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Differentiation of salivary gland tumors through tumor heterogeneity: a comparison between pleomorphic adenoma and Warthin tumor using CT texture analysis

  • Head-Neck-ENT Radiology
  • Published:
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Abstract

Purpose

We compared the diagnostic performance of CT texture analysis in single-phase CT scan with that of conventional enhancement pattern analysis in a two-phase CT scan for discrimination of salivary gland tumors, Warthin tumor (WT) from pleomorphic adenoma (PA).

Methods

One hundred seventy-eight patients with PA and 84 patients with WT were selected and CT texture analysis was separately performed on early (40s) and delayed (180s) phases, after injection of the contrast agent, using commercially available software. The attenuation changes and enhancement patterns were visually and quantitatively assessed with Hounsfield units (HU). Differences between PAs and WTs were analyzed using χ2 test and independent t test. Diagnostic performance of texture parameters in single-phase CT was compared with that of dynamic enhancement pattern in two-phase CT using the McNemar test.

Results

Ratio of tumoral HU (delayed phase/early phase) was significantly higher in PAs compared with WTs (p < 0.001). Tumor heterogeneity parameters, standard deviation (SD) and entropy, were significantly lower in WTs regardless of the type of filter used (p ≤ 0.001). Mean with coarse filter (AUC = 0.944) on early phase scan and entropy with medium filter (AUC = 0.901) on delayed scan were best discriminators between PAs and WTs. Diagnostic accuracy of mean (90.5%) on early scan and entropy (84.7%) on delayed scan was not significantly different from the accuracy (89.3%) of conventional wash-out pattern for distinguishing WTs from PAs (p = 0.742, p = 0.088, respectively).

Conclusion

Diagnostic performance of texture parameters was similar to that of quantitative enhancement pattern for differentiating WTs from PAs, with the advantage in lower radiation exposure.

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Acknowledgments

We would like to thank Editage (www.editage.co.kr) for English language editing.

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The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology, Ajou University School of Medicine, Ajou University Medical Center, 164, World Cup-ro, Yeongtong-gu, Suwon, Republic of Korea, 16499

    Yong Jun Jung, Miran Han, Eun Ju Ha & Jin Wook Choi

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  1. Yong Jun Jung
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  2. Miran Han
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Correspondence to Miran Han.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this retrospective study, formal consent is not required.

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Written informed consent was waived by the Institutional Review Board. Institutional Review Board approval was obtained (AJIRB-MED-MDB-19-137).

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Jung, Y.J., Han, M., Ha, E.J. et al. Differentiation of salivary gland tumors through tumor heterogeneity: a comparison between pleomorphic adenoma and Warthin tumor using CT texture analysis. Neuroradiology 62, 1451–1458 (2020). https://doi.org/10.1007/s00234-020-02485-x

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