European Radiology

, Volume 25, Issue 11, pp 3247–3254 | Cite as

Perfusion imaging of parotid gland tumours: usefulness of arterial spin labeling for differentiating Warthin’s tumours

  • Hiroki Kato
  • Masayuki Kanematsu
  • Haruo Watanabe
  • Kimihiro Kajita
  • Keisuke Mizuta
  • Mitsuhiro Aoki
  • Tomoyuki Okuaki
Head and Neck



To assess prospectively the efficacy of arterial spin labelling (ASL) against conventional and diffusion-weighted (DW) MR imaging for differentiating parotid gland tumours.


We included 10 pleomorphic adenomas, 12 Warthin's tumours, and nine malignant tumours of the parotid glands. Only tumours larger than 10 mm were included in this study. All parotid gland tumours underwent T1-weighted, T2-weighted, DW, and ASL imaging. Tumour-to-parotid gland signal intensity ratios (SIRs) and apparent diffusion coefficients (ADCs) of solid components were correlated with these pathologies.


SIRs on T2-weighted images and ADCs were higher in pleomorphic adenomas than in Warthin's tumours (p < .01) and malignant tumours (p < .01). SIRs on ASL were higher in Warthin's tumours than in pleomorphic adenomas (p < .01) and malignant tumours (p < .05). Az value of SIRs on ASL for differentiating Warthin's tumours from the other pathologies was 0.982. The sensitivity, specificity, and accuracy of SIRs on ASL for the diagnosis of Warthin's tumours at an optimal SIR threshold of over 8.70 were 91.7 %, 94.7 %, and 93.5 %, respectively.


ASL with SIR measurements could non-invasively evaluate tumour blood flow of parotid gland tumours and differentiate Warthin's tumours from pleomorphic adenomas and malignant tumours.

Key Points

ASL non-invasively evaluates tumour blood flow of parotid gland tumours

ASL differentiates Warthin's tumours from pleomorphic adenomas and malignant tumours

ASL cannot differentiate between pleomorphic adenomas and malignant tumours


Arterial spin labelling Diffusion-weighted imaging Parotid gland Salivary gland tumour Warthin’s tumour 



The scientific guarantor of this publication is Hiroki Kato. Tomoyuki Okuaki is employee of Philips Healthcare. The other authors of this manuscript declare no relationships with any companies. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional review board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. No study subjects or cohorts have been previously reported. Methodology: retrospective, diagnostic or prognostic study, performed at one institution.


