Jia C H, Cao R, Kuai X P, Zhang H Q, Ding Q G
Department of Radiology, The Fifth Clinical Medical College of Yangzhou University, Changshu No. 2 People's Hospital, Changshu 215500, China.
Department of Stomatology, The Fifth Clinical Medical College of Yangzhou University, Changshu No.2 People's Hospital, Changshu 215500, China.
Zhonghua Kou Qiang Yi Xue Za Zhi. 2019 Feb 9;54(2):94-100. doi: 10.3760/cma.j.issn.1002-0098.2019.02.004.
To assess the conventional and functional MRI features of parotid Warthin tumor (adenolymphoma) and to investigate the correlation between MRI and clinicopathological features which can provide evidence for clinical diagnosis and treatment. Sixty-seven patients with parotid Warthin tumor who were treated in the Department of Stomatology, The Fifth Clinical Medical College of Yangzhou University, Changshu No. 2 People's Hospital from June 2008 to April 2017 were included in this study. The retrospective study evaluated preoperative conventional and functional MRI features and clinicopathological findings of this group of patients. Among 67 patients (65 males, 2 females) with 92 lesions, there were 16 patients with multiple lesions and others with single lesion. Their age was (62.1±8.8) years, ranging from 42 to 84 years. According to pathological features, parotid Warthin tumor were classified into two types. Type Ⅰ was predominantly solid component which included completely solid or solid tumor with some cystic components. Type Ⅱ was predominantly cystic component which was characterized by big cyst with some solid components, and could be divided into capsule-like and scum-like cystic type, based on whether its interface of solid and cystic component was clear or not. On contrast-enhanced MRI, according to whether the lesion showed enhancement or not, solid or cystic component was defined. Seventy-two lesions were located in the lower pole of the parotid gland, of which sixty-eight lesions were located in posterior inferior quadrant. In addition, sixteen lesions were located in the upper pole and four lesions in the middle. Because MRI features were consistent with pathological findings, parotid Warthin tumor were classified into solid (73) and cystic types (19). On T2WI, solid components showed isointense (92), whereas on T1WI cystic components demonstrated hyperintense (90). On contrast enhanced T1WI, solid types showed marginal vasculature sign (73), mild (69) or moderate (4) enhancement, whereas its cystic component showed no enhancement. On contrast enhanced T1WI, cystic types showed ring-like enhancement of cycle-wall and intra-cystic septal linear enhancement, whereas its solid components demonstrated mild enhancement (19). On diffusion weighted imaging, these masses demonstrated hyperintensity and lower apparent diffusion coefficient value indicating restricted diffusion (59/59). On dynamic contrast-enhanced-MRI, the masses showed "wash-out" pattern (28/29) or plateau pattern (1/29). Parotid Warthin tumor mainly occur in the posterior inferior quadrant of parotid gland and mostly in mid-aged or elder men. It has certain characteristics on conventional and function MRI. There is correlation between MRI and clinicopathological findings and it is useful for accurate diagnosis and treatment to understand these features.
评估腮腺沃辛瘤(腺淋巴瘤)的传统及功能磁共振成像(MRI)特征,并探讨MRI与临床病理特征之间的相关性,为临床诊断和治疗提供依据。纳入2008年6月至2017年4月在扬州大学第五临床医学院常熟市第二人民医院口腔科治疗的67例腮腺沃辛瘤患者。本回顾性研究评估了该组患者术前的传统及功能MRI特征和临床病理表现。67例患者(男65例,女2例)共92个病灶,其中16例为多发病灶,其余为单发病灶。患者年龄为(62.1±8.8)岁,范围在42至84岁之间。根据病理特征,腮腺沃辛瘤分为两型。Ⅰ型以实性成分为主,包括完全实性或含有一些囊性成分的实性肿瘤。Ⅱ型以囊性成分为主,其特征为大囊肿伴有一些实性成分,根据实性和囊性成分的界面是否清晰可分为包膜样和浮渣样囊性型。在增强MRI上,根据病灶是否强化来界定实性或囊性成分。72个病灶位于腮腺下极,其中68个病灶位于后下象限。此外,16个病灶位于上极,4个病灶位于中部。由于MRI特征与病理结果一致,腮腺沃辛瘤分为实性(73个)和囊性型(19个)。在T2加权成像(T2WI)上,实性成分呈等信号(92个),而在T1加权成像(T1WI)上囊性成分呈高信号(90个)。在增强T1WI上,实性型表现为边缘血管征(73个),轻度(69个)或中度(4个)强化,而其囊性成分无强化。在增强T1WI上,囊性型表现为囊壁环状强化和囊内分隔线状强化,而其实性成分呈轻度强化(19个)。在扩散加权成像上,这些肿块呈高信号且表观扩散系数值较低,提示扩散受限(59/59)。在动态对比增强MRI上,肿块表现为“廓清”型(28/29)或平台型(1/29)。腮腺沃辛瘤主要发生于腮腺后下象限,多见于中老年男性。其在传统及功能MRI上具有一定特征。MRI与临床病理表现之间存在相关性,了解这些特征有助于准确诊断和治疗。