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Pseudo-continuous arterial spin labeling MR images in Warthin tumors and pleomorphic adenomas of the parotid gland: qualitative and quantitative analyses and their correlation with histopathologic and DWI and dynamic contrast enhanced MRI findings

  • Head-Neck-ENT Radiology
  • Published:
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Abstract

Purpose

We investigated the correlation between tumor blood flow (TBF) and histopathologic features of Warthin tumors (WTs) and pleomorphic adenomas (PAs) to determine the TBF in the differential diagnosis of these tumors and evaluated how well pCASL-MRI can differentiate PAs from WTs compared to conventional MRI.

Methods

The ADC, time intensity curve (TIC) pattern of dynamic contrast enhancement, and pCASL (visual assessment and TBF of the MR images of 10 WTs and 13 PAs) were reviewed. We compared the pCASL and ADC or TIC patterns in WT and PA images. Tissue sections were stained with CD34 to evaluate microvessel density (MVD). The TBF and MVD results were compared. The Mann-Whitney U test was used to compare the TBFs, ADCs, and MVDs of these tumors. The diagnostic accuracy was determined by analyzing the receiver operating characteristic curve.

Results

On visual assessment, the signal intensity was higher in all but three cases of WT. The TBF and MVD of the WTs were significantly higher (both, p < 0.01) than the PAs, and the ADC was significantly lower (p < 0.01). Many WTs had early enhancement of the TIC pattern and high washout; many PAs had gradual enhancement. The diagnostic accuracies of visual analysis, TBF, and ADC for differentiation between WTs and PAs were 91.3, 95.7, and 87.0%, respectively.

Conclusions

The TBF were significantly higher in WTs than in PAs, and there was a positive correlation between TBF and MVD. Moreover, pCASL-MRI provides more accurate imaging than conventional MRI to differentiate WTs and PAs.

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Abbreviations

ADC:

apparent diffusion coefficiency

ASL:

arterial spin labeling

AUC:

area under the curve

CBF:

cerebral blood flow

CNS:

central nervous system

DWI:

diffusion weighted image

EPI:

echo-planar imaging

FOV:

field of view

FSE:

fast spin-echo

MRI:

magnetic resonance imaging

MVD:

microvessel density

NEX:

number of excitation

NPV:

negative predictive value

NRI:

net reclassification improvement

PA:

pleomorphic adenoma

PASL:

pulsed ASL

pCASL:

pseudo-continuous ASL

PPV:

positive predictive value

ROC:

receiver operating characteristic

ROI:

region of interest

SNR:

signal-to-noise ratio

T1WI:

T1 weighted image

T2WI:

T2 weighted image

TBF:

tumor blood flow

TIC:

time intensity curve

TSE:

turbo spin-echo

WR:

washout ratio

WT:

Warthin tumor

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Authors and Affiliations

  1. Department of Diagnostic Radiology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan

    Tatsuya Yamamoto

  2. Department of Radiology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji-cho, Fukui, 910-1193, Japan

    Tatsuya Yamamoto & Hirohiko Kimura

  3. Division of Biostatistics and Bioinformatics, Graduate School of Public Health, St. Luke’s International University, 3-6-2 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Kuniyoshi Hayashi

  4. Division of Surgical Pathology, University of Fukui Hospital, 23-3 Matsuoka-Shimoaizuki, Eiheiji-cho, Fukui, 910-1193, Japan

    Yoshiaki Imamura & Masaki Mori

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  1. Tatsuya Yamamoto
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Correspondence to Hirohiko Kimura.

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Funding

This study was funded in part by Grants-in-Aid for Scientific Research (C) (15k09916) from the Japan Society for the Promotion of Science (HK).

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The authors declare that they have no conflict of interest.

Ethical standards

We declare that all human and animal studies have been approved by the University of Fukui Ethics Committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. For this type of study formal consent is not required.

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Yamamoto, T., Kimura, H., Hayashi, K. et al. Pseudo-continuous arterial spin labeling MR images in Warthin tumors and pleomorphic adenomas of the parotid gland: qualitative and quantitative analyses and their correlation with histopathologic and DWI and dynamic contrast enhanced MRI findings. Neuroradiology 60, 803–812 (2018). https://doi.org/10.1007/s00234-018-2046-9

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  • DOI: https://doi.org/10.1007/s00234-018-2046-9

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