超声造影对涎腺肿块定性诊断的初步研究

摘要

目的 探讨超声造影对涎腺肿块定性诊断的价值.方法 采用超声造影剂SonoVue静脉团注观察78个涎腺肿块的超声造影表现,并与手术病理对照.结果 78个涎腺肿块中多形性腺瘤29个(37.2％),Warthin's瘤19个(24.4％),基底细胞腺瘤7个(8.9％),其他良性肿块11个(14.1％),恶性肿瘤12个(15.4％).以肿块呈低增强、增强后边界清楚、周边有完整的增强环、肿块无增大为良性肿块的诊断标准,其准确性为87.2％,敏感性为95.2％,特异性为56.3％,阳性预测值89.4％,阴性预测值75.0％,阳性似然比2.178,阴性似然比0.085.对涎腺发病率最高的三种良性肿瘤即多形性腺瘤、Warthin's瘤、基底细胞腺瘤超声增强表现进行两两比较,多形性腺瘤与Warthin' s瘤、基底细胞腺瘤差异有统计学意义(P＜0.01)；而Warthin's瘤与基底细胞腺瘤差异无统计学意义(P＞0.05).结论 涎腺肿块超声造影表现有助于涎腺肿块的鉴别诊断.%Objective To investigate the qualitative diagnosis of salivary gland mass with contrastenhanced ultrasound(CEUS).Methods The CEUS manifestations in 78 cases with salivary gland mass were observed after intravenous bolus injection with contrast agent SonoVue and confirmed by histology.Results Among 78 salivary gland masses,there were 29 cases with pleomorphic adenomas (37.2％),19with Warthin's tumors (24.4 ％),7 with basal cell adenomas (8.9 ％),and 11 with the other benign masses (14.1％),12 with malignant tumors (15.4％).The intensity of contrast-enhanced masses,whether the enhanced mass margin was clear,whether the peripheral enhancement rim was complete and whether the mass was enlarged were the diagnostic criteria to differentiate the benign and malignant tumors.The accuracy,the sensitivity,specificity,positive predictive value and negative predictive value were 87.2％,95.2％,56.3％,89.4％,75.0％ respectively,and the results also displayed positive likelihood ratio and negative likelihood ratio were 2.178,0.085 respectively.Although they presented with the highest incidence among benign tumors,their CEUS manifestations showed remarkable statistical differences when the pleomorphic adenoma was compared with Warthin' s tumor and basal cell adenoma respectively in enhancement intensity(P ＜0.01) while there were no statistical differences between Warthin's tumors and basal cell adenomas (P ＞0.05).Conclusions CEUS manifestations of salivary gland mass were helpful to the differential diagnosis of various salivary gland tumors.