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Rm Multiparamétrica En El Estudio De Los Tumores De Las Glándulas Salivales

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Rm Multiparamétrica En El Estudio De Los Tumores De Las Glándulas Salivales UNIVERSIDAD AUTÓNOMA DE MADRID FACULTAD DE MEDICINA DEPARTAMENTO DE MEDICINA RM MULTIPARAMÉTRICA EN EL ESTUDIO DE LOS TUMORES DE LAS GLÁNDULAS SALIVALES MEMORIA TESIS DOCTORAL BEATRIZ BREA ÁLVAREZ MADRID, 2015 RM MULTIPARAMÉTRICA EN EL ESTUDIO DE LOS TUMORES DE LAS GLÁNDULAS SALIVALES MADRID, 2015 UNIVERSIDAD AUTÓNOMA DE MADRID FACULTAD DE MEDICINA DEPARTAMENTO DE MEDICINA DOCTORANDO: BEATRIZ BREA ÁLVAREZ Adjunta de la sección de Neurorradiología. Servicio de Radiodiagnóstico. Hospital Universitario Puerta de Hierro- Majadahonda DIRECTORAS: TERESA FONTANILLA ECHEVESTE Adjunta de la sección de Radiología Abdominal. Servicio de Radiodiagnóstico. Hospital Universitario Puerta de Hierro- Majadahonda Profesora asociada. Departamento de Medicina Universidad Autónoma de Madrid CONCEPCIÓN GONZÁLEZ HERNANDO Jefe de Servicio. Servicio de Radiodiagnóstico. Hospital Universitario Puerta de Hierro- Majadahonda Profesora asociada. Departamento de Medicina Universidad Autónoma de Madrid RM MULTIPARAMÉTRICA EN EL ESTUDIO DE LOS TUMORES DE LAS GLÁNDULAS SALIVALES MEMORIA TESIS DOCTORAL DEDICATORIA A mis maestros, mis padres: Amparo y Tomás. A mis compañeros de viaje: Manoli, Amparín, Tomás y Toño. A mis hijos: Antonio y María Jesús. Porque sois preciosos. A mi mejor elección: Jesús. AGRADECIMIENTOS A los Técnicos de Rayos y Enfermeras de Radiodiagnóstico del Hospital Puerta de Hierro: Jose, Rosa, Moni, Maribel, Ana, Pilar, Juan Carlos, Membri, Dori, Mati, Charo y… . No os quepa duda que sin vuestro trabajo no hubiera sido posible. A los otorrinos, cirujanos, radioterapeutas, nucleares, patólogos y oncólogos por compartir conmigo la patología en el comité de tumores de cabeza y cuello. A mis compañeros radiólogos que estuvieron pendientes de los casos (Prado, Ana P., Laura, Ana A. y Carmen) y que algunas, además, son mis amigas. A mis ―adjuntos‖: Luis Ramos, Patricia, Agustín, Miguel y Maca por darme ánimos y estar en muchos momentos. A David por su dedicación al conocimiento. A Rocío por acordarse de mí. A los residentes: sois un estímulo y una diversión. A Javier Minaya y Teresa Fontanilla por estar pendientes de mis estudios y hacerme tan fácil el trabajo. A Javier Sánchez por ayudarme a diseñar las secuencias del estudio. A Isabel Millán por hacer la estadística, por su dedicación y por mantener las ganas de hacer bien las cosas hasta el final. A mis compañeras neurorradiólogas: A Gertrudis porque ha sido mi profesora y mentora, a Yolanda porque me ha escuchado y animado mucho. A Mercedes porque me apoya, es mi amiga y por Isabel. A Concha, mi jefa y tutora de tesis por tener tiempo cuando no lo tenía y por proponerme tantas cosas. A Teresa, tutora de mi tesis por decirme en Monfragüe: ―pónte una fecha y hazlo. Tu vales mucho‖ y por su entusiasmo por la radiología. A mis padres y mis hermanos, los Telerín, han sido y son un apoyo y fuerza constante, os quiero mucho. A mis sobrinos: El esfuerzo siempre vale la pena. A mis hijos porque me hacen querer que las cosas se hagan bien. A mi marido Jesús: GRACIAS por animarme, diseñar la página del estudio, corregir y ayudar a dar forma a la tesis y sobre todo, por estar conmigo. RM Multiparamétrica en el estudio de los tumores de glándulas salivales Índice Pág I. NECESIDAD Y JUSTIFICACIÓN ........................................................................... 10 II. HIPÓTESIS ............................................................................................................... 15 III. OBJETIVOS .............................................................................................................. 17 IV. INTRODUCCIÓN ..................................................................................................... 19 1. DEFINICIÓN .......................................................................................................... 20 1.1. Desarrollo embriológico .................................................................................... 20 1.2. Anatomía macroscópica ..................................................................................... 22 1.3. Histología .......................................................................................................... 26 1.4. Fisiología ........................................................................................................... 27 2. CLASIFICACIÓN DE LAS LESIONES ................................................................. 30 2.1. Consideraciones generales ................................................................................. 30 2.1.1. Diferenciación de los procesos de las glándulas salivales: procesos no neoplásicos ............................................................................................ 