MRI对直径≤2cm的多形性腺瘤和基底细胞腺瘤的诊断价值及病理相关性分析  

MRI diagnostic value and pathological correlation analysis of pleomorphic adenoma and basal cell adenoma≤2 cm in diameter

作　　者：郇通 王海滨 韩志江[2] 魏培英 汪荣 段青云 HUAN Tong;WANG Haibin;HAN Zhijiang;WEI Peiying;WANG Rong;DUAN Qingyun(Department of Pathology,Hangzhou First People's Hospital,Zhejiang University School of Medicine,Hangzhou 310006,China;Department of Radiology,Hangzhou First People's Hospital,Zhejiang University School of Medicine,Hangzhou 310006,China;Department of Stomatology,Hangzhou First People's Hospital,Zhejiang University School of Medicine,Hangzhou 310006,China)

机构地区：[1]浙江大学医学院附属杭州市第一人民医院病理科,浙江杭州310006 [2]浙江大学医学院附属杭州市第一人民医院放射科,浙江杭州310006 [3]浙江大学医学院附属杭州市第一人民医院口腔科,浙江杭州310006

出　　处：《实用放射学杂志》2020年第11期1727-1731,共5页Journal of Practical Radiology

摘　　要：目的探讨直径≤2 cm的多形性腺瘤(PA)和基底细胞腺瘤(BCA)的MRI征象及各征象的病理学基础,提高鉴别诊断效能.方法回顾经手术证实的直径≤2 cm PA和BCA的MRI影像和病理资料,归纳瘤体位置、形态、囊变、包膜、T2 WI上瘤体信号均匀度、T2 WI上高信号轮廓清晰度在二者中的分布,通过Fisher精确检验进行分析;测量增强一期和二期信号强度比值(SIR),计算增强信号强度值比值(eSIR)(eSIR=增强二期信号强度值/增强一期信号强度值),通过t检验对二者的年龄和eSIR进行检验,并通过ROC曲线获得鉴别PA和BCA的最佳eSIR阈值.结果13例PA和10例BCA中,位于腮腺浅叶分别为13例和8例(P=0.178),形态规则分别为6例和9例(P=0.074),囊变分别为4例和4例(P=0.685),有包膜分别为10例和9例(P=0.604),T2 WI上信号不均匀分别为11例和6例(P=0.341),T2 WI上高信号轮廓不清晰分别为9例和1例(P=0.035),PA和BCA发病年龄分别为(37±13)岁和(59±9)岁(t=4.434,P=0.000);PA和BCA的eSIR分别为1.02±0.15和1.16±0.11(t=-2.495,P=0.024),eSIR鉴别二者的AUC为0.8,当eSIR为1.0时,敏感度和特异度分别为92.3%和60%.结论MRI对直径≤2 cm的PA和BCA的鉴别具有重要价值,年轻患者、T2 WI上瘤体高信号轮廓不清和eSIR≥1有助于PA的诊断,而老年患者、T2 WI上瘤体高信号轮廓清晰和eSIR<1则提示BCA的诊断.Objective To investigate the MRI signs of pleomorphic adenomas(PA)and basal cell adenoma(BCA)W2 cm in diameter and the pathological basis of each sign,to improve the diagnostic efficacy.Methods The MRI images and pathological data of PA and BCA with diameters W2 cm confirmed by surgery were analyzed retrospectively.The condition of tumor location and morphology,cystic change and capsule,distribution of tumor signal uniformity on T2 WI and the high signal shape definition on T2 WI were analyzed by Fisher's exact test;the signal intensity ratio(SIR)of the enhanced phase I and phase Ⅱ were measured,and then the enhanced SIR(eSIR)were calculated(eSIR=signal intensity of enhanced phase Ⅱ/signal intensity of enhanced phase I).The ages and eSIR were tested by t test,and the optimal eSIR threshold for identifying PA and BCA was obtained by ROC curve.Results Among the 13 PA and 10 BCA cases,the cases were located in the superficial parotid gland were 13 and 8 cases(P=0.178)respectively,and the cases of regular morphology were 6 and 9 cases(P=0.074)respectively,and the cases associated with cystic changes were 4 and 4 cases(P=0.685)respectively,and there were 10 cases and 9 cases with capsules(P=0.604).The unevenness of signal intensities on T2 WI were 11 and 6 cases(P=0.341)respectively.The unclear shape of high signal intensities on T2 WI were 9 and 1 case(P=0.035)respectively,and the onset age of PA and BCA was 37±13 and 59±9(T=4.434=0.000);The eSIR of PA and BCA were 1.02±0.15 and 1.16±0.11(t=-2.495,P=0.024).The AUC for eSIR identification was 0.8.When eSIR was 1.0,the sensitivity and specificity were 92.3%and 60%,respectively.Conclusion The identification of PA and BCA W2 cm in diameter on MRI has a high value.Young patients and T2 WI with unclear tumor shape of high signal intensities and eSIR≥l are helpful for PA diagnosis,while elderly patients and T2 WI with clear tumor shape of high signal intensities and eSIR<1 prompts the diagnosis of BCA.

关 键 词：腮腺 多形性腺瘤 基底细胞腺瘤 磁共振成像 病理学 

分 类 号：R739.8[医药卫生—肿瘤] R445.2[医药卫生—临床医学]