目的：探讨DWI和动态增强MR诊断腮腺木村病（KD）的价值。方法：回顾性分析本院经病理证实的7例腮腺KD患者的临床资料及MRI表现。结果：2例为双侧同时发病，5例为单侧发病。根据病灶的形态和累及组织的不同分为3种类型：Ⅰ型（3例），皮下病变弥漫浸润至腮腺；Ⅱ型（3例），腮腺内肿大淋巴结；Ⅲ型（1例），混合模式。平扫时，Ⅰ型表现为T1等信号、T2混杂稍高信号；Ⅱ型表现为T1等信号、T2稍高信号2例，表现为T1等信号、T2等信号1例；Ⅲ型表现为T1稍高信号、T2混杂稍高信号。动态增强MRI扫描皮下浸润至腮腺病变均呈渐进性强化，反应性淋巴结呈早期明显强化；正常腮腺ADC值为（0.89±0.06）×10-3 mm2/s，皮下浸润至腮腺病变ADC值为（1.24±0.10）×10-3 mm2/s，反应性淋巴结ADC值为（0.62±0.06）×10-3 mm2/s。结论：皮下浸润至腮腺病变的ADC值均高于正常腮腺，反应性淋巴结的ADC值低于正常腮腺；动态增强扫描浸润性腮腺病变呈渐进性强化，腮腺内淋巴结和反应性淋巴结呈早期强化。这些可作为腮腺KD的特征性MR表现，结合其临床表现和实验室检查，可以高度提示腮腺KD的诊断。
Abstract
Objective: To evaluate the value of diffusion weighted imaging(DWI) and dynamic contrast enhanced MR imaging combined with conventional MR imaging(MRI) in the diagnosis of Kimura disease(KD). Methods: The clinical data and MRI findings of 7 patients with KD located in parotid glands proven by histopathologic examination were retrospectively analyzed. Results: Two patients had bilateral onset and 5 patients had unilateral onset. According to the shape of the lesion and the involved tissues, they were divided into 3 types: type Ⅰ(3 cases): subcutaneous lesions diffuse infiltration to the parotid gland; type Ⅱ(3 cases): intraparotid lymphadenopathies; type Ⅲ(1 case): mixed mode. On plain scan, type Ⅰ showed equal signal on T1WI, mixed slightly high signal on T2WI; type Ⅱ showed equal signal on T1WI, slightly high signal on T2WI in 2 cases, equal signal in 1 case; type Ⅲ showed slightly high signal on T1WI, mixed slightly high signal on T2WI. Dynamic enhanced MRI scan showed progressive enhancement of subcutaneous infiltration to parotid gland lesions, and early enhancement of reactive lymph nodes. The ADC value of normal parotid gland was (0.89±0.06)×10-3 mm2/s, that of subcutaneous infiltration to parotid gland lesions was (1.24±0.10)×10-3 mm2/s, and that of reactive lymph nodes was (0.62±0.06)×10-3 mm2/s. Conclusions: The ADC values of subcutaneous infiltration to parotid lesions were higher than those of normal parotid glands, and the ADC values of reactive lymph node lesions were lower than those of normal parotid glands. On dynamic enhanced scan, infiltrative parotid gland lesions showed progressive enhancement, and the parotid gland lymph nodes and reactive lymph nodes showed early enhancement. These features can be used as characteristic MR manifestations of KD, combined with its clinical manifestations and laboratory examinations, can highly suggest the diagnosis of KD.
关键词
腮腺疾病 /
血管淋巴样增生 /
嗜酸粒细胞增多性 /
磁共振成像
Key words
Parotid diseases /
Angiolymphoid hyperplasia with eosinophilia /
Magnetic resonance imaging
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基金
河南省医学科技攻关计划普通项目，编号：201602085。
