| Background and objectives:Salivary gland tumors are a group of complex neoplasms accounting for an estimated 3% of all head and neck tumors.Salivary gland tumors are mainly located in the parotid gland.Approximately 80% of salivary gland tumors are PA(Pleomorphic adenoma),they are benign but recurrence rates reach 40%,and PA have the potential for malignant transformation in 3-4% of cases.AL(Adenolymphomas)are the second most common benign tumors of the salivary glands,arise from remnant lymphoid ducts and have little tendency to recur.Malignant tumors of the salivary glands are rare and have a complex pathology,followed by chemotherapy or radiation therapy.The purpose of this study was to discuss the diagnostic value of color doppler flow imaging(CDI),contrast enhanced ultrasonography(CEUS)and ultrasonic elastography(UE)in salivary tumors.Methods:1.The ratio of grade blood signal,peak systolic velocity(PSV)and resistance index(RI)of 82 salivary gland cases were measured by use of CDI.then the result were analysed between BT and MT group,PA and AL group compatively.Then shear wave velocity(SWV)of 56 patients were measured by virtual tough tissues quantification(VTQ)and shear wave elastography(SWE),then the result of SWV and Young modulus were analysed between BT and MT,PA and AL compatively too.All cases were confirmed by pathological results after tumorectomy or fine needle aspiration biopsy.2.87 salivary gland masses were underwent CEUS,then the degree of homogeneous,type,margin,rim and area,the enhancement degree,type of enter-in and wash-out were observed respectively,the result were analyzed between MT and BT group.Then TIC of 75 patients with parotid gland masse were obtained,value of time to peak(TTP),peak intensity(PI)and time from peak to one half(TFP)in tumors and surrounding area were acquired,them of PA,AL and MT goups analyzed quantitatively versus their surrounding gland.The pathological results after tumorectomy were regarded as the gold standard for diagnosis in a week.Results:1.There were 12 MTs and 70 BTs(including 38 PAs,24 ALs,10 others)by pathology in CDI,10 MTs and 46 BTs(including 27 PAs,11 ALs,8 others)in VTQ and SWE.The ratio of grade 0-I and II-III blood signal,RI and PSV of MT and BT group were not statistically significant difference(all P>0.05).Although 66.7%(16/24)ALs had the ratio of grade III blood signal,a significant difference of the ratio of grade 0-I and II-III blood signal in PA and AL group were not found(P>0.05),the difference in PSV between them was not significant either(P>0.05),but the difference in RI was statistically significant(P<0.05),and a ROC was obtained,the cut-off value and area under curve(AUC)of RI in PA and AL were 0.74 and 0.822,the sensiticity,specificity and Youden index were 78.9%,75% and 0.539 respectively.There were 56 patiens were observed by VTQ and SWE finally.In VTQ,the difference between MT and BT group was not statistically significant(P>0.05),but there was a significant difference between the PA and ALgroup in the values of SWV(P<0.05),and a ROC was obtained,the cut-off value and AUC of SWV in PA and AL were 2.10m/s and 0.766,the sensiticity,specificity and Youden index were 70.4%,63.6% and 0.340 respectively.In SWE,the maximal,mean,minimum Young modulus and standard deviation of MT and BT group were not statistically significant difference(all P>0.05),but them of PA and AL group were statistically significant difference(all P<0.05),after the ROC were drawed,the maximal Young modulus had the best diagnostic efficiency,the cut-off value and AUC were 32.4KPa and 0.805,the sensiticity,specificity and Youden index were 70.4%,81.8% and 0.522 respectively.Besides,a statistically significant differerence of RI,SWV and maximal Young modulus of BT and MT group were found(all P<0.05)after PAs were exclude from BT group.2.There were 74 BTs and 13 MTs in 91 patients by pathology.Number of enhancement degree,type and degree of homogenous did not show statistical differences between MT and BT group(all P>0.05),type of enter-in and wash-out showed no statistically difference between the two groups(all P>0.05)eihter.The number of margin,rim and area showed statistical differences between them(all P<0.05),The differential diagnostic sensitivity,specificity and accuracy were 70.59%(12/17),87.83%(65/74),84.61%(77/91)and 82.35%(14/17),71.62%(53/74),87.91%(80/91)by ill-defined margin and absent enhancement rim,and 70.59%(12/17),95.95%(71/74),90.21%(83/91)by enlarged area of enhancement.Combing them,the sensitivity,specificity and accuracy could be improve up to 82.35%(14/17),95.95%(71/74),93.41%(85/91).In TIC,there were 31 PAs,27 ALs and 17 MTs,TTP and TFP of PA group were not different from the surrounding gland(all P>0.05),but the difference of PI was statistically significant(P<0.01),PAs could be apt to show identical in identical out hyper-enhancement.In AL group,the difference of TFP and PI were statistically significant among them(all P<0.01)except of TTP,ALs might manifest identical in slowly out hyper-enhancement obviously,the differential diagnostic sensitivity,specificity and accuracy of ALs was 81.48%(22/27),68.75%(33/48)and 73.33%(55/75)by combing the slowly out and hyperenhancement.However,in MT group,both TTP and PI were statistically significant different versus the salivary gland(all P<0.05)except of TFP,MTs tend to present fast in identical out hyper-enhancement,the differential diagnostic sensitivity,specificity and accuracy of MT was 60.70%(11/17),50.00%(29/58)and 53.33%(40/75)respectively by fast in,then the differential diagnostic sensitivity,specificity and accuracy of MT was up to 88.23%(15/17),77.59%(45/58)and 80.00%(60/75)respectively by combing the fast in and not slowly out.Conclusions:1.CDI,UE might be good to differentiate ALs from PAs,PAs had higher RI,SWV and Young modulus,ALs had richest blood,lower RI,SWV and Young modulus,and the diagnostic efficiency of the three ultrsonogrphy methods were equal.But they might were limit to differentiate BTs from MTs.However,CDI,UE could identify MTs from BTs by RI,SWV and maximal Young modulus after PAs were excluded.2.In CEUS,the concentric enhancement was the feature of PA.The absent enhancement rim,ill-defined margin and enlarged enhancement area were features of MTs,but the specificity and sensitivity of the latter two were low in differentiating MTs from BTs,fortunately,the differentiated diagnostic efficacy improved greatly by combining all of them.In TIC,PAs,ALs and MTs of parotid gland were characteristic relatively too,the obvious hyperenhamcement and slowly out in ALs were characteristic,the diagnostic value was high,but the value of fast in in MTs were low,the diagnostic efficacy to MTs in parotid gland was imporved by combining fast in and not slowly out. |
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