切换至 "中华医学电子期刊资源库"

中华医学超声杂志(电子版) ›› 2022, Vol. 19 ›› Issue (12) : 1366 -1372. doi: 10.3877/cma.j.issn.1672-6448.2022.12.009

浅表器官超声影像学

多模态超声在涎腺局灶性病变良恶性鉴别诊断中的价值
彭柳清1, 韩鹏1, 李楠1, 梁舒媛1, 费翔1,()   
  1. 1. 100853 北京,解放军总医院第一医学中心超声科
  • 收稿日期:2021-06-09 出版日期:2022-12-01
  • 通信作者: 费翔

Value of multi-modal ultrasound in differential diagnosis of benign and malignant focal lesions of the salivary gland

Liuqing Peng1, Peng Han1, Nan Li1, Shuyuan Liang1, Xiang Fei1,()   

  1. 1. Department of Ultrasound, Chinese PLA General Hospital, Beijing 100853, China
  • Received:2021-06-09 Published:2022-12-01
  • Corresponding author: Xiang Fei
引用本文:

彭柳清, 韩鹏, 李楠, 梁舒媛, 费翔. 多模态超声在涎腺局灶性病变良恶性鉴别诊断中的价值[J/OL]. 中华医学超声杂志(电子版), 2022, 19(12): 1366-1372.

Liuqing Peng, Peng Han, Nan Li, Shuyuan Liang, Xiang Fei. Value of multi-modal ultrasound in differential diagnosis of benign and malignant focal lesions of the salivary gland[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2022, 19(12): 1366-1372.

目的

探讨多模态超声鉴别诊断涎腺局灶性病变性质的价值。

方法

回顾性分析2018年1月至2020年12月在解放军总医院第一医学中心收治的128例涎腺局灶性病变患者的临床资料以及超声影像资料。以手术或穿刺病理结果为金标准,将其分为良性组和恶性组。128例均行常规超声(US)、实时超声弹性成像(RTE)及超声造影(CEUS)检查,记录并分析3种模态的超声图像特征。采用χ2检验比较2组间病灶的超声图像特征,绘制受试者工作特征(ROC)曲线,计算US、US+RTE、US+CEUS、US+RTE+CEUS诊断涎腺局灶性病变的诊断效能以及ROC曲线下面积。

结果

128例中,病理诊断良性病灶85例,恶性病灶43例。良性组病灶中91.8%(78/85)边界清晰、58.8%(50/85)形态规则,分别高于恶性病灶的58.1%(25/43)、18.6%(8/43),差异均有统计学意义(P均<0.001);恶性组病灶中46.5%(20/43)RTE分级为Ⅲ级、72.1%(31/43)CEUS模式表现为Ⅱc型,良性组病灶中仅16.5%(14/85)RTE分级为Ⅲ级、11.8%(10/85)CEUS模式表现为Ⅱc型,2组比较差异均有统计学意义(P均<0.05)。US+RTE任意一项结果阳性即诊断恶性对涎腺病变良恶性诊断的敏感度、特异度为0.767、0.800,ROC曲线下面积和约登指数为0.784、0.567。US+CEUS任意一项结果阳性即诊断恶性的敏感度、特异度分别为0.791、0.882,ROC曲线下面积和约登指数为0.837、0.673。US+RTE+CEUS中任意2项或以上结果阳性即诊断为恶性,其敏感度、特异度、准确性、阳性预测值和阴性预测值分别为0.767、0.941、0.883、0.868、0.889,ROC曲线下面积和约登指数为0.854、0.708。

结论

多模态超声联合应用有助于提高超声对涎腺局灶性病变良恶性的鉴别诊断价值。

Objective

To assess the value of multi-modal ultrasound in the differential diagnosis of focal lesions of the salivary gland.

