Objective To evaluate the value of real-time tissue elastography (RET) in differential diagnosis of benign and malignant parotid tumors. Methods The elastography of parotid lesions in 48 patients with 52 lesions were first examined by the two dimensional ultrasound and color Doppler flow imaging (CDFI) to observe their position, size, shape, margin, echogenicity, and vascularity. Then under elastic imaging mode, these lesions were evaluate by elastographic strain grades , which were classified into five grades. The diagnosis were compared with pathological results. Results The elastographic grades of most benign lesions(81. 8% ,36/44) were 0-Ⅱ , while most of malignancy lesions (87. 5% ,7/8) were Ⅲ-Ⅳ.The elastographic grades of benign and malignant lesions were of significant difference statistically (P =0.035 ). The sensitivity, specificity, the accuracy, positive predictive value, and negative predictive value of RET for diagnosing malignant parotid lesions were 87.5% (7/8) ,81. 8% (36/44) ,82.7% (43/52) ,46. 7% (7/15) , and 97. 3% (36/37) , respectively. Conclusions The RET can provide information on the flexibility of tissue,which is useful in the differential diagnosis of parotid lesions . But the findings of some pleomorphic adenomas may overlap with the malignant tumors in the elastography . It is necessary to combine with the two dimensional ultrasound ,CDFI,and the clinical features of the patients in the diagnosis .%目的 探讨实时超声弹性成像技术在腮腺良恶性占位性病变鉴别诊断中的应用价值.方法 对48例52个腮腺占位性病变首先行二维超声检查,观察病灶的位置、大小、形态、边界、内部回声、后方回声等,然后切换到实时超声弹性成像模式进行实时超声弹性成像检查,将弹性图像分为0～Ⅳ级,并与手术病理结果进行比较.结果 良性病变组81.8%(36/44)占位性病变弹性分级为0～Ⅱ级,而恶性病变组87.5%(7/8)占位性病变弹性分级为Ⅲ～Ⅳ级,两组病变的弹性分级情况比较差异有统计学意义(P=0.039).以弹性分级Ⅲ～Ⅳ级为恶性预测指标,其敏感度、特异度、准确性、阳性预测值、阴性预测值分别为87.5%(7/8)、81.8%(36/44)、82.7%(43/52)、46.7%(7/15)、97.3%(36/37).结论 实时超声弹性成像提供了组织软硬度的信息,有助于腮腺良恶性占位性病变的鉴别.但部分多形性腺瘤和恶性病变在弹性图上存在一定重叠,需结合二维超声、彩色多普勒超声等常规超声及临床资料进行综合评价,帮助鉴别诊断.
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