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Non-enhanced MRI in combination with color Doppler flow imaging for improving diagnostic accuracy of parotid gland lesions

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Abstract

Purpose

To determine the value of non-enhanced MRI in combination with color Doppler flow imaging (CDFI) for differentiating malignant parotid tumors from benign ones.

Methods

This retrospective study analyzed 51 parotid gland lesions (39 benign and 12 malignant) in 51 patients who underwent preoperative CDFI as well as non-enhanced MRI including T1-weighted, T2-weighted, and diffusion-weighted imaging (DWI). Degrees of intratumor vascularity were categorized into four grades basing on CDFI findings. The relationships between the lesion and its adjacent external carotid artery and retromandibular vein were inspected on T1-weighted and T2-weighted images. Apparent diffusion coefficient (ADC) values were calculated from diffusion-weighted images, and were used to classify the parotid gland lesions with and without reference to the CDFI findings. The classification results were compared using the McNemar test. Sensitivity, specificity, and accuracy percentages were calculated when the non-enhanced MRI/CDFI findings were used to differentiate benign lesions from malignant ones.

Results

The diagnostic accuracy (96.1 vs 82.4%) was significantly improved when ADCs were used together with CDFI findings for classifying parotid gland lesions compared to when ADCs were used alone. Pleomorphic adenomas had the highest ADCs. The ADC thresholds were 1.425 × 10−3 mm2/s for differentiating pleomorphic adenomas from carcinomas, 0.999 × 10−3 mm2/s for differentiating pleomorphic adenomas from other benign lesions, and 0.590 × 10−3 mm2/s for differentiating benign lesions other than pleomorphic adenomas from lymphomas.

Conclusion

Combining CDFI with non-enhanced MRI can improve the diagnostic accuracy of MRI for classifying parotid gland lesions.

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References

  1. Thompson L (2006) World Health Organization classification of tumours: pathology and genetics of head and neck tumours. Ear Nose Throat J 85(2):74

    PubMed  Google Scholar 

  2. De Vincentiis M, Magliulo G, Soldo P, Manciocco V, Pagliuca G, Del Gaizo R, Gallo A (2005) Extended parotidectomy. Acta Otorhinolaryngol Ital 25(3):169–173

    PubMed  PubMed Central  Google Scholar 

  3. Lima RA, Tavares MR, Dias FL, Kligerman J, Nascimento MF, Barbosa MM, Cernea CR, Soares JR, Santos IC, Salviano S (2005) Clinical prognostic factors in malignant parotid gland tumors. Otolaryngol Head Neck Surg 133(5):702–708. https://doi.org/10.1016/j.otohns.2005.08.001

    Article  PubMed  Google Scholar 

  4. Cho HW, Kim J, Choi J, Choi HS, Kim ES, Kim SH, Choi EC (2011) Sonographically guided fine-needle aspiration biopsy of major salivary gland masses: a review of 245 cases. AJR Am J Roentgenol 196(5):1160–1163. https://doi.org/10.2214/AJR.10.4256

    Article  PubMed  Google Scholar 

  5. Chakrabarti S, Bera M, Bhattacharya PK, Chakrabarty D, Manna AK, Pathak S, Maiti K (2010) Study of salivary gland lesions with fine needle aspiration cytology and histopothology along with immunohistochemistry. J Indian Med Assoc 108(12):833–836

    PubMed  Google Scholar 

  6. Jin GQ, Su DK, Xie D, Zhao W, Liu LD, Zhu XN (2011) Distinguishing benign from malignant parotid gland tumours: low-dose multi-phasic CT protocol with 5-min delay. Eur Radiol 21(8):1692–1698. https://doi.org/10.1007/s00330-011-2101-y

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Yuan Y, Tang W, Tao X (2016) Parotid gland lesions: separate and combined diagnostic value of conventional MRI, diffusion-weighted imaging and dynamic contrast-enhanced MRI. Br J Radiol 89(1060):20150912. https://doi.org/10.1259/bjr.20150912

    Article  PubMed  PubMed Central  Google Scholar 

  8. Sakamoto M, Iikubo M, Kojima I, Sasano T, Mugikura S, Murata T, Watanabe M, Shiga K, Ogawa T, Takahashi S (2014) Diagnostic value of capsule-like rim enhancement on magnetic resonance imaging for distinguishing malignant from benign parotid tumours. Int J Oral Maxillofac Surg 43(9):1035–1041. https://doi.org/10.1016/j.ijom.2014.03.008

    Article  CAS  PubMed  Google Scholar 

  9. Lechner Goyault J, Riehm S, Neuville A, Gentine A, Veillon F (2011) Interest of diffusion-weighted and gadolinium-enhanced dynamic MR sequences for the diagnosis of parotid gland tumors. J Neuroradiol J Neuroradiol 38(2):77–89. https://doi.org/10.1016/j.neurad.2009.10.005

