The value of dynamic contrast-enhanced MRI in diagnosis of malignant lymphoma of the head and neck

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Abstract

In this study, we attempted to diagnose malignant lymphoma on the basis of magnetic resonance imagings (MRIs) and dynamic contrast-enhanced MRI (DCE-MRI). Eighteen lesions (in eight patients), all of which had been proven histopathologically, were detected on MRI. The eight patients included five patients with diffuse large B-cell lymphoma, one with B-cell low-grade MALT lymphoma, one with follicular lymphoma, and one with Hodgkin's lymphoma. Nine lesions were located in the submandibular region, three in the buccal region, two in the orbit region, two in the submental region, and one each in the palatal and tonsil regions. The diameter of the lesions ranged between 9 and 42.2 mm (average: 22.4 mm). The signal intensities (SIs) of the 18 lesions were examined on T1-weighted (T1WI), T2WI, and gadopentetate (Gd)-T1WI. One lesion in case 8 was excluded from DCE-MRI findings, i.e., the regions of interest could not be adequately set on DCE-MRIs. The contrast index (CI) curves of the remaining 17 lesions were prepared. All 18 lesions showed almost the same images on T1WI, T2WI, and Gd-T1WI, although they represented four types of lymphoma. The images showed homogeneous SI that was intermediate to slightly high SI on T1WI, slightly high SI on T2WI, and moderately enhanced on Gd-T1WI. Thus, the cases of malignant lymphoma in this study showed relatively characteristic features based on MRI; however, these features might be non-specific. The CI curves in this study showed a relatively rapid increase, reaching a maximum CI at 45–120 s, and a relatively rapid decrease in most lesions (14/17; 82.4%); on the other hand, the curves of 3 of the 15 lesions (17.6%) showed relatively rapid increase, sustenance of a plateau, and a gradual decrease thereafter. These patterns of CI curves may indicate characteristic features useful for distinguishing malignant lymphomas from other lesions.

Introduction

Lymphoma is the second most common malignant tumor of the head and neck. These tumors are mainly classified as either Hodgkin's or non-Hodgkin's lymphoma and as comprised of either B- or T-lymphocytes. Hodgkin's disease and non-Hodgkin's lymphoma are potentially curable malignancies. Chemotherapy, radiotherapy, or a combination of these is performed in the treatment of malignant lymphomas. For squamous cell carcinoma (SCC), the most common malignant tumor of head and neck, surgical treatment has mainly been performed. Differentiating lymphoma from SCC is useful because these tumors require different treatment. Magnetic resonance images (MRIs) have been used in the diagnosis and definition of lesions in the oral and maxillofacial region [1], [2], [3]. It has been reported that dynamic contrast-enhanced MRI (DCE-MRI) is useful for differential diagnosis of some tumors, and many investigators have attempted to identify the differences between benign and malignant tumors, as well as to assess the malignancy of these tumors using DCE-MRI [4], [5], [6], [7]. However, there have been few previous reports of DCE-MRI used for diagnosis of malignant lymphoma in the head and neck.

In this study, we attempted to diagnose malignant lymphoma on the basis of MRI and DCE-MRI.

Section snippets

Cases

MRI with or without gadopentetate dimeglumine (Gd-DTPA)-enhancement in eight patients with histopathologically proven lymphoma was performed (Table 1).

MR sequences

MR examination was performed using a 1.5 T unit (Magnetom Vision; Siemens, Erlangen, Germany) with a head and neck coil. T1-weighted spin-echo sequences (T1WI: repetition time (TR) ms/echo time (TE) ms=600/15) and T2-weighted fast-spin-echo sequences with fat suppression technique (T2WI: TR/TE=3000–4300/90, seven echo train lengths) were obtained

Clinical information, MRI findings and results of pathological evaluation

Eighteen histopathologically proven lesions of malignant lymphoma in eight patients were detected on MRI (Table 1). The eight patients included five patients with the diffuse large B-cell lymphoma, one with B-cell low-grade MALT lymphoma, one with follicular lymphoma, and one with Hodgkin's lymphoma. Nine lesions were located in the submandibular region, three in the buccal region, two in the orbit region, two in the submental region, and one each in the palatal and tonsil regions. The diameter

Discussion

MRI is effective for diagnosing tumors and has some advantages over traditional techniques [8], [9]. Several previous reports have described the characteristic MRI features of several types of tumors [3], [4], [5], [8], [9]. However, MRI examination has not come into use yet for the differential diagnosis of tumors. Therefore, plain MR signals cannot often contribute to differential diagnosis or indicate whether a tumor is benign or malignant. In the present cases, all lesions showed almost the

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