Oral and maxillofacial radiology
Magnetic resonance imaging (MRI) and dynamic MRI evaluation of extranodal non-Hodgkin lymphoma in oral and maxillofacial regions

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Objective

The purpose of this study was to evaluate the diagnostic value of magnetic resonance imaging (MRI), especially dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), in extranodal non-Hodgkin lymphoma (NHL) of oral and maxillofacial regions.

Study design

Thirteen cases with extranodal NHL were examined using MRI. T1-weighted images (T1WI) and T2-weighted images (T2WI) or short TI inversion recovery (STIR) images were obtained in all cases. Contrast-enhanced images and DCE-MRI were acquired in 10 and 7 cases, respectively. On DCE-MRIs, we analyzed the parameters as follows: contrast index at maximal contrast enhancement (CImax), maximum contrast index (CI) gain/CImax ratio, and washout ratios (WR300, WR600, and WR900) at 300, 600, and 900 seconds after contrast medium injection.

Results

The signal intensity of all lesions was hypointense to isointense on T1WIs and showed variable contrast enhancement patterns. On T2WIs and STIR images, the signal intensity was isointense to hyperintense in almost all cases. Analysis of DCE-MRI parameters in extranodal NHLs resulted in the identification of 4 types of CI curves according to CImax and WR: (1) CImax greater than 2.0 and WR900 greater than 40%, (2) CImax greater than 2.0 and WR900 less than 40%, (3) CImax less than 1.5 and WR900 greater than 40%, and (4) CImax less than 1.5 and WR900 greater than 40%.

Conclusions

The signal intensities on MRI were not specific to extranodal NHL and resembled those of other tumor types. When CImax was less than 1.5 or WR900 was less than 40%, these parameters contributed to diagnosis in extranodal NHLs.

Section snippets

Patients

Twenty-six patients were histopathologically diagnosed with extranodal NHL in our hospital between April 1993 and December 2009. Of these patients, we evaluated the records of 13 who underwent MR examination with or without contrast medium enhancement in this retrospective study. This study was approved by our institutional review board (No. 232). The patients were 5 men and 8 women with a mean age of 66.5 years (age range, 44-79 years) (Table I).

MRI study protocol

The MR examination was performed using a 1.5-T

MR findings (size and characteristics of SI)

The MR findings of all cases are summarized in Table I. The mean greatest dimension of the tumor was 34.2 mm (range: 18-59 mm). On T1WIs, all cases had homogeneous or nearly homogeneous SIs that were hypointense or isointense (Figure 2, Figure 3, A, and 3, A). On T2WIs (n = 9) and STIR images (n = 4), almost all cases had nearly homogeneous SIs that were isointense or hypointense (Figures 2, B, and 3, B). On the CE-T1WIs of 10 cases, almost all cases had (nearly) homogeneous SIs, although the

Discussion

Malignant lymphoma is the second most common malignancy in the head and neck region, although its morbidity rate is not high.38, 39, 40, 41 The occurrence rate of extranodal NHL is reported to be approximately 40%, and the most common site in the head and neck region is Waldeyer's ring.1, 8, 42, 43, 44, 45, 46, 47, 48 Only 3.0% to 9.5% of extranodal NHL arises in the oral region, and its most common sites are the palate and maxilla.1, 2, 3, 4, 5, 6, 7, 42, 44

In the cases of extranodal NHL

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