Department of Otorhinolaryngology, Head and Neck Surgery, Nordstadt Clinic, Academic Hospital, Haltenhoffstr. 41, 30167, Hannover, Germany.
Eur Arch Otorhinolaryngol. 2022 Aug;279(8):4137-4146. doi: 10.1007/s00405-022-07303-z. Epub 2022 Mar 1.
Diagnosis of parotid gland tumors is sometimes challenging due to their diversity and pleomorphic histological appearance. B-scan sonography along with color-coded duplex sonography is the gold standard in the diagnostic workup of these lesions, whereas histopathology is to date the gold standard for the final diagnosis. To date no single imaging technique provides the chance for an art-diagnosis with highly diagnostic accuracy. Contrast enhanced ultrasonography (CEUS) on the other hand provides information of the perfusion down to the capillary level. Currently there are only a few papers published with systematical examination of the perfusion in benign parotid gland tumors and its diagnostic significance.
One hundred patients with a parotid gland tumor were examined. The examinations included conventional B-scan sonography, color-coded duplexsonography along with contrast enhanced ultrasonography (CEUS). B-scan sonographic parameters, i.e. echogenicity, shape, size, demarcation, and borders of a lesion along with vascularization estimated by color-coded-duplexsonography were analyzed. Analysis of quantitative CEUS parameters was performed using 8 regions of interest (ROI), which were standardized located throughout the entire tumors. The perfusion parameters were analyzed for particular tumor entities. Qualitative CEUS analysis with estimating the perfusion pattern was additionally performed.
Histological examination revealed benign tumors in 92 cases, with pleomorphic adenomas and Warthin´s tumors were the most frequent entities. Malignant conditions were found in 8 cases. CEUS revealed a centripetal perfusion pattern in malignant tumors significantly more frequently than in benign tumors. CEUS showed a significant heterogenic perfusion in all tumors, with a higher perfusion in the medial parts of the tumors and in some cases also in the center. Perfusion patterns of PA and WT were different. WT displayed centrifugal, centripetal, and central diffuse perfusion more often than PA, whereas in PA perfusion often was limited to the capsule or periphery. Oncocytoma had the highest perfusion values. Intraglandular cysts showed no intralesional perfusion.
CEUS analysis in different parts of benign tumors revealed a significant heterogeneity in tumor perfusion. Some perfusion pattern could be identified which might be characteristic for particular lesions. Based on this, the diagnostic accuracy of CEUS in the differential diagnosis of parotid gland tumors can be increased. In particular, the perfusion analysis within the tumors using ROIs located standardized throughout the entire tumor provides additional information which are important for the art diagnosis and in differentiation of tumor entity.
由于腮腺肿瘤的多样性和多形性组织学表现，其诊断有时具有挑战性。B 型超声扫描结合彩色双功能超声是这些病变诊断评估的金标准，而组织病理学是目前最终诊断的金标准。迄今为止，没有单一的成像技术可以提供具有高度诊断准确性的艺术诊断。另一方面，对比增强超声（CEUS）可提供直至毛细血管水平的灌注信息。目前只有少数几篇论文对良性腮腺肿瘤的灌注及其诊断意义进行了系统检查。
对 100 例腮腺肿瘤患者进行了检查。检查包括常规 B 型超声扫描、彩色双功能超声以及对比增强超声（CEUS）。分析了 B 型超声的参数，即回声性、形状、大小、边界和病变的边界以及彩色双功能超声估计的血管化。使用 8 个标准化定位在整个肿瘤内的感兴趣区（ROI）进行定量 CEUS 参数分析。对特定肿瘤实体进行灌注参数分析。此外，还进行了定性 CEUS 分析，以评估灌注模式。
组织学检查显示 92 例为良性肿瘤，其中多形性腺瘤和沃辛氏瘤最常见。8 例为恶性肿瘤。CEUS 显示恶性肿瘤的中央灌注模式明显多于良性肿瘤。CEUS 显示所有肿瘤的灌注均存在明显异质性，肿瘤内部的灌注较高，某些情况下中心也有灌注。PA 和 WT 的灌注模式不同。WT 显示离心、向心和中央弥漫性灌注的频率高于 PA，而 PA 的灌注通常局限于包膜或周围。嗜酸细胞瘤的灌注值最高。腺内囊肿无瘤内灌注。
对良性肿瘤不同部位的 CEUS 分析显示肿瘤灌注存在显著异质性。可以识别出一些可能是特定病变特征的灌注模式。在此基础上，CEUS 在腮腺肿瘤鉴别诊断中的诊断准确性可以提高。特别是，使用标准化定位在整个肿瘤内的 ROI 进行肿瘤内灌注分析可提供对艺术诊断和肿瘤实体分化很重要的额外信息。
