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腮腺肿瘤的MSCT诊断及误诊分析

作者:李高峰 黄学武 黄耀华

所属单位:广州中医药大学第一附属医院影像科(广东 广州 510405)

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摘要

目的探讨腮腺肿瘤的MSCT 表 现,分析误诊原因,提高诊断水平。方 法 回顾性分析手术病理证实的83例腮腺 肿瘤患者CT 资料,探讨其MSCT表现并分 析误诊原因。结果 良性61例,恶性22 例;良性肿瘤多位于浅叶,边界多清晰 光滑,持续或渐进性强化多见,腺淋巴 瘤早期明显强化;混合瘤、血管瘤可见 钙化,腺淋巴瘤囊变多见。恶性肿瘤多 位于深叶,具恶性肿瘤一般特点。CT误 诊9例:2例腺淋巴瘤、1例良性肌上皮瘤 及1例海绵状血管瘤误诊为混合瘤,1例 混合瘤误诊为血管瘤,1例基底细胞腺 瘤误判为恶性,3例边界清楚长径小于 2.5cm的恶性肿瘤误判为良性。结论 腮 腺肿瘤MSCT能准确定位并判定良恶性, 大部分可术前明确诊断;部分表现不典 型或互有重叠,拘泥于好发部位、性别 年龄等均可成为误诊原因。

Objective To investigate the MSCT features of parotid tumors and to analyze the causes of misdiagnosis and improve the diagnostic level. Methods The MSCT findings of 83 patients with parotid tumors proved by surgery and pathology were analyzed retrospectively. The MSCT findings and the causes of misdiagnosis were analyzed. Results 61 cases were benign, and the other was malignant in 22 cases. Benign tumors were located in the superficial lobe, and the border was clear and smooth, persistent or progressive intensification, adenolymphoma was enhanced obviously in the early phase, calcification could be found in pleomorphic adenoma and hemangioma, most adenolymphomas were with cystic change. Most malignant tumors of parotid were located in the deep lobe, with the general characteristics of malignant tumors. CT misdiagnosis in 9 cases: 2 case of adenolymphoma, 2 case of myoepithelioma and 1 case hemangioma were misdiagnosed as pleomorphic adenoma, 1 case pleomorphic adenoma was misdiagnosed as hemangioma,1 case basal cell adenoma was misdiagnosed as malignant tumor,3 cases of malignant tumors with clear boundary length of less than 2.5cm misdiagnosed as benign. Conclusion MSCT can accurately locate and determine the benign and malignant tumors of parotid gland, most of them can be diagnosed before operation, some of them are not typical, and overdependence on predilection sites, gender, age, etc will lead to misdiagnosis.

【关键词】腮腺;肿瘤;体层摄影术;X线计算机;诊断

【中图分类号】R781.7+3

【文献标识码】A

【DOI】10.3969/j.issn.1672-5131.2018.09.027

前言

腮腺肿瘤种类繁多,临床表现缺乏特异性。术前准确定位及判定 良恶性对治疗和预后尤为重要。穿刺活检虽为术前诊断金标准,但受 肿瘤位置及取材限制,且易引起种植播散。CT可确定肿瘤的位置、大 小、数目、周围结构、淋巴结及骨质情况,对临床诊断及指导手术均 有重要价值。但因腮腺肿瘤病理分型复杂,部分影像表现可不典型或 互有重叠,术前误诊仍时有发生。现搜集分析我院2010年1月~2017 年2月经手术病理证实的83例腮腺肿瘤患者的CT资料,探讨其CT表现并 分析误诊原因,以期提高诊断水平。