摘要目的 探讨腮腺沃辛瘤常规及功能MRI特征与临床病理的联系,为临床诊断和治疗方案的制定提供依据.方法 回顾性分析2008年6月至2017年4月就诊于扬州大学第五临床医学院常熟市第二人民医院口腔科的67例腮腺沃辛瘤患者[男性65例,女性2例,年龄(62.1±8.8)岁(42～84岁),67例中16例为多发,共92个病变]的术前常规和功能MRI以及病理资料,对照MRI与病理表现进行分析.根据病变的大体病理进行分型:①实性为主型,完全实性或瘤内含囊性成分(瘤包囊);②囊性为主型,大囊内见实性成分(囊包瘤),根据囊性、实性成分分界是否清晰分为胶囊样囊性为主型和败絮样囊性为主型.MRI分型根据增强后有无强化明确实性、囊性成分后对照病理分型.结果 92个病变中72个病变位于腮腺下极(下极后部68个),16个位于上极,4个位于中部.MRI与病理分型一致,实性为主型病变73个,囊性为主型病变19个.MRI平扫显示,两种类型肿瘤的实性成分在T2加权成像均呈等信号或接近等信号,即灰色信号(92个),而囊性成分表现为T1加权成像高信号(90个).实性为主型病变MRI常规增强表现为肿瘤边缘贴边血管征(73个),实性成分轻度(69个)或中度强化(4个),囊性成分均无强化.囊性为主型病变MRI常规增强均表现为囊壁环状强化,囊内分隔线状强化,实性成分轻度强化(19个).肿瘤实性成分的功能MRI表现为弥散加权成像明显高信号,表观扩散系数减低,扩散受限(59/59);动态增强的时间信号曲线为流出型(28/29)及平台型(1/29).结论 沃辛瘤为好发于中老年男性腮腺下极后部的良性肿瘤,常规及功能MRI具有一定特征性,认识并掌握其特征有助于做出较准确的术前诊断,从而为临床治疗方案的制定提供有价值的信息.

abstractsObjective 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.Methods 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.Results 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).Conclusions 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.