The Value of Dynamic MRI Studies in Parotid Tumors

doi:10.1016/j.acra.2007.03.004

Academic Radiology

Volume 14, Issue 6, June 2007, Pages 701-710

https://doi.org/10.1016/j.acra.2007.03.004 Get rights and content

Rationale and Objectives

To evaluate the ability of dynamic contrast-enhanced magnetic resonance imaging (MRI) to differentiate several tumor entities of the parotid gland in a prospective clinical trial.

Materials and Methods

A total of 112 patients with parotid tumors were examined with dynamic contrast-enhanced 1.5 T MRI. Precontrast axial T1-weighted imaging was used to select five slices for the dynamic study. Subsequently, a T1-weighted FLASH sequence was used for the dynamic contrast study (0.2 ml Gd/kg × body weight). Contrast agent application and the FLASH sequence were started simultaneously. Ten acquisitions of 10 seconds’ scan time each were performed (total acquisition time 1:40 minutes). Signal intensity versus time (SIvT) curves was obtained for all tumors. After correlation of the categorized SIvT curves, these were compared with histopathology. Finally, all MRIs together with the tumor specific SIvT curves were re-read and correlated with histopathologic diagnosis. All reading sessions were done by three experienced radiologists.

Results

Four characteristic intensity-time curves were observed: pleomorphic adenoma showed a gradual increase in signal intensity, followed by a plateau phase on a low intensity level. Cysts showed a vacillating course at a low signal intensity level. Adenolymphomas as well as carcinomas showed a rapid increase in signal intensity followed by a plateau phase. Statistic significance was found for the time-to-peak values for adenolymphomas and pleomorphic adenomas and for the maximum peak signal intensity values for carcinomas. Together with other morphologic MRI criteria (contrast enhancement, border characteristics) and clinical features, a differentiation between adenolymphoma and carcinoma was possible.

Conclusions

With additional dynamic contrast-enhanced MRI, a more reliable differentiation between common parotid tumors is possible before surgery.

Section snippets

Materials and methods

Between July 2002 and January 2004, 112 consecutive patients (55 male, 57 female, ages 11–86 years, mean age 54 years) presenting with a palpable parotid mass were examined with dynamic contrast-enhanced MRI on a 1.5-T MR scanner (Magnetom Symphony, Siemens, Erlangen/Germany) in a prospective study. Approval of the local ethical committee and written informed consent for each patient was obtained. The MRI study protocol consisted of localizer sequences in transversal, sagittal, and coronal

Results

The histopathology work-up of the specimens obtained at surgery revealed Pleomorphic adenoma (n = 46), adenolymphoma (Warthin-Tumors) (n = 24), other benign entities (n = 29), and carcinoma (n = 13) (Table 1). All carcinomas were high grade carcinomas, low grade malignancies such as lymphoma were not found.

Typical signal characteristics were seen in cross sectional pre- and postcontrast images. Pleomorphic adenomas as well as malignant tumors showed hyperintense signal on T2-weighted images,

Discussion

To reliably differentiate benign from malignant parotid masses is of fundamental concern, because it strongly influences therapeutic decisions: extracapsular dissection, partial parotidectomy versus radical parotidectomy with removal of the facial nerve are possible surgical strategies. Although biopsy is still a gold standard in diagnosis of parotid tumors (1, 4, 12, 15), given the technical developments of the last 20 years imaging modalities such as ultrasonography, CT, and MRI, can provide

Conclusion

Dynamic contrast-enhanced MRI at 1.5T field strength allows a better differentiation between the common parotid tumors (pleomorphic adenoma, adenolymphoma, high-grade malignancies [ie, carcinomas]) before surgery without need for invasive diagnostic tools (eg, biopsy). The additional time needed for dynamic imaging sequences is less than 2 minutes and, with dedicated software, quick and accurate evaluation of the signal characteristics of tumor entities is possible. Time-to-peak curves and

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Cited by (41)

