常规超声联合剪切波弹性成像与MRI对腮腺多形性腺瘤与Warthin瘤的鉴别诊断价值  

Value of conventional ultrasound combined with shear wave elastography and MRI in the differential diagnosis of pleomorphic adenoma and Warthin’s tumor of parotid

作　　者：毛翠莲 李奥[1] 胡彧[1] 马倩[1] 朱榴宁 MAO Cuilian;LI Ao;HU Yu;MA Qian;ZHU Liuning(Department of Ultrasound Diagnosis,First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院超声诊断科,南京市210029

出　　处：《临床超声医学杂志》2023年第10期806-810,共5页Journal of Clinical Ultrasound in Medicine

摘　　要：目的 探讨常规超声联合剪切波弹性成像(SWE)鉴别诊断腮腺多形性腺瘤与Warthin瘤的价值,并与MRI进行对比分析。方法 选取我院经手术病理证实的81例腮腺肿瘤患者,包括多形性腺瘤58例和Warthin瘤23例,比较两种病变的常规超声表现和SWE参数[杨氏模量最大值(Emax)、平均值(Emean)、最小值(Emin)、标准差(SD)]的差异。分别建立基于常规超声表现、SWE参数、常规超声表现联合SWE参数鉴别诊断多形性腺瘤与Warthin瘤的Logistic回归模型,绘制受试者工作特征(ROC)曲线分析并比较不同模型、MRI鉴别诊断多形性腺瘤与Warthin瘤的效能。结果 多形性腺瘤与Warthin瘤肿块形态、内部强回声及无回声占比、主要血管分布、血流分级、Emax、Emean、SD比较,差异均有统计学意义(均P<0.05)。建立了3个分别基于常规超声表现、SWE参数、常规超声表现联合SWE参数的Logistic回归模型(模型Ⅰ、模型Ⅱ、模型Ⅲ);ROC曲线分析显示,模型Ⅰ、模型Ⅱ、模型Ⅲ鉴别诊断多形性腺瘤与Warthin瘤的曲线下面积(AUC)分别为0.881、0.837、0.962,模型Ⅲ的AUC均高于模型Ⅰ和模型Ⅱ,差异均有统计学意义(均P<0.05)。剔除MRI、常规超声及SWE误诊的病灶后,常规超声联合SWE(模型Ⅲ)鉴别诊断多形性腺瘤与Warthin瘤的灵敏度为85%,特异度为88%,准确率为86%,AUC为0.867;MRI的灵敏度为87%,特异度为84%,准确率为86%,AUC为0.856,二者AUC比较差异无统计学意义。结论 常规超声联合SWE在腮腺多形性腺瘤与Warthin瘤的鉴别诊断中具有较好的应用价值,且其诊断效能与MRI相当。Objective To explore the value of conventional ultrasound(US)combined with shear wave elastography(SWE)in the differential diagnosis of pleomorphic adenoma and Warthin’stumor of parotid,and compare it with MRI.Methods A total of 81 cases of parotid tumors confirmed by surgery and pathology in our hospital were selected,including 58 cases of pleomorphic adenoma and 23 cases of Warthin’s tumor.The differences of US manifestations and SWE parameters[maximum(Emax),mean value(Emean),minimum value(Emin),standard deviation(SD)of Young’smodulus]between the two lesions were compared.Logistic regression models were established for the differential diagnosis of pleomorphic adenoma and Warthin’s tumor based on US manifestations,SWE parameters,and US manifestations combined with SWE parameters,respectively.Receiver operating characteristic(ROC)curve was drawn to analyze and compare the efficacy of different models and MRI in the differential diagnosis of pleomorphic adenoma and Warthin’s tumor.Results There were statistical significance in the tumor shape,proportion of internal hyper echoic and anechoic,blood flow distribution,blood flow grade,Emax,Emean,SD between pleomorphic adenoma and Warthin’stumor(all P<0.05).Three Logistic regression models(modelⅠ,modelⅡ,modelⅢ)were established for the differential diagnosis of pleomorphic adenoma and Warthin’s tumor based on US manifestations,SWE parameters,US manifestations combined with SWE parameters,respectively.ROC curve analysis showed that the area under the curve(AUC)of modelⅠ,modelⅡand modelⅢin the differential diagnosis of pleomorphic adenoma and Warthin’s tumor were 0.881,0.837 and 0.962,respectively.The AUC of modelⅢwas higher than that of modelⅠand modelⅡ,and the differences were statistically significant(both P<0.05).After the lesions which misdiagnosed by MRI,US and SWE were eliminated,the sensitivity,specificity,accuracy and AUC of US combined with SWE(modelⅢ)in the differential diagnosis of pleomorphic adenoma and Warthin’s tumor

关 键 词：超声检查 剪切波弹性成像 MRI 多形性腺瘤 WARTHIN瘤 鉴别诊断 

分 类 号：R445.1[医药卫生—影像医学与核医学] R739.9[医药卫生—诊断学]