2017 年第 10 期 第 12 卷

颌下腺导管癌螺旋CT影像特征及其术前诊断价值

Image features and preoperative diagnostic value of spiral CT in ductal carcinoma of submandibular gland

作者：崔海龙赵亮张慧生

英文作者：Cui Hailong Zhao Liang Zhang Huisheng

单位：046000山西省长治市人民医院影像科

英文单位：Department of Medical Imaging People′s Hospital of Changzhi City Shanxi Province Changzhi 046000 China

关键词：导管癌；颌下腺；体层摄影技术；X线计算机

英文关键词：Ductalcarcinoma;Submandibulargland;Tomography;X-raycomputed

• 摘要：

• 目的 分析颌下腺导管癌的螺旋CT影像特征及其术前诊断价值。方法 回顾性分析2003年 2月至2016年10月山西省长治市人民医院和长治医学院附属和平医院共13例颌下腺导管癌的多排螺旋CT影像征象及临床资料，并与病理特征对照。术前均行多层螺旋CT双期增强扫描，分析肿块的位置、大小、边缘、密度、强化方式及侵犯范围。结果 13例患者均为颌下腺单发肿块，肿块最大径2.2～11.0 cm，平均（3.0±1.2）cm。4例类圆形肿块，9例不规则肿块。平扫低密度肿块11例，等密度肿块 2例；2例散在点状钙化。11例动脉期肿块明显不均匀强化，2例轻度强化。11例延迟期肿块实性部分强化程度减低，10例中心合并囊变坏死。13例均有淋巴结肿大、颌下腺周围组织均受侵犯，其中咽旁间隙侵犯3例，舌骨及下颌骨体部骨质破坏1例。肿瘤临床分期Ⅱ期5例、Ⅲ期7例、Ⅳ期1例。术前螺旋CT定位及定性诊断正确率分别为100%（13/13）及92.3%（12/13）。术后放疗12例、1例未放疗。随访3个月~4年5例复发、8例未复发。结论 颌下腺导管癌的典型CT表现为具有侵袭性、易坏死囊变、明显强化的肿块，并伴有明显强化的颈部肿大淋巴结，其术前诊断对指导临床手术治疗有重要价值。

• Objective To analyze image features and preoperative diagnostic value of spiral CT in ductal carcinoma of submandibular gland. Methods From February 2003 to October 2016, Clinical data of 13 cases of submandibular gland ductal carcinoma diagnosed by surgical pathology from People′s Hospital of Changzhi City and Affiliated Peace Hospital of Changzhi Medicine College were retrospectively analyzed. All patients had multi-slice spiral CT scanning before operation; site, size, morphology, density, range and enhancement pattern of tumors in CT image were analyzed. Results All 13 patients had solitary ductal carcinoma; the maximum diameter of tumor ranged from 2.2 cm to 11.0 cm and the mean diameter was （3.0±1.2）cm. Four cases had round or oval tumors and 9 cases had irregular tumors. Eleven tumors showed low density in CT plain scanning; 2 tumors were isodensity; 2 tumors had punctate calcification. Eleven tumors had inhomogeneous enhancement in CT image and 2 tumors had mild enhancement. In the delayed stage, the solid part of mass decreased, and 10 cases were complicated with cystic necrosis. Thirteen cases had lymph node enlargement and surrounding tissue of submaxillary gland involvement; parapharyngeal space was involved in 3 cases; hyoid bone and mandibular bone were involved in 1 case. There were 5 cases of stage Ⅱ, 7 cases of stage Ⅲ and 1 case of stage Ⅳ. The diagnostic accuracy of multi-slice CT was 100% in tumor location and 92.3% in characterization. Twelve cases had radiotherapy after operation. Five cases had recurrence during follow-up(3 months to 4 years). Conclusion Ductal carcinoma of submandibular gland shows invasive masses with cystic degeneration or necrosis and marked enhancement in spiral CT image, which is usually accompanied by contrast enhancement of enlarged cervical lymph nodes.