多模态超声在腮腺多形性腺瘤及Warthin瘤鉴别诊断中的应用

Application of multimodal ultrasound in the diagnosis of pleomorphic adenoma and Warthin tumor of parotid gland

目的:分析多形性腺瘤(pleomorphic adenoma,PA)及Warthin瘤(Warthin tumor,WT)的常规超声(ultrasound,US)、剪切波弹性成像(shear wave elastography,SWE)及超微血管三维立体成像(3D-superb microvascular imaging,3D-SMI)特征,探讨US联合SWE及3D-SMI对PA与WT的鉴别诊断价值。方法:回顾性收集于2021年05月至2022年06月间于我院行US、SWE及3D-SMI检查,并经手术病理证实的符合纳入标准的腮腺肿瘤患者80例,共85个病灶,对腮腺肿瘤的US、SWE及3D-SMI超声特征进行分析,并采用受试者工作特征曲线比较US、US+SWE以及US+SWE+3D-SMI三种超声诊断方法对PA和WT的诊断效能。结果:病理结果显示54个PA,31个WT,PA组与WT组比较,在“钙化(χ^(2)=6.506)、内部低或无回声(χ^(2)=16.029)、网格回声(χ^(2)=24.070)、杨氏模量平均值(t=4.988)、内部血流信号丰富程度(χ^(2)=32.690)及血供模式(χ^(2)=26.908)”等差异有统计学意义(P均<0.05),联合US、SWE及3D-SMI的多模态超声对WT与PA诊断的敏感度、特异度、准确度、阳性预测值、阴性预测值分别为80.65%、87.04%、84.71%、78.13%、88.68%,其曲线下面积大于US(0.838 vs 0.596;Z=4.990,P<0.001)。结论:联合US、SWE及3D-SMI有助于区分PA与WT,其诊断效能高于常规超声。

Objective:To analyse the ultrasonic characteristics of conventional ultrasound(US),shear wave elastography(SWE)and 3D-superb microvascular imaging(3D-SMI)in pleomorphic adenoma(PA)and Warthin tumor(WT)of parotid gland,and to investigate the application value of US,SWE and 3D-SMI in PA and WT.Methods:The retrospective analysis was performed in our hospital.From May 2021 to June 2022,80 patients with parotid gland tumor which met the inclusion criteria and were confirmed by surgery and pathology underwent US,SWE and 3D-SMI examinations.To analyse and compare the diagnostic efficiency in US,US+SWE and US+SWE+3D-SMI for PA and WT by receiver operating characteristic(ROC)curve.Results:Pathological results showed that 54 tumors were PA and 31 tumors were WT.There were significant differences between PA and WT in"calcification(χ^(2)=6.506),hypoecho or anecho(χ^(2)=16.029),grid echo(χ^(2)=24.070),the average Young modulus(t=4.988),internal vascularity(χ^(2)=32.690)and vascular distributions(χ^(2)=26.908)".The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of US+SWE+3D-SMI in the diagnosis of PA and WT were 80.65%,87.04%,84.71%,78.13%and 88.68%.The diagnostic efficiency of US+SWE+3D-SMI was significantly better than that of US,and the AUC of US+SWE+3D-SMI was significantly higher than that of US(0.838 vs 0.596;Z=4.990,P<0.001).Conclusion:The diagnostic efficiency of multimodal ultrasound is better than conventional ultrasound.Multimodal ultrasound(US+SWE+3D-SMI)can help to differentiate PA and WT.