Multiparametric magnetic resonance imaging of parotid tumors: A systematic review
2021, Diagnostic and Interventional Imaging
The purpose of this systematic review was to provide an overview of the contribution of multiparametric magnetic resonance imaging (MRI) in the diagnosis of parotid tumors (PT) and recommendations based on current evidences.
We performed a retrospective systematic search of PubMed, EMBASE, and Cochrane Library databases from inception to January 2020, using the keywords “magnetic resonance imaging” and “salivary gland neoplasms”.
The initial search returned 2345 references and 90 were deemed relevant for this study. A total of 54 studies (60%) reported the use of diffusion-weighted imaging (DWI) and 28 studies (31%) the use of dynamic contrast-enhanced (DCE) imaging. Specific morphologic signs of frequent benign PT and suggestive signs of malignancy on conventional sequences were reported in 37 studies (41%). DWI showed significant differences in apparent diffusion coefficient (ADC) values between benign and malignant PT, and especially between pleomorphic adenomas and malignant PT, with cut-off ADC values between 1.267 × 10⁻³ mm²/s and 1.60 × 10⁻³ mm²/s. Perfusion curves obtained with DCE imaging allowed differentiating among pleomorphic adenomas, Warthin's tumors, malignant PT and cystic lesions. The combination of morphological MRI sequences, DCE imaging and DWI helped increase the diagnostic accuracy of MRI.
Multiparametric MRI, including morphological MRI sequences, DWI and DCE imaging, is the imaging modality of choice for the characterization of focal PT and provides features that are highly suggestive of a specific diagnosis.
The diagnostic role of ultrasonography, computed tomography, magnetic resonance imaging, positron emission tomography/computed tomography, and real-time elastography in the differentiation of benign and malignant salivary gland tumors: a meta-analysis
2019, Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Citation Excerpt :
MRI has been used mandatorily to assess complete tumor extent, local invasion, and perineural spread when tumors are located in deep tissues or when they are suspected to have a high risk of malignancy. Several studies have argued that the ability of MRI in predicting salivary gland malignancy is limited.51,52 However, our meta-analysis showed great potential for MRI in discriminating between benign and malignant salivary gland tumors.
The objective of this study was to assess the diagnostic properties of ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography/computed tomography (PET/CT), and real-time elastography (RTE) in distinguishing between benign and malignant salivary gland tumors.
English databases were searched for eligible studies. Diagnostic accuracy parameters, including sensitivity, specificity, diagnostic odds ratio (DOR), and summary receiver operating characteristic curves (SROC) were calculated. Meta-regression and subgroup analyses were performed to identify the source of heterogeneity.
In total, 38 studies were included. Pooled sensitivities for ultrasonography, CT, MRI, PET/CT, and RTE were 0.66, 0.70, 0.80, 0.81, and 0.80, respectively. Pooled specificities were 0.92, 0.73, 0.90, 0.89, and 0.70, respectively. The DORs were 23, 6, 38, 20, and 10, respectively. The areas under the curve (AUC) of SROC for US, CT, MRI, PET/CT, and RTE were 0.91, 0.77, 0.92, 0.88, and 0.82, respectively.
Based on the results of the meta-analysis, MRI may be the first choice for the differential diagnosis of benign and malignant salivary gland tumors for its relatively high diagnostic value. PET/CT tends to have greater accuracy than CT. Ultrasonography and RTE may help achieve better diagnostic outcomes if they are used in conjunction.
Diagnostic Accuracy of Multiparametric Magnetic Resonance Imaging for Differentiation Between Parotid Neoplasms
2019, Canadian Association of Radiologists Journal
This study was designed to evaluate the role of multiparametric magnetic resonance imaging (MRI) for differentiation of parotid gland neoplasms.
Prospective study was conducted upon 52 consecutive patients (30 men, 22 women; aged 24–78 years; mean, 51 years) with parotid tumours that underwent multiparametric MRI using combined static MRI, dynamic contrast enhanced (DCE) MRI, and diffusion-weighted imaging (DWI). The static MRI parameter, time signal intensity curves (TIC) derived from DCE-MRI, and apparent diffusion coefficient (ADC) values of parotid tumours were correlated with histopathological findings.
Static MRI revealed a significant difference between both benign and malignant lesions in regards to margin definition (P < .001) and T2 hypointensity (P < .013), with a diagnostic accuracy 95% and 78.33% respectively. Study of the TIC type on DCE-MRI revealed statistically significant difference between benign and malignant lesions (P < .001) and diagnostic accuracy 96.55%. There was no statistically significant difference (P = .181) between the ADC values of benign and malignant lesions. ROC curve analysis revealed that by using ADC cut-off value of 1 × 10⁻³ mm²/s had accuracy of 84.62% respectively for differentiating Warthin from malignant tumours that could be modified to higher value (94.28%) by excluding lymphoma from malignant lesions. By using cutoff value of 1.3 × 10⁻³ mm²/s to differentiate pleomorphic adenoma from malignancy, ROC curve analysis had high accuracy of 97.06%.
Multiparametric MRI can be used for differentiation of malignant from benign parotid tumours and characterization of some benign parotid tumours.
Cette étude a été conçue pour évaluer le rôle de l'imagerie par résonance magnétique (IRM) multiparamétrique pour la différenciation des néoplasmes de la glande parotide.
Une analyse prospective a été conduite sur 52 patients consécutifs (30 hommes et 22 femmes âgés de 24 à 78 ans; âge moyen de 51 ans) présentant des tumeurs parotidiennes et s’étant soumis à une IRM multiparamétrique par l'utilisation combinée d’IRM statique, d’IRM dynamique rehaussée par produit de contraste (DPC) et d'imagerie pondérée en diffusion (IPD). Les paramètres de l’IRM statique, les courbes d'intensité de signal en fonction du temps (CIT) dérivées des IRM-DPC et le coefficient de diffusion apparent (CDA) des tumeurs parotidiennes coïncidaient avec les résultats histopathologiques.
L’IRM statique a conduit à une différence significative entre les lésions à la fois bénignes et malignes concernant la définition de la marge (P < 0,001) et un hyposignal en T2 (P < 0,013), avec une exactitude diagnostique de 95 % et 78,33 % respectivement. L’étude des types de CIT obtenues par IRM-DPC a révélé une différence statistiquement significative entre les lésions bénignes et malignes (P < 0,001) et une exactitude diagnostique de 96,55 %. Aucune différence statistiquement significative (P = 0,181) n'a été obtenue entre les lésions bénignes et malignes au niveau du coefficient de diffusion apparent. L'analyse de la courbe ROC a permis de démontrer que l'utilisation d'une valeur seuil de 1 × 10⁻³ mm²/s pour le CDA avait une exactitude de 84,62 % pour la différenciation des tumeurs de Warthin des tumeurs malignes pouvant être haussée à une valeur supérieure (94,28 %) en excluant les lymphomes des lésions malignes. Avec une valeur seuil établie à 1,3 × 10⁻³ mm²/s afin de différencier les adénomes pléomorphes de la malignité, l'analyse de la courbe ROC a adopté une exactitude supérieure (de 97,06 %).
L’IRM multiparamétrique peut être utilisée pour différencier les tumeurs parotidiennes malignes des tumeurs bénignes et pour caractériser certaines tumeurs parotidiennes bénignes.
ACR Appropriateness Criteria <sup>®</sup> Neck Mass-Adenopathy
2019, Journal of the American College of Radiology
Citation Excerpt :
The main disadvantages of MRI are increased time, susceptibility artifacts, and motion artifacts. Advanced MRI techniques, such as perfusion imaging and texture analysis, show promise in differentiating benign from malignant lesions but are currently not used in routine clinical practice [83-87]. Noninvasive MRI sialography may provide assessment of the parotid ducts [88] complementary to anatomic MRI of the face or neck, if there is a clinical concern for acute parotitis in the setting of duct obstruction.
A palpable neck mass may be the result of neoplastic, congenital, or inflammatory disease. Older age suggests neoplasia, and a congenital etiology is more prevalent in the pediatric population. The imaging approach is based on the patient age, mass location, and clinical pulsatility. Underlying human papillomavirus-related malignancy should be considered in all age groups. Although the imaging appearance of some processes in the head and neck overlap, choosing the appropriate imaging examination may allow a specific diagnosis, or a limited differential diagnosis. Tissue sampling is indicated to confirm suspected malignancy.
The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Dynamic Contrast-Enhanced MR Imaging in Head and Neck Cancer
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2013, Annales Francaises d'Oto-Rhino-Laryngologie et de Pathologie Cervico-Faciale

