53例第一鳃裂囊肿影像学与临床病理学特征的相关性分析

Correlation analysis of imaging features and clinicopathological features in 53 cases of first branchial cleft cyst

目的:分析第一鳃裂囊肿(first branchial cleft cyst,FBCC)的影像学特点与不同病理分型的相关性,以及各病理分型的不同临床治疗方法。方法:回顾2013年1月—2019年12月于上海交通大学医学院附属第九人民医院经手术病理证实且术前均行CT和MRI检查的53例FBCC患者的临床、病理、影像学及预后信息,采用SPSS 26.0软件包对数据进行统计学分析。结果:53例患者中,49例(49/53,92.5%)位于腮腺区,4例(4/53,7.5%)位于下颌角以下、舌骨上方。按Work分型分为Ⅰ型(45例)和Ⅱ型(8例),伴明显继发感染7例(Ⅰ型3例,Ⅱ型4例),伴窦道、瘘管6例(Ⅰ型2例,Ⅱ型4例)。患者行肿物切除术49例,肿物扩大切除术4例,中位随访时间(41.52±24.59)个月,6例(6/53,11.3%)术后复发。患者年龄(≤10岁)、伴瘘管/窦道、病灶位于面神经深部及切开引流史对复发有显著影响(P<0.05)。FBCC多位于面神经分支间(32/53,60.4%),多数边界清晰(48/53,90.6%),WorkⅠ型和Ⅱ型在形态、CT值、密度/信号方面有显著差别(P<0.05)。薄层CT联合多平面重建技术(multiplanner reformation,MPR)显示瘘管/窦道6例(6/6,100%),测量长度为1.5~3 mm,管径为0.7~1.5 mm,MRI均未见明显瘘管/窦道。结论:不同临床病理特征的FBCC具有不同的影像学特征,薄层CT联合MPR重建技术可更好地显示合并的窦道/瘘管,对临床诊治和预防复发具有重要的指导价值。

PURPOSE: To analyze the correlation between imaging characteristics of the first branchial cleft cyst(FBCC) and different pathological types, and to analyze the different clinical treatment methods of each pathological type.METHODS: A retrospective study was conducted for FBCC patients who were confirmed by surgery and postoperative pathology in Shanghai Ninth Peoples’ Hospital from January 2013 to December 2019. All the patients underwent CT and MRI examinations before surgery. The clinical, pathological, imaging and prognostic data were statistically analyzed using SPSS 26.0 software package. RESULTS: All 53 cases were confirmed by surgical pathology. Forty-nine cases(49/53,92.5%) were located in the parotid gland areas, and 4 cases(4/53, 7.5%) were located below the submandibular angle and above the hyoid bone. TypeⅠ was in 45 cases and type Ⅱ was in 8 cases. Obvious infection was seen in 7 cases(typeⅠ:3 cases, type Ⅱ: 4 cases), sinus/fistula in 6 cases(typeⅠ: 2 cases, type Ⅱ: 4 cases). Forty-nine patients underwent tumor resection, and 4 patients underwent expanded tumor resection. The median follow-up time was(41.52±24.59) months. Six patients(6/53, 11.3%) recurred after operation. The patient’s age(≤10 years old), cysts with fistula/sinus, deep location deep to the facial nerve and history of incision and drainage had significant differences on recurrence(P<0.05). FBCCs were mostly located between facial nerve branches(32/53, 60.4%), and most of them had clear boundary(48/53, 90.6%).Type Ⅰ and Ⅱ had significant differences in morphology, CT value, density/signal(P<0.05). Thin-slice CT combined with multiplanner reformation(MPR) technique showed 6 cases(6/6, 100%) of FBCC with fistula/sinus tracts, the lengths were 1.5-3 mm and tube diameters were 0.7-1.5 mm, without obvious fistula/sinus tract on MRI. CONCLUSIONS: FBCC with different clinicopathological features has different imaging features, and thin-slice CT combined with MPR reconstruction technology can better display the accompanied sinus/fistula, which play an important guiding role in clinical diagnosis, treatment and prevention of recurrence.