed cases, 1 DPS tumor was mistaken for PS tumor, and a mutual mispositioning between CS tumor and PS tumor was seen in two separate cases. Conclusions A remarkable rise of accuracy of CT positioning diagnosis of tumors in the DPRS can be made by anatomical landmarks, which has a fundamental significance in making surgical plans.