31 2.1.2. Epidemiología y etiopatogenia de los tumores de glándulas salivales ....... 36 2.1.3. Aspectos clínicos de los tumores de glándulas salivales ........................... 38 2.2. Lesiones tumorales ............................................................................................ 39 2.2.1. Neoplasias epiteliales benignas ................................................................ 40 2.2.2. Neoplasias epiteliales malignas ................................................................ 47 2.2.3. Neoplasias de partes blandas mesenquimales benignas ............................. 52 2.2.4. Neoplasias de partes blandas mesenquimales malignas ............................ 54 2.2.5. Tumores hematolinfoides ......................................................................... 55 2.2.6. Tumores secundarios ............................................................................... 55 2.3. Graduación y estadificación de los tumores de glándulas salivales ..................... 56 2.4. Tratamiento de los tumores de glándulas salivales ............................................. 59 3. TÉCNICAS DE IMAGEN DE GLÁNDULAS SALIVALES ................................... 62 3.1. Radiografía simple ............................................................................................. 64 3.2. Sialografía convencional .................................................................................... 64 3.3. Ecografía ........................................................................................................... 65 3.3.1. Ecografía en Modo B ............................................................................... 65 3.3.2. Ecografía Doppler .................................................................................... 66 3.3.3. Ecografía con contraste ............................................................................ 67 3.3.4. Elastografía .............................................................................................. 67 Índice Página 7 RM Multiparamétrica en el estudio de los tumores de glándulas salivales 3.4. Punción-Aspiración con aguja fina y biopsia con aguja gruesa ........................... 68 3.4.1. Punción-Aspiración con aguja fina ........................................................... 68 3.4.2. Biopsia con aguja gruesa .......................................................................... 69 3.5. Gammagrafía ..................................................................................................... 70 3.6. Tomografía por Emisión de Positrones (PET)- Tomografía Computadorizada (TC) ...................................................................................... 70 3.7. Tomografía Computadorizada (TC) y Sialografía con TC .................................. 71 3.8. Resonancia Magnética Multiparamétrica ........................................................... 73 3.8.1. RM morfológica ...................................................................................... 74 3.8.2. Imagen de perfusión ................................................................................. 77 3.8.2.1. TC de perfusión ........................................................................... 80 3.8.2.2. RM de perfusión .......................................................................... 81 3.8.3. Imagen de difusión................................................................................... 87 V. MATERIAL Y MÉTODOS ........................................................................................ 92 1. PACIENTES Y MATERIALES DE ESTUDIO ....................................................... 93 2. METODOLOGÍA ..................................................................................................... 95 2.1. Método morfológico .......................................................................................... 95 2.1.1. Protocolo de RM ...................................................................................... 95 2.1.2. Registro de pacientes ............................................................................... 96 2.2. Método analítico ................................................................................................ 96 2.2.1. Análisis morfológico ................................................................................ 96 2.2.2. Análisis de difusión ................................................................................ 100 2.2.3. Análisis de perfusión............................................................................... 101 2.2.4. Estudio histológico ................................................................................. 103 2.3. Método estadístico ............................................................................................ 103 VI. RESULTADOS .......................................................................................................
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