CAJ | 학술논문

目的：结合病理探讨腺淋巴瘤的MRI表现，试图进一步提高对该疾病的认识。资料和方法回顾性分析18例经手术证实的腺淋巴瘤患者，均行MRI增强检查。结合其发病年龄、吸烟史等，重点观察肿瘤部位、形态、大小、边界、磁共振信号、增强程度、颈部淋巴结肿大等，统计分析MRI表现及与病理亚型的相关性。结果18例共31个病灶,其中男17例,女1例；年龄53-83岁,平均62.8岁，14例有吸烟史。单发者11例、多发者7例。病灶位于腮腺后下极占81%(25/31)，均有完整包膜，包膜能明显强化占74%(23/31)。肿瘤长轴平行于下颌骨升支占90%(28/31)。肿瘤实性部分增强后呈中度以上强化占74%(23/31)；囊性成分MRI信号多变。颈部淋巴结增大占89%(16/18)。病理亚型为Ⅰ型占61%(19/31)，MRI及病理多为囊实性病灶；Ⅱ型者占26%(8/31), MRI表现均为实性或伴小囊状病灶；Ⅲ型者占13%(4/31)，均为实性肿块。结论腺淋巴瘤好发老年吸烟男性，有一定的特征(可多发、常位于腮腺后下极、纵向生长、有完整富血供包膜等)。MRI表现和病理密切相关：1)经典型(Ⅰ型)最常见，肿块为囊实性为主；2)上皮主导型(Ⅱ型)为实性肿块或伴小囊变；3)淋巴主导型(Ⅲ型)为相对均匀的实性肿块。囊性成分为蛋白成分，MRI信号复杂，实性成分多呈快进快出强化。
목적：결합병리탐토선림파류적MRI표현，시도진일보제고대해질병적인식。자료화방법회고성분석18례경수술증실적선림파류환자，균행MRI증강검사。결합기발병년령、흡연사등，중점관찰종류부위、형태、대소、변계、자공진신호、증강정도、경부림파결종대등，통계분석MRI표현급여병리아형적상관성。결과18례공31개병조,기중남17례,녀1례；년령53-83세,평균62.8세，14례유흡연사。단발자11례、다발자7례。병조위우시선후하겁점81%(25/31)，균유완정포막，포막능명현강화점74%(23/31)。종류장축평행우하합골승지점90%(28/31)。종류실성부분증강후정중도이상강화점74%(23/31)；낭성성분MRI신호다변。경부림파결증대점89%(16/18)。병리아형위Ⅰ형점61%(19/31)，MRI급병리다위낭실성병조；Ⅱ형자점26%(8/31), MRI표현균위실성혹반소낭상병조；Ⅲ형자점13%(4/31)，균위실성종괴。결론선림파류호발노년흡연남성，유일정적특정(가다발、상위우시선후하겁、종향생장、유완정부혈공포막등)。MRI표현화병리밀절상관：1)경전형(Ⅰ형)최상견，종괴위낭실성위주；2)상피주도형(Ⅱ형)위실성종괴혹반소낭변；3)림파주도형(Ⅲ형)위상대균균적실성종괴。낭성성분위단백성분，MRI신호복잡，실성성분다정쾌진쾌출강화。
Objective The purpose of this investigation is to study the MRI imaging characteristics of Wathin tumor with pathologically,in order to further improve the understanding the disease. Materials and Methods We studied retrospectively on MRI findings and pathologic results in 18 patients who were with wathin tumor confirmed by surgery pathology ,all of them had underwent contrast-enhanced dynamic MR examination before surgeries. Based on these patients' relevant clinical data such as age, smoking history etc. The statistical analysis focused on the lesions' location, shape,size,border of tumors, MRI signal intensity, enhancement degree, and cervical lymph node enlargement etc. Then combination with surgical pathology results, analysis the relationship between imaging characteristics and pathological subtypes. Results 18 cases (17 males, 1 female)included 31 lesions;median age, 62.8 years;range, 53-83 years. 14 cases had smoking history.11 cases were single lesions whereas the rest 7 were Multiple lesions.81%lesions have been found that located in parotid posterior inferioring quadrant (25/31).All lesions circumscribed well.Capsule of 74%lesions enhanced obviously(23/31). Lesions with long axis paralleled to the mandibular branch accounted for 90%(28/31).74%lesions enhanced obviously on T1WI(23/31). There were 16 lesions containing cystic components which showed complex intensity in MRI.Cervical lymph nodes enlarged in 89% cases(16/18).The pathological subtypes of 61% lesions were typeⅠ(19/31),in which we can observed big cysts frequently in MRI;26%lesions were typeⅡ(8/31),which presented solid mass or with small cysts;13% lesions were typeⅢ(4/31),of which were solid mass all. Conclusion Wathin tumors are occurring easily in smoking mid-aged and elder men. It has some alike characteristics (multiple, located in the posterior inferioring quadrant of parotid gland, longitudinal growth, full and rich vascular capsule,etc.).MRI findings closely related to the pathological subtypes: 1)The classic type (typeⅠ)was the commonest type which mostly showed cystic-solid mixed masses in MRI; 2) Epithelial leading(typeⅡ)mainly showed solid masses or containing small cysts in MRI;3) Lymphatic leading(typeⅢ)showed relatively homogeneous solid mass. Cystic components containing protein showed complex situations on intensity of MRI. Solid components showed characteristics of early enhancement and early washout.