论著-头颈部
腮腺结核的CT表现和病理分析*
作者:曾 春1 李 娴2 李咏梅1 欧阳羽1 王静杰1 刘 义1 尹 平1 韩永良1
所属单位:1.重庆医科大学附属第一医院放射 科 (重庆 400016) 2.重庆医科大学病理教研室 (重庆 400016)
PDF摘要
目的 总结腮腺结核的CT特点, 旨在提高对该病的认识和术前诊断水平。 方法 回顾性分析经手术病理证实的26例 腮腺结核的CT特点,并与病理结果对照。 结果 (1)病灶部位:23例为单侧,3例为 双侧。1例弥漫性病灶,10例为单发病 灶,15例为多发病灶;累及浅叶8例,同 时累及浅叶和深叶18例。(2)病灶的数量 和形态:共56个病灶,10个单发病灶中结 节型6个、肿块型4个;45个多发病灶结节 型32个、肿块型13个。(3)病灶的密度和 强化方式:均未见钙化灶,18例病灶密度 均匀,8例病灶密度不均匀。均匀强化病 灶6例,环形强化病灶19例,弥漫性强化 1例。(4)周围皮肤改变及颈部淋巴结情 况:18例出现腮腺周围皮肤增厚。23例患 者只有同侧颈动脉鞘周围肿大,3例肺结 核患者表现为双侧颈动脉鞘周围淋巴结肿 大。结论 腮腺结核的CT表现多样性,与 其病理表现密切相关,正确认识在腮腺结 核CT特点有助于鉴别诊断,但最终诊断仍 依赖于病理检查结果。
Objective To summarize the CT characteristics of tuberculosis in parotid gland, improving diagnostic accuracy of this disease. Methods 26 patients with tuberculosis in parotid confirmed by surgical pathology were analyzed retrospectively. All patients underwent preoperative CT plain scan and enhanced scan, comparing with the pathological results. Results (1) Location of the lesions: 23 cases were in one parotid gland and three cases were in both parotid glands. One case was diffuse lesion, 10 cases were single lesions, and 15 cases were multiple lesions. Eight cases involved the shallow lobes of parotid gland, 18 cases involved both the shallow and deep lobes. (2) Amount and morphology of lesions: A total of 56 lesions were found. Six lesions were nodular type and four were tumor type in 10 single lesions; 45 multiple lesions concluded 32 nodular type and 13 tumor type. (3) Density and enhancement forms of the lesions: Focal calcification was not found in all lesions. On CT plain scan, 18 cases showed homogeneous density, and eight cases were inhomogeneous density. On CT enhanced scan, moderate homogeneous enhancement was seen in six cases, ring enhancement was seen in 19 cases, diffuse enhancement was seen in one case. (4) Change of adjacent skin and lymph modes in neck: Thickening of skin around the parotid gland were found in 18 cases. Ipsilateral lmphadenectasis were found in carotid sheath, posterior triangle of the neck and sub maxillary region in 23 patients, bilateral lmphadenectasis were seen in three cases. Conclusion CT characteristics of tuberculosis presents diversity in parotid gland, relating pathological manifestation closely. Correct understanding characteristic CT performance of tuberculosis presents diversity in parotid gland is helpful for differential diagnosis, but final diagnosis still depend on laboratory results and pathological examination.
【关键词】腮腺疾病;结核;病理;体层 摄影技术;X线计算机
【中图分类号】R816.96
【文献标识码】A
【DOI】10.3969/j.issn.1672- 5131.2016.02.001
前言
腮腺结核多数发生在腮腺淋巴结内,只有少部分发生在腮腺实质 内,是大涎腺少见的感染性疾病。目前国内外对腮腺结核的报道较 少,且这些报道主要讨论其临床表现和治疗方案,较少涉及影像学表 现[1-3]。腮腺结核的临床表现缺乏特异性,对其CT表现认识不够,术前 常被误诊为腮腺的其它疾病。本研究回顾性分析了26例经手术病理证 实为腮腺结核的CT征象,结合文献并与病理对照,总结腮腺结核的CT 特点,旨在提高对该病的认识和术前诊断水平。
中国CT和MRI杂志
第14卷, 第 2 期
2016年02月
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