Methods

A retrospective analysis was conducted on the clinical and ultrasonic imaging data of 128 patients with focal lesions of salivary gland who were cured at the First Medical Center of PLA General Hospital from January 2018 to December 2020. Those patients were divided into either a benign group or a malignant group based on the pathology results as golden standard. All the patients underwent conventional ultrasound (US), real-time ultrasound elastography (RTE), and contrast enhanced ultrasound sonography (CEUS), and the features of all ultrasound images were recorded and analyzed. The χ2 test was used to compare the multimodal ultrasound image characteristics of the lesions between the two groups, and the receiver operating characteristic (ROC) curve was plotted. The diagnostic efficacy of US, US+RTE, US+CEUS, and US+RTE+CEUS in the diagnosis of focal salivary gland lesions was assessed by the area under the ROC curve (AUC).

Results

Among the 128 patients included, 85 were confirmed to have benign lesions through pathological diagnosis, and 43 had malignant lesions. The incidence of sharpness of the border and regularity of the shape on US was significantly higher in the benign group than in the malignant group (P<0.001). In the malignant group, 46.5% (20/43) of cases were classified as grade Ⅲ by RTE and 72.1% (31/43) were classified as type IIc by CEUS; the corresponding percentages in the benign group were only 16.5% (14/85) and 11.8% (10/85), respectively. When positivity obtained by either US or RTE was used to diagnose malignancy, the sensitivity, specificity, AUC, and Youden's index were 0.767, 0.800, 0.784, and 0.567, respectively. When positivity obtained by either US or CEUS was used to diagnose malignancy, the sensitivity, specificity, AUC, and Youden's index were 0.791, 0.882, 0.837, and 0.673, respectively. When positivity obtained by any one of US, RTE, and CEUS was used to diagnose malignancy, the sensitivity, specificity, accuracy, negative predictive value, and positive predictive value were 0.767, 0.941, 0.883, 0.868, and 0.889, respectively, and the AUC and Youden's index were 0.854 and 0.708, respectively.

Conclusion

Combined application of multi-modal ultrasound can improve the differential diagnosis of benign and malignant focal lesions of the salivary gland.

