CAJ | 학술논문

目的探讨颌下腺良恶性病变的特征性CT表现.方法回顾性分析经手术病理证实的75例颌下腺良恶性病变的CT表现,其中多形性腺瘤38例,恶性肿瘤22例,慢性炎症11例,肌上皮瘤2例,神经鞘瘤及血管瘤各1例；总结其CT诊断及鉴别诊断要点.结果 (1)38例多形性腺瘤病灶均仅累及患侧颌下腺的一部分,其中35例位于颌下腺边缘,33例边缘光整,30例密度均匀；增强后33例病灶呈轻中度强化；10例病灶呈“靶状”强化.(2)22例恶性肿瘤中3例淋巴瘤边缘光整、密度均匀,位于颌下腺边缘,增强后呈轻中度强化；余19例边缘不光整、密度不均匀,18例边界不清楚,其中2例侵犯大部分颌下腺,16例侵犯整个颌下腺,增强后17例呈明显不均匀强化,其中12例内见增粗迂曲的血管影；9例伴有颈部短径＞1.0 cm的肿大淋巴结.(3)颌下腺慢性炎症11例,均表现为颌下腺弥漫增大,边缘较光整,边界较清楚,增强后多呈较均匀中等强化；其中6例伴有颌下腺导管内结石及导管扩张；11例均伴有颈部短径＜1.0 cm的淋巴结,其中8例短径＜0.5 cm.(4)2例肌上皮瘤具有明显不规则环形强化的CT表现；1例神经鞘瘤伴明显囊变,增强后边缘轻度强化；1例血管瘤内见多个静脉石,增强后呈明显持续强化.结论颌下腺良恶性病变大多数具有一定的特征性CT表现,但颌下腺淋巴瘤与多形性腺瘤较难鉴别.
목적 탐토합하선량악성병변적특정성CT표현.방법 회고성분석경수술병리증실적75례합하선량악성병변적CT표현,기중다형성선류38례,악성종류22례,만성염증11례,기상피류2례,신경초류급혈관류각1례；총결기CT진단급감별진단요점.결과 (1)38례다형성선류병조균부루급환측합하선적일부분,기중35례위우합하선변연,33례변연광정,30례밀도균균；증강후33례병조정경중도강화；10례병조정“파상”강화.(2)22례악성종류중3례림파류변연광정、밀도균균,위우합하선변연,증강후정경중도강화；여19례변연불광정、밀도불균균,18례변계불청초,기중2례침범대부분합하선,16례침범정개합하선,증강후17례정명현불균균강화,기중12례내견증조우곡적혈관영；9례반유경부단경＞1.0 cm적종대림파결.(3)합하선만성염증11례,균표현위합하선미만증대,변연교광정,변계교청초,증강후다정교균균중등강화；기중6례반유합하선도관내결석급도관확장；11례균반유경부단경＜1.0 cm적림파결,기중8례단경＜0.5 cm.(4)2례기상피류구유명현불규칙배형강화적CT표현；1례신경초류반명현낭변,증강후변연경도강화；1례혈관류내견다개정맥석,증강후정명현지속강화.결론 합하선량악성병변대다수구유일정적특정성CT표현,단합하선림파류여다형성선류교난감별.
Objective To explore the characteristic CT features of benign and malignant submandibular gland lesions.Methods CT scans of 75 cases of submandibular gland lesions verified pathologically after surgery were analyzed retrospectively,including 38 cases of pleomorphic adenoma,22 cases of malignant tumors,11 cases of chronic submaxillaritis,2 cases of myoepithelioma,1 case of neurilemoma and 1 case of hemangioma.Results ( 1 ) All 38 cases of submandibular gland pleomorphic adenoma only occupied a part of submandibnlar gland.Thirty five lesions were on the edge of submandibular gland.The edge of 33 lesions were smooth and the density of 30 lesions were even.Thirty three lesions were slightly or moderately enhanced and 10 lesions showed “target sign” on enhanced CT.( 2 ) There were 22 cases of submandibular gland malignant tumors.Three lesions of lymphoma located at the edge of submandibular gland with smooth edge and even density,and showed mild to moderate enhancement.The remaining 19 lesions showed rough edge and uneven density.Eighteen of the 19 lesions showed ill-defined boundary,2 of the 18 lesions invaded most of submandibular gland and 16 of the 18 lesions invaded the whole submandibular gland.Seventeen lesions were unevenly enhanced,thickened,cirvilinear vessels were seen in 12 of the 17 lesions.Nine cases were accompanied with swollen lymph nodes ( minor diameter greater than 1.0 cm) in neck.(3)There were 11 cases of chronic submaxillaritis,which showed enlargement of the whole submandibular gland with relative smooth edge and relative clear boundary.Most of lesions were moderately and evenly enhanced.Six cases were companied with submandibular duct lithiasis and dilatation.All of 11 cases were accompanied with lymph node enlargement in neck.(4) Two cases of myoepithelioma demonstrated irregular ring enhancement on CT;one case of neurilemoma showed obvious cystic changes and slight enhancement on the edge;1 case of hemangioma showed multiple phleboliths and prolonged contrast enhancement.Conclusions Most of submandibular gland benign and malignant lesions show some degree of characteristic CT findings.It is relatively difficult to discriminate between lymphoma and submandibular gland pleomorphic adenoma.