    Article  CAS  PubMed  Google Scholar 

  10. Christe A, Waldherr C, Hallett R, Zbaeren P, Thoeny H (2011) MR imaging of parotid tumors: typical lesion characteristics in MR imaging improve discrimination between benign and malignant disease. AJNR Am J Neuroradiol 32(7):1202–1207. https://doi.org/10.3174/ajnr.A2520

    Article  CAS  PubMed  Google Scholar 

  11. Yabuuchi H, Matsuo Y, Kamitani T, Setoguchi T, Okafuji T, Soeda H, Sakai S, Hatakenaka M, Nakashima T, Oda Y, Honda H (2008) Parotid gland tumors: can addition of diffusion-weighted MR imaging to dynamic contrast-enhanced MR imaging improve diagnostic accuracy in characterization? Radiology 249(3):909–916. https://doi.org/10.1148/radiol.2493072045

    Article  PubMed  Google Scholar 

  12. Eida S, Ohki M, Sumi M, Yamada T, Nakamura T (2008) MR factor analysis: improved technology for the assessment of 2D dynamic structures of benign and malignant salivary gland tumors. J Magn Reson Imaging JMRI 27(6):1256–1262. https://doi.org/10.1002/jmri.21349

    Article  PubMed  Google Scholar 

  13. Strympl P, Kodaj M, Bakaj T, Kominek P, Starek I, Sisola I, Tomaskova H, Matousek P (2014) Color Doppler ultrasound in the pre-histological determination of the biological character of major salivary gland tumors. Biomedical papers of the Medical Faculty of the University Palacky. Olomouc Czechoslov 158(3):465–469. https://doi.org/10.5507/bp.2012.074

    Google Scholar 

  14. Bradley MJ, Durham LH, Lancer JM (2000) The role of colour flow Doppler in the investigation of the salivary gland tumour. Clin Radiol 55(10):759–762. https://doi.org/10.1053/crad.2000.0541

    Article  CAS  PubMed  Google Scholar 

  15. Schick S, Steiner E, Gahleitner A, Bohm P, Helbich T, Ba-Ssalamah A, Mostbeck G (1998) Differentiation of benign and malignant tumors of the parotid gland: value of pulsed Doppler and color Doppler sonography. Eur Radiol 8(8):1462–1467. https://doi.org/10.1007/s003300050576

    Article  CAS  PubMed  Google Scholar 

  16. Shellock FG, Kanal E (1999) Safety of magnetic resonance imaging contrast agents. J Magn Reson Imaging JMRI 10(3):477–484

    Article  CAS  PubMed  Google Scholar 

  17. Svaland MG, Lundby B, Kristoffersen DT (1994) Comparison of the safety of the standard dose and a higher dose of gadodiamide injection for MR imaging of the central nervous system. J Magn Reson Imaging JMRI 4(3):419–423

    Article  CAS  PubMed  Google Scholar 

  18. Martinoli C, Derchi LE, Solbiati L, Rizzatto G, Silvestri E, Giannoni M (1994) Color Doppler sonography of salivary glands. AJR Am J Roentgenol 163(4):933–941. https://doi.org/10.2214/ajr.163.4.8092039

    Article  CAS  PubMed  Google Scholar 

  19. Davachi B, Imanimoghaddam M, Majidi MR, Sahebalam A, Johari M, Javadian Langaroodi A, Shakeri MT (2014) The efficacy of magnetic resonance imaging and color Doppler ultrasonography in diagnosis of salivary gland tumors. J Dent Res Dent Clin Dent Prospects 8(4):246–251. https://doi.org/10.5681/joddd.2014.044

    PubMed  PubMed Central  Google Scholar 

  20. Izzo L, Sassayannis PG, Frati R, Stasolla A, Alradhi H, Caputo M, Costi U, Gabriele R, Biacchi D, Guerrisi R, Fiori E, Marini M (2004) The role of echo colour/power Doppler and magnetic resonance in expansive parotid lesions. J Exp Clin Cancer Res CR 23(4):585–592

    CAS  PubMed  Google Scholar 

  21. Eida S, Sumi M, Sakihama N, Takahashi H, Nakamura T (2007) Apparent diffusion coefficient mapping of salivary gland tumors: prediction of the benignancy and malignancy. AJNR Am J Neuroradiol 28(1):116–121

    CAS  PubMed  Google Scholar 

  22. Habermann CR, Gossrau P, Graessner J, Arndt C, Cramer MC, Reitmeier F, Jaehne M, Adam G (2005) Diffusion-weighted echo-planar MRI: a valuable tool for differentiating primary parotid gland tumors? RoFo Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin 177(7):940–945. https://doi.org/10.1055/s-2005-858297