图1 良性与恶性涎腺肿块常规超声、超声弹性成像和超声造影图像。图a~c为涎腺良性肿块常规超声、超声弹性成像及超声造影图像,图a、c显示病灶边界清晰、形态规则(箭头所示),图b显示病灶超声弹性成像分级为Ⅱ级;图d~f为涎腺恶性肿块常规超声、超声弹性成像及超声造影图像,图d显示病灶局部边界欠清晰(星号所示),病灶局部形态不规则(箭头所示),图e显示病灶超声弹性成像分级为Ⅲ级,图f显示病灶局部边界不清(箭头所示)
表1 良性与恶性涎腺局灶性病变的常规超声特征比较[例(%)]
表2 良性与恶性涎腺局灶性病变RTE分级结果比较[例(%)]
表3 良性与恶性涎腺局灶性病变CEUS分型结果比较[例(%)]
图2 不同超声成像模式诊断涎腺病变良恶性的ROC曲线注:US为常规超声;RTE为实时超声弹性成像;CEUS为超声造影;cut-off point为截断值
表4 不同超声成像模式诊断涎腺病变良恶性的效能
表5 不同超声成像模式诊断结果与病理诊断结果的对比分析
1
Joshi NP, Broughman JR. Postoperative management of salivary gland tumors[J]. Curr Treat Options Oncol, 2021, 22(3): 23.
2
Takumi K, Nagano H, Kikuno H, et al. Differentiating malignant from benign salivary gland lesions: a multiparametric non-contrast MR imaging approach[J]. Sci Rep, 2021,11(1): 2780.
3
李匡政, 江义霞, 范晓升, 等. 不同手术方式治疗腭部涎腺肿瘤的临床观察[J]. 微创医学, 2018, 13(5): 631-632, 662.
4
Rzepakowska A, Osuch-Wójcikiewicz E, Sobol M, et al. The differential diagnosis of parotid gland tumors with high-resolution ultrasound in otolaryngological practice[J]. Eur Arch Otorhinolaryngol, 2017, 274(8): 3231-3240.
5
Kapetas P, Clauser P, Woitek R, et al. Quantitative multiparametric breast ultrasound: application of contrast-enhanced ultrasound and elastography leads to an improved differentiation of benign and malignant lesions[J]. Invest Radiol, 2019, 54(5): 257-264.
6
Liang L, Zhi X, Sun Y, et al. A nomogram based on a multiparametric ultrasound radiomics model for discrimination between malignant and benign prostate lesions[J]. Front Oncol, 2021, 11: 610785.
7
Martinoli C, Derchi LE, Solbiati L, et al. Color Doppler sonography of salivary glands[J]. AJR Am J Roentgenol, 1994, 163(4): 933-941.
8
韩明丽, 史秋生, 陈红燕, 等. 超声鉴别诊断涎腺肿瘤良恶性的特征分析[J]. 临床超声医学杂志, 2020, 22(6): 458-461.
9
文宏, 何娇, 周琳, 等. 腮腺上皮来源性肿瘤超声图像特点与病理对照研究[J]. 医学影像学杂志, 2018, 28(11): 1818-1821.
10
李巧珍, 肖萤, 徐乐天, 等. 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[J/CD]. 中华医学超声杂志(电子版), 2012, 9(9): 809-812.
11
岳林先. 浅表淋巴结病变的超声诊断[J]. 四川医学, 2004, 25(7): 822-823.
12
Wei X, Li Y, Zhang S, et al. Evaluation of microvascularization in focal salivary gland lesions by contrast-enhanced ultrasonography (CEUS) and Color Doppler sonography[J]. Clin Hemorheol Microcirc, 2013, 54(3): 259-271.
13
Kong X, Li H, Han Z. The diagnostic role of ultrasonography, computed tomography, magnetic resonance imaging, positron emission tomography/computed tomography, and real-time elastography in the differentiation of benign and malignant salivary gland tumors: a meta-analysis[J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2019, 128(4): 431-443.e1.
14
Cunha J, Hernandez-Guerrero JC, De Almeida OP, et al. Salivary gland tumors: a retrospective study of 164 cases from a single private practice service in mexico and literature review[J]. Head Neck Pathol, 2021, 15(2): 523-531.
15
David E, Cantisani V, De Vincentiis M, et al. Contrast-enhanced ultrasound in the evaluation of parotid gland lesions: an update of the literature[J]. Ultrasound, 2016, 24(2): 104-110.
16
Tatar IG, Ergun O, Kurt A, et al. The role of elastosonography in the differentiation of parotid gland lesions: report of three cases and review of the literature[J]. Pol J Radiol, 2014, 79: 398-401.
17
