腮腺多形性腺瘤和腺淋巴瘤的MSCT灌注成像研究

Pleomorphic adenoma and adenolymphoma of parotid gland:multislice CT perfusion imaging and pathologic analysis

目的:探讨腮腺多形性腺瘤和腺淋巴瘤的MSCT灌注成像特征,以提高两者的诊断及鉴别诊断水平。方法:19例腮腺肿瘤患者术前行常规MSCT平扫后立即进行灌注扫描,采集数据输入Philips EBW后处理工作站,使用Perfusion软件进行数据处理,通过动态分析模块获得肿瘤感兴趣区时间-密度曲线(TDC),计算肿瘤血容量(BV)、达峰时间(TTP)和强化峰值(PEI),并根据色阶分别获取相应的伪彩图。所有患者最终均经手术病理学明确诊断。结果:1手术病理:19例腮腺肿瘤中,多形性腺瘤6例,腺淋巴瘤12例(其中2例因图像伪影明显不计入研究),腮腺癌1例(排除研究)。2MSCT灌注TDC特征:9例腺淋巴瘤呈"快进快退"型,1例呈"快进缓降"型,6例多形性腺瘤均呈"缓慢上升"型。3腺淋巴瘤的BV和PEI值均高于多形性腺瘤,而TTP值低于多形性腺瘤(P均<0.05)。4受试者工作特征(ROC)曲线显示BV和PEI值在多形性腺瘤和腺淋巴瘤间具有统计学差异,曲线下面积分别为0.93和0.97,而TTP值在两者间不存在统计学差异。结论:MSCT灌注成像在腮腺多形性腺瘤和腺淋巴瘤的诊断及鉴别诊断中具有重要价值。

Objctive：To study the MSCT perfusion features of pleomorphic adenoma and adenolymphoma of parotid gland,and to correlate with the pathological basis for improving the diagnosis accuracy. Methods： 19 cases with parotid tumor were examined with MSCT before operation, and CT perfusion examinations were performed after plain scan. The acquisition data were collected and transferred to Philips EBW post-processing workstation,and analyzed by using the perfusion tool dynamic analysis module. The time-density curve of tumors was obtained,and perfusion parameters such as blood volume （BV）, time to peak （TTP） and peak enhancement index （PEI） were evaluated. All cases were confirmed by surgery and pathology. Results：①Pathology of the 19 cases：6 cases were pleomorphic adenomas, 12 cases were adenolymphoma （2 cases were excluded becasue of artifact） , and one case was carcinoma （it was exculded in this study）. ② TDC features：9 cases of adenolymphoma showed a curve characterized by fast enhancement and fast washout, one adenolymphoma case showed fast enhancement and slow washout,whereas 9 cases of pleomorphic adenomas presented gradual increase. ③ Compared with pleomorphic adenomas, the BV and PEI values of adenolymphoma were much higher, and TTP value was lower. There was statistically significant difference between these two tumors （P〈0.05）. ④ROC demonstrated that there was statistical difference in BV and PEI value between pleomorphic adenoma and adenolymphoma, the areas under the curve were 0.93 and 0.97, respectively. Conclusions： MSCT perfusion imaging can reflect the pathological features of adenolymphoma and pleomorphic adenoma,and it is useful in differential diagnosis.