    Article  CAS  PubMed  Google Scholar 

  23. Sumi M, Van Cauteren M, Sumi T, Obara M, Ichikawa Y, Nakamura T (2012) Salivary gland tumors: use of intravoxel incoherent motion MR imaging for assessment of diffusion and perfusion for the differentiation of benign from malignant tumors. Radiology 263(3):770–777. https://doi.org/10.1148/radiol.12111248

    Article  PubMed  Google Scholar 

  24. Thoeny HC (2007) Imaging of salivary gland tumours. Cancer Imaging 7:52–62. https://doi.org/10.1102/1470-7330.2007.0008

    Article  PubMed  PubMed Central  Google Scholar 

  25. Thoeny HC, De Keyzer F, Claus FG, Sunaert S, Hermans R (2005) Gustatory stimulation changes the apparent diffusion coefficient of salivary glands: initial experience. Radiology 235(2):629–634. https://doi.org/10.1148/radiol.2352040127

    Article  PubMed  Google Scholar 

  26. Freling NJ, Molenaar WM, Vermey A, Mooyaart EL, Panders AK, Annyas AA, Thijn CJ (1992) Malignant parotid tumors: clinical use of MR imaging and histologic correlation. Radiology 185(3):691–696. https://doi.org/10.1148/radiology.185.3.1438746

    Article  CAS  PubMed  Google Scholar 

  27. Habermann CR, Arndt C, Graessner J, Diestel L, Petersen KU, Reitmeier F, Ussmueller JO, Adam G, Jaehne M (2009) Diffusion-weighted echo-planar MR imaging of primary parotid gland tumors: is a prediction of different histologic subtypes possible? AJNR Am J Neuroradiol 30(3):591–596. https://doi.org/10.3174/ajnr.A1412

    Article  CAS  PubMed  Google Scholar 

  28. Motoori K, Iida Y, Nagai Y, Yamamoto S, Ueda T, Funatsu H, Ito H, Yoshitaka O (2005) MR imaging of salivary duct carcinoma. AJNR Am J Neuroradiol 26(5):1201–1206

    PubMed  Google Scholar 

  29. Thoeny HC, De Keyzer F, Boesch C, Hermans R (2004) Diffusion-weighted imaging of the parotid gland: influence of the choice of b-values on the apparent diffusion coefficient value. J Magn Reson Imaging JMRI 20(5):786–790. https://doi.org/10.1002/jmri.20196

    Article  PubMed  Google Scholar 

  30. Shen ZY, Hu B, Wu MF (2012) Correlation between blood flow signal of color flow imaging and nottingham prognostic index in patients with breast carcinoma. Breast Care 7(2):126–130. https://doi.org/10.1159/000337766

    Article  PubMed  PubMed Central  Google Scholar 

  31. Ikeda M, Motoori K, Hanazawa T, Nagai Y, Yamamoto S, Ueda T, Funatsu H, Ito H (2004) Warthin tumor of the parotid gland: diagnostic value of MR imaging with histopathologic correlation. AJNR Am J Neuroradiol 25(7):1256–1262

    PubMed  Google Scholar 

  32. Wang J, Takashima S, Takayama F, Kawakami S, Saito A, Matsushita T, Momose M, Ishiyama T (2001) Head and neck lesions: characterization with diffusion-weighted echo-planar MR imaging. Radiology 220(3):621–630. https://doi.org/10.1148/radiol.2202010063

    Article  CAS  PubMed  Google Scholar 

  33. Sumi M, Nakamura T (2009) Diagnostic importance of focal defects in the apparent diffusion coefficient-based differentiation between lymphoma and squamous cell carcinoma nodes in the neck. Eur Radiol 19(4):975–981. https://doi.org/10.1007/s00330-008-1217-1

    Article  PubMed  Google Scholar 

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Acknowledgements

This work was supported by International Communication of Guangxi Medical University Graduate Education, for which the authors are very grateful. We are very grateful to the editor and reviewers.

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Author notes

  1. Wei Zhang, Zhichao Zuo and Ningbin Luo contributed equally.

Authors and Affiliations

  1. Department of Radiology, Affiliated Tumor Hospital of Guangxi Medical University, 71 Hedi Road, Nanning, 530021, Guangxi, China

    Wei Zhang, Zhichao Zuo, Ningbin Luo, Guanqiao Jin & Danke Su

  2. Department of Ultrasound Diagnosis, Affiliated Tumor Hospital of Guangxi Medical University, 71 Hedi Road, Nanning, 530021, Guangxi, China

    Lianfeng Liu & Junjie Liu

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  1. Wei Zhang
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Correspondence to Junjie Liu or Danke Su.

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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.

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Zhang, W., Zuo, Z., Luo, N. et al. Non-enhanced MRI in combination with color Doppler flow imaging for improving diagnostic accuracy of parotid gland lesions. Eur Arch Otorhinolaryngol 275, 987–995 (2018). https://doi.org/10.1007/s00405-018-4895-6

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  • DOI: https://doi.org/10.1007/s00405-018-4895-6

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