Dumitriu D, Dudea S, Botar-Jid C, et al. Real-time sonoelastography of major salivary gland tumors[J]. AJR Am J Roentgenol, 2011, 197(5): W924- W930.
18
Cortcu S, Elmali M, Tanrivermis Sayit A, et al. The role of real-time sonoelastography in the differentiation of benign from malignant parotid gland tumors[J]. Ultrasound Q, 2018, 34(2): 52-57.
19
Altinbas NK, Gundogdu Anamurluoglu E, Oz II, et al. Real-time sonoelastography of parotid gland tumors[J]. J Ultrasound Med, 2017, 36(1): 77-87.
20
苟加梅, 陈琴, 周果, 等. 超声造影对涎腺肿块定性诊断的初步研究[J]. 中华超声影像学杂志, 2013(2): 141-144.
21
蒋丽萍, 周爱云, 余美琴. CEUS鉴别诊断涎腺良恶性病变[J]. 中国医学影像技术, 2019, 35(4): 521-525.
22
陈丽羽, 周玲燕, 吴丽丽, 等. 超声造影在大涎腺良、恶性多形性腺瘤鉴别诊断中的价值[J]. 中华超声影像学杂志, 2017, 26(3): 259-263.
23
Zheng N, Li R, Liu W, et al. The diagnostic value of combining conventional, diffusion-weighted imaging and dynamic contrast-enhanced MRI for salivary gland tumors[J]. Br J Radiol, 2018, 91(1089): 20170707.
24
Heřman J, Sedláčková Z, Vachutka J, et al. Differential diagnosis of parotid gland tumors: role of shear wave elastography[J]. Biomed Res Int, 2017, 2017: 9234672.
25
蒋丽萍. 超声检查在涎腺肿瘤中的应用[D] 南昌:南昌大学, 2020.
26
邵琦, 陈丽羽, 徐栋, 等. 31例涎腺黏液表皮样癌的超声表现与病理分析[J]. 肿瘤学杂志, 2016, 22(11): 969-971.
27
张旭, 刘丹, 黄品同. 多模态超声在颈部淋巴瘤诊断中的价值[J/CD]. 中华医学超声杂志(电子版), 2020, 17(10): 987-992.
28
Ying M, Bhatia KS, Lee YP, et al. Review of ultrasonography of malignant neck nodes: greyscale, Doppler, contrast enhancement and elastography[J]. Cancer Imaging, 2014, 13(4): 658-669.
29
曹文斌, 陈琴, 岳林先, 等. 原发性腮腺淋巴瘤常规超声造影表现及相关文献复习[J]. 中国超声医学杂志, 2019, 35(2): 180-183.
[1] 王亚红, 蔡胜, 葛志通, 杨筱, 李建初. 颅骨骨膜窦的超声表现一例[J/OL]. 中华医学超声杂志(电子版), 2024, 21(11): 1089-1091.
[2] 汪洪斌, 张红霞, 何文, 杜丽娟, 程令刚, 张雨康, 张萌. 低级别阑尾黏液性肿瘤与阑尾黏液腺癌超声及超声造影特征分析[J/OL]. 中华医学超声杂志(电子版), 2024, 21(09): 865-871.
[3] 宋勇, 李东炫, 王翔, 李锐. 基于数据挖掘法分析3 种超声造影剂不良反应信号[J/OL]. 中华医学超声杂志(电子版), 2024, 21(09): 890-898.
[4] 王博冉, 乔春梅, 李春歌, 王欣, 王晓磊. 超声造影评估类风湿关节炎亚临床滑膜炎疾病进展的价值[J/OL]. 中华医学超声杂志(电子版), 2024, 21(08): 802-808.
[5] 马晓菊, 梁潇, 段云友, 袁丽君, 赵萍. NBAV脂质纳泡对ApoE -/-小鼠动脉粥样硬化病变的评估和干预[J/OL]. 中华医学超声杂志(电子版), 2024, 21(06): 608-616.
[6] 马旦杰, 黄品同, 徐琛, 周芳芳, 潘敏强. 超声造影LI-RADS系统联合甲胎蛋白对有无高危因素背景人群肝细胞癌的诊断价值[J/OL]. 中华医学超声杂志(电子版), 2024, 21(03): 288-296.
[7] 邢益民, 张天飞, 戴慧勇. 胃肠充盈超声造影检查在反酸、嗳气患者临床诊断中的应用[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(03): 303-306.
[8] 郑大雯, 王健东. 胆囊癌辅助诊断研究进展[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 769-773.
[9] 张红君, 郑博文, 廖梅, 任杰. 超声及超声造影在肝移植术后上腹部淋巴结良恶性鉴别诊断中的应用[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(04): 562-567.
[10] 温绍敏, 王雅晳, 施依璐, 段莎莎, 云书荣, 张小杉. 靶向超声造影技术在动脉粥样硬化治疗中的应用进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(05): 496-499.
[11] 黄宏山, 陈成彩. 经淋巴管超声造影在乳腺癌前哨淋巴结诊断中的研究进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(04): 411-414.
[12] 赵欣, 李昊昌, 卫星彤. 多模态超声在非肿块型乳腺病变中的研究进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(04): 407-410.
[13] 曹建辉, 冯斌, 黄伟伟, 张超. 超声造影在乳腺BI-RADS 4A类结节诊断及穿刺活检中的应用价值[J/OL]. 中华临床医师杂志(电子版), 2024, 18(04): 363-368.
[14] 卫星彤, 李昊昌, 赵欣. 甲状腺木乃伊结节于多模态超声下的研究进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(04): 415-419.
[15] 史宛瑞, 崔立刚. 颈动脉一过性血管周围炎综合征的影像学诊断研究进展[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(05): 516-519.
阅读次数
全文


摘要