腮腺Warthin瘤的CT诊断及误诊分析

CT diagnosis and misdiagnosis analysis of Warthin tumor of parotid gland

目的总结腮腺Warthin瘤的CT影像特征及其与腮腺混合瘤的鉴别要点,以提高影像定性诊断与病理符合率。方法收集有完整手术或穿刺病理记录的17例患者的资料,其中14例为腮腺Warthin瘤,3例影像报告Warthin瘤但病理证实为混合瘤病例。患者均采用常规平扫加多期动态增强扫描,观察病灶数目、形态特征、密度、强化特征及周围淋巴结情况。对所有病灶平扫、动脉期、延迟期CT值进行详细测量,并对病灶所在腮腺腺体CT值进行测量。结果14例Warthin瘤中,男11例,女3例;中位年龄64岁。单侧单发病例7例,单侧或双侧多发病例7例;位于浅叶后下部11例;边缘清晰13例;病灶最大径>3 cm 7例。平扫均为高密度病灶。密度均匀6例,密度不均8例。均匀强化2例,不均匀强化12例,延迟廓清11例。结论腮腺Warthin瘤是腮腺较常见肿瘤,其CT表现具有良性肿瘤的特征,好发于50岁以上男性,易出现单或双侧多发病灶,多期动态增强扫描表现出的延迟廓清有一定的特异性,密切结合临床资料,多可于术前做出定性诊断。

Objective To summarize the CT imaging features of Warthin tumor of parotid gland and the key points of differential diagnosis between Warthin tumor and mixed tumor of parotid gland,so as to improve the coincidence rate of imaging qualitative diagnosis and pathology.Methods The data of 17 patients with complete surgical or puncture pathologic records were collected,including 14 patients with Warthin tumor of the parotid gland and 3 cases with imaging report of Warthin tumor but pathologically confirmed as mixed tumor.The patients were given conventional plain scan and multistage dynamic enhanced scan to observe the number of lesions,morphological characteristics,density,enhancement characteristics and surrounding lymph nodes.CT values of all lesions in plain scan,arterial phase and delayed phase were measured in detail,and the parotid gland CT values of lesions were measured.Results Among the 14 cases of Warthin tumors,there were 11 males and 3 females,with a median age of 64 years.There were 7 cases of unilateral single case and 7 cases of unilateral or bilateral multiple cases;11 cases were located in the lower part of the posterior superficial lobe;there were 13 cases with clear edge;the maximum diameter of the lesion was>3 cm in 7 cases.All the lesions were high density on plain scan.There were 6 cases with uniform density and 8 cases with uneven density.There were 2 cases of homogeneous enhancement,12 cases of heterogeneous enhancement and 11 cases of delayed clearance.Conclusion Warthin tumor of the parotid gland is a common tumor of the parotid gland,and its CT manifestation has the characteristics of benign tumor.It tends to occur in males over 50 years old,prone to unilateral or bilateral multiple lesions,and the delayed clearance shown by multi-phase dynamic enhanced scan has certain specificity.Closely combined with clinical data,more qualitative diagnosis can be made before surgery.