口内超声成像在18例口腔非咀嚼黏膜白斑诊疗中的评价

Application of intraoral ultrasonic imaging in diagnosis and treatment of 18 patients with oral leukoplakia in non-masticatory mucosa

目的:探讨口腔非咀嚼黏膜白斑的声像图表现,根据声像图特征将黏膜白斑分类,并为临床诊疗方案提供参考依据.方法:选取就诊于上海交通大学医学院附属第九人民医院口腔黏膜科并最终病理确诊为口腔黏膜白斑的患者18例(24处病灶),病灶分别位于舌部、口底、颊黏膜、唇黏膜.在病灶切取活检前,于超声科行口腔内路径超声检查,观察病灶范围、连续性、有无角化形成、上皮各层厚度及病损处彩色多普勒血流信号.并应用定量分析软件Qontraxt,对白斑区黏膜表面随机取值测量相对回声强度,总结与之对应的病损角化类型.数据应用SPSS 25.0软件包进行统计分析.结果:口腔黏膜白斑声像图表现为出现角化层并增厚,回声增强,中间层表现为低回声增厚条带,部分病灶局部表层回声减低及血流信号增多.白斑区高回声条带明显增厚(P<0.001)、回声增强,其中舌部和颊黏膜差异最显著.低回声条带明显增厚(P<0.001),其中颊黏膜、唇黏膜差异最显著.通过Qontraxt定量分析软件测定表层及角化层回声强度值,判断是否存在角化及角化类型,其中非白斑区为43.28±9.33,白斑正角化为92.88±3.12,白斑不全角化为84.75±5.76.结论:超声成像可以有效观察黏膜白斑并测量上皮内各层厚度,此外可发现特殊伴随改变,如溃疡、感染及癌变等,可为临床诊断、治疗方案制定及治疗后随访提供影像学依据,有助于避免不必要的黏膜医源性损伤或治疗后疾病复发.

PURPOSE:To explore the sonographic appearance of leukoplakia in non-masticatory oral mucosa,classifying mucosal leukoplakia according to the characteristics of sonogram,and providing reference for clinical diagnosis and treatment.METHODS:Eighteen patients(24 lesions)were diagnosed as oral leukoplakia at the Department of Oral Mucosal Diseases,Shanghai Ninth People's Hospital.The lesions were located in the tongue,floor of mouth,buccal mucosa and libial mucosa.Before the biopsy was taken,intra-oral path ultrasound was performed at the Department of Ultrasound to observe the lesion's extent,continuity,presence or absence of keratinization,the thickness of each layer in the epithelium,and color doppler flow imaging of the lesions.Quantitative analysis software'Qontraxt'was used to randomly measure the relative echo intensity of the mucosal surface in leukoplakia areas,and summarize the keratinization type.SPSS 25.0 software package was used for statistical analysis of the data,and paired t test was used for inter-group comparison of the data.RESULTS:Oral leukoplakia sonograms showed that the epithelial layer appeared keratinization,the epithelial was thickened,and the echo was enhanced.The stratum intermedium showed a low echo thickening band,and the echo of partial lesions'surface decreased or the blood flow signal in oral mucosa increased.The hyperechoic band in the leukoplakia area was significantly thickened(P<0.001),and the echo was enhanced,with the tongue and buccal mucosa being the most significant.The hypoechoic band was significantly thicker(P<0.001),with the buccal mucosa and labial mucosa being the most significant.The surface and stratum corneum echo intensity values were determined by Qontraxt quantitative analysis software to determine whether there were keratinization and the keratinization types.The echo intensity values was 43.28±9.33 in non-OLK area,92.88±3.12 in OLK with orthokeratosis,and 84.75±5.76 in OLK with parakeratosis.CONCLUSIONS:Ultrasound imaging can effectively define mucosal leukoplakia and measure the thickness of each layer in the epithelium.In addition,special adjoint changes such as ulcers,infections and cancerous changes can be detected.Intraoral ultrasonic imaging can provide imaging evidence for clinical diagnosis,treatment planning and post-treatment follow-up and contribute to avoid unnecessary mucosal iatrogenic injury or recurrence of disease after treatment.