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