  1. 1.
    Das DK, Petkar MA, Al-Mane NM, Sheikh ZA, Mallik MK, Anim JT (2004) Role of fine needle aspiration cytology in the diagnosis of swellings in the salivary gland regions: a study of 712 cases. Med Princ Pract 13:95–106CrossRefPubMedGoogle Scholar
  2. 2.
    Som PM, Biller HF (1989) High-grade malignancies of the parotid gland: identification with MR imaging. Radiology 173:823–826CrossRefPubMedGoogle Scholar
  3. 3.
    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 32:1202–1207CrossRefPubMedGoogle Scholar
  4. 4.
    Yabuuchi H, Fukuya T, Tajima T, Hachitanda Y, Tomita K, Koga M (2003) Salivary gland tumors: diagnostic value of gadolinium-enhanced dynamic MR imaging with histopathologic correlation. Radiology 226:345–354CrossRefPubMedGoogle Scholar
  5. 5.
    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 27:1256–1262CrossRefPubMedGoogle Scholar
  6. 6.
    Tsushima Y, Matsumoto M, Endo K (1994) Parotid and parapharyngeal tumours: tissue characterization with dynamic magnetic resonance imaging. Br J Radiol 67:342–345CrossRefPubMedGoogle Scholar
  7. 7.
    Hisatomi M, Asaumi J, Yanagi Y et al (2007) Diagnostic value of dynamic contrast-enhanced MRI in the salivary gland tumors. Oral Oncol 43:940–947CrossRefPubMedGoogle Scholar
  8. 8.
    Muller-Schimpfle M, Noack F, Oettling G et al (2000) Influence of histopathological factors on dynamic MR mammography. Röfo 172:894–900PubMedGoogle Scholar
  9. 9.
    Matsushima N, Maeda M, Takamura M, Takeda K (2007) Apparent diffusion coefficients of benign and malignant salivary gland tumors. Comparison to histopathological findings. J Neuroradiol 34:183–189CrossRefPubMedGoogle Scholar
  10. 10.
    Habermann CR, Arndt C, Graessner J et al (2009) Diffusion-weighted echo-planar MR imaging of primary parotid gland tumors: is a prediction of different histologic subtypes possible? AJNR Am J Neuroradiol 30:591–596CrossRefPubMedGoogle Scholar
  11. 11.
    Yabuuchi H, Matsuo Y, Kamitani T et al (2008) Parotid gland tumors: can addition of diffusion-weighted MR imaging to dynamic contrast-enhanced MR imaging improve diagnostic accuracy in characterization? Radiology 249:909–916CrossRefPubMedGoogle Scholar
  12. 12.
    Detre JA, Alsop DC, Vives LR, Maccotta L, Teener JW, Raps EC (1998) Noninvasive MRI evaluation of cerebral blood flow in cerebrovascular disease. Neurology 50:633–641CrossRefPubMedGoogle Scholar
  13. 13.
    Chalela JA, Alsop DC, Gonzalez-Atavales JB, Maldjian JA, Kasner SE, Detre JA (2000) Magnetic resonance perfusion imaging in acute ischemic stroke using continuous arterial spin labeling. Stroke 31:680–687CrossRefPubMedGoogle Scholar
  14. 14.
    Alsop DC, Detre JA, Grossman M (2000) Assessment of cerebral blood flow in Alzheimer’s disease by spin-labeled magnetic resonance imaging. Ann Neurol 47:93–100CrossRefPubMedGoogle Scholar
  15. 15.
    Wolf RL, Alsop DC, Levy-Reis I et al (2001) Detection of mesial temporal lobe hypoperfusion in patients with temporal lobe epilepsy by use of arterial spin labeled perfusion MR imaging. AJNR Am J Neuroradiol 22:1334–1341PubMedGoogle Scholar
  16. 16.
    Wolf RL, Detre JA (2007) Clinical neuroimaging using arterial spin-labeled perfusion magnetic resonance imaging. Neurotherapeutics 4:346–359PubMedCentralCrossRefPubMedGoogle Scholar
  17. 17.
    Warmuth C, Gunther M, Zimmer C (2003) Quantification of blood flow in brain tumors: comparison of arterial spin labeling and dynamic susceptibility-weighted contrast-enhanced MR imaging. Radiology 228:523–532CrossRefPubMedGoogle Scholar
  18. 18.
    Wolf RL, Wang J, Wang S et al (2005) Grading of CNS neoplasms using continuous arterial spin labeled perfusion MR imaging at 3 Tesla. J Magn Reson Imaging 22:475–482CrossRefPubMedGoogle Scholar
  19. 19.
    Kimura H, Takeuchi H, Koshimoto Y et al (2006) Perfusion imaging of meningioma by using continuous arterial spin-labeling: comparison with dynamic susceptibility-weighted contrast-enhanced MR images and histopathologic features. AJNR Am J Neuroradiol 27:85–93PubMedGoogle Scholar
  20. 20.
    Noguchi T, Yoshiura T, Hiwatashi A et al (2008) Perfusion imaging of brain tumors using arterial spin-labeling: correlation with histopathologic vascular density. AJNR Am J Neuroradiol 29:688–693CrossRefPubMedGoogle Scholar
  21. 21.
    Jarnum H, Steffensen EG, Knutsson L et al (2010) Perfusion MRI of brain tumours: a comparative study of pseudo-continuous arterial spin labelling and dynamic susceptibility contrast imaging. Neuroradiology 52:307–317PubMedCentralCrossRefPubMedGoogle Scholar
  22. 22.
    Weber MA, Thilmann C, Lichy MP et al (2004) Assessment of irradiated brain metastases by means of arterial spin-labeling and dynamic susceptibility-weighted contrast-enhanced perfusion MRI: initial results. Investig Radiol 39:277–287CrossRefGoogle Scholar
  23. 23.
    Fujima N, Kudo K, Tsukahara A et al (2014) Measurement of tumor blood flow in head and neck squamous cell carcinoma by pseudo-continuous arterial spin labeling: comparison with dynamic contrast-enhanced MRI. J Magn Reson Imaging. doi: 10.1002/jmri.24637 Google Scholar
  24. 24.
    Fujima N, Kudo K, Yoshida D et al (2014) Arterial spin labeling to determine tumor viability in head and neck cancer before and after treatment. J Magn Reson Imaging 40:920–928CrossRefPubMedGoogle Scholar
  25. 25.
    Batsakis JG (1987) Carcinoma ex papillary cystadenoma lymphomatosum. Malignant Warthin’s tumor. Ann Otol Rhinol Laryngol 96:234–235CrossRefPubMedGoogle Scholar
  26. 26.
    Fruehwald-Pallamar J, Czerny C, Holzer-Fruehwald L et al (2013) Texture-based and diffusion-weighted discrimination of parotid gland lesions on MR images at 3.0 Tesla. NMR Biomed 26:1372–1379CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Radiology 2015

Authors and Affiliations

  • Hiroki Kato
    • 1
  • Masayuki Kanematsu
    • 1
    • 2
  • Haruo Watanabe
    • 1
  • Kimihiro Kajita
    • 2
  • Keisuke Mizuta
    • 3
  • Mitsuhiro Aoki
    • 3
  • Tomoyuki Okuaki
    • 4
  1. 1.Department of RadiologyGifu University School of MedicineGifuJapan
  2. 2.High-level Imaging Diagnosis CenterGifu University HospitalGifuJapan
  3. 3.Department of OtolaryngologyGifu University School of MedicineGifuJapan
  4. 4.Philips HealthcareTokyoJapan

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