Application Of Multimodal Ultrasound In Salivary Gland Lesions

Part one Application of conventional ultrasound in focal lesions of the salivary glandsObjective To explore the diagnostic value of conventional ultrasound in focal lesions of the parotid gland.Methods We retrospectively analyzed the conventional ultrasound features of137 cases of focal parotid lesions confirmed by surgical or puncture biopsy at Lanzhou University Second Hospital,determined the benignity and malignancy of focal parotid lesions initially by comparing their conventional ultrasound features and also differentiated parotid pleomorphic adenoma from adenolymphoma by using conventional ultrasound.Results There was no statistically significant difference(P>0.05)between the focal benign and malignant lesions of the parotid gland in terms of gender,age and side.And their conventional ultrasound features showed no statistically significant differences in lesion size,echo and colour Doppler flow signal(P>0.05),while the differences in shape and border were statistically significant(P<0.05).The sensitivity,specificity and AUC for the diagnosis of malignant lesions in the focal parotid gland by shape and border of conventional ultrasound were 64.0%,82.1%,0.748 and 52.0%,92.0%,0.720 respectively.The differences between patients with pleomorphic adenoma and adenolymphoma were statistically significant in terms of age and gender(P<0.05),but not in terms of side(P>0.05).The differences of conventional ultrasound features between pleomorphic adenoma and adenolymphoma were statistically significant(P < 0.05)in terms of lesion size,shape and colour Doppler flow signal,but not in terms of echo and border(P > 0.05).Conclusion Conventional ultrasound is an important imaging method for focal lesions of the parotid gland,and can be used to make a preliminary identification of benign and malignant lesions based on their shape and border.A preliminary differentiation between pleomorphic adenoma and adenolymphoma which were the most common tumour of the parotid gland can be based on the size,shape and the colour Doppler blood flow signal of the lesion.Part two Application of ultrasonography in focal lesions of the salivary glandsObjective To explore the diagnostic value of contrast-enhanced ultrasound(CEUS)for focal lesions of the salivary gland.Methods We retrospectively analyzed 91 cases of focal salivary gland lesions confirmed by pathology with preoperative conventional ultrasound and CEUS examination in the ultrasound department of Lanzhou University Second Hospital,and compared the CEUS characteristics of focal benign and malignant salivary gland lesions and pleomorphic adenoma with those of adenolymphoma.And binary logistic regression analysis of CEUS characteristics was used to predict the degree of risk of malignancy in focal lesions of the salivary gland.Results There was no statistically significant difference between focal benign and malignant salivary gland lesions in terms of arrival time,enhancement level,and wash-out time(P>0.05);whereas there were statistically significant differences in enhancement pattern,enhancement uniformity,enhancement boundary,and post-enhancement lesion size(P<0.05).Statistically significant indicators of CEUS features of focal benign and malignant salivary gland lesions were subjected to binary logistic regression analysis,and two CEUS features independently associated with malignant focal salivary gland lesions,which were screened in order of relative risk(OR): enhancing border and post-enhancing lesion size.The differences between pleomorphic adenomas and adenolymphomas of the common salivary glands were statistically significant in terms of arrival time,enhancement level,and enhancement uniformity(P<0.05),but not in terms of washout time,enhancement border,and post-enhancement lesion size(P>0.05).Conclusion CEUS has important differential diagnostic value for focal benign and malignant lesions of the salivary gland,where the enhanced border and post-enhancement lesion size are particularly critical in assessing the risk of malignancy in focal lesions of the salivary gland.Part three Application of Ultrasound Elastography in Diffuse Salivary Gland DiseasesObjective To explore the diagnostic value of two-dimensional ultrasound combined with ultrasound elastography for the diagnosis of Sj(?)gren’s syndrome(SS).Methods Forty-three cases of SS patients(test group)and 60 cases of healthy volunteers(control group)at the same time were collected.Two-dimensional ultrasound scoring of the salivary glands was performed,and shear wave velocity(SWV)of the parotid and submandibular glands was measured bilaterally using the Virtual touch tissue imaging quantification(VTIQ)technique,respectively.Receiver operating characteristic(ROC)curves for diagnosing salivary SS with two-dimensional ultrasound,VTIQ technique and combined diagnostic technique(two-dimensional ultrasound combined with VTIQ technique)were drew and got the best cut-off value to explore the initially differential diagnostic value of two-dimensional ultrasound and combined diagnostic techniques for salivary gland SS.Results The two-dimensional ultrasound score of the salivary glands in the test group was higher than that of the control group,and the difference was statistically significant(P<0.05),2 score was the optimal cut-off value for the diagnosis of salivary SS by 2-dimensional ultrasound scoring.There was no statistically significant difference between the SWV values of the right and left parotid and submandibular glands in the same group,and the SWV values of the bilateral salivary glands in the test group were significantly higher than those in the control group(P<0.05).Parotid SWV value = 2.05m/s and submandibular SWV value = 2.16m/s are the best cut-off values for diagnosing SS in salivary glands.Two-dimensional ultrasound and combined ultrasound diagnostic techniques have high diagnostic specificity and sensitivity for SS in salivary glands.Conclusion Two-dimensional ultrasound combined with ultrasound elastography can qualitatively and quantitatively reflect the histomorphological and hardness changes of salivary glands in SS,and improve the diagnositic specificity and sensitivity of SS,provide an important imaging basis for clinical practice at the same time.