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¹: Supported by a grant from the Wilhelm-Sander-Foundation, Neustadt a.d. Donau/Germany.

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Double mammography diagnostic accuracyThe Value of Dynamic MRI Studies in Parotid Tumors1

Rationale and Objectives

Materials and Methods

Results

Conclusions

Section snippets

Materials and methods

Results

Discussion

Conclusion

Crit Rev Oncol Hematol

Otolaryngol Head Neck

J Clin Imaging

Neuroimaging Clin N Am

Clin Radiol

Oral Oncol

Major salivary gland imaging

Radiology

Aetiopathogenese und histopathologie der speicheldruesenerkrankungen

Laryngo-Rhino-Otol

Indikation und aussagekraft von CT und MRT im Kopf-Hals-Bereich

HNO

Doppler-und farbkodierte duplexsonographie im Kopf-Hals-Bereich

Sonography of the salivary glands

Eur Radiol

Major salivary glands masses; comparison of MR imaging and CT

Radiology

Salivary glands

The salivary glands

Parotid pleomorphic adenomas: delayed CT enhancement

AJNR Am J Neuroradiol

Ultrafast computed tomography and three-dimensional image processing of CT sialography in patients with parotid masses poorly defined by magnetic resonance imaging

Acta Otolaryngol (Stockh)

Double mammography diagnostic accuracy
The Value of Dynamic MRI Studies in Parotid Tumors1