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Parotid gland tumours: MR tractography to assess contact with the facial nerve

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Abstract

Objectives

To assess the feasibility of intraparotid facial nerve (VIIn) tractographic reconstructions in estimating the presence of a contact between the VIIn and the tumour, in patients requiring surgical resection of parotid tumours.

Methods

Patients underwent MR scans with VIIn tractography calculated with the constrained spherical deconvolution model. The parameters of the diffusion sequence were: b-value of 1000 s/mm2; 32 directions; voxel size: 2 mm isotropic; scan time: 9’31’. The potential contacts between VIIn branches and tumours were estimated with different initial fractional anisotropy (iFA) cut-offs compared to surgical data. Surgeons were blinded to the tractography reconstructions and identified both nerves and contact with tumours using nerve stimulation and reference photographs.

Results

Twenty-six patients were included in this study and the mean patient age was 55.2 years. Surgical direct assessment of VIIn allowed identifying 0.1 as the iFA threshold with the best sensitivity to detect tumour contact. In all patients with successful VIIn identification by tractography, surgeons confirmed nerve courses as well as lesion location in parotid glands. Mean VIIn branch FA values were significantly lower in cases with tumour contact (t-test; p ≤ 0.01).

Conclusions

This study showed the feasibility of intraparotid VIIn tractography to identify nerve contact with parotid tumours.

Key points

• Diffusion imaging is an efficient method for highlighting the intraparotid VIIn.

• Visualization of the VIIn may help to better manage patients before surgery.

• We bring new insights to future trials for patients with VIIn dysfunction.

• We aimed to provide radio-anatomical references for further studies.

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Abbreviations

VIIn:

Facial nerve

CF:

Cervicofacial branch

TF:

Temporofacial branch

DTI:

Diffusion tensor imaging

CSD:

Constrained spherical deconvolution

FA:

Fractional anisotropy

bFFE:

Balanced fast field echo

ROI:

Region of interest

FND:

Facial nerve division

ODF:

Orientation density function

SNR:

Signal to noise ratio

SH:

Spherical harmonic

IAC:

Internal auditory canal

DW:

Diffusion-weighted imaging

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Acknowledgments

We acknowledge the valuable assistance of Patrice Jousse (Neuroradiology – Grenoble) for editing artwork and Matthieu Roustit (Clinical Research Center – Inserm CIC1406) for helping with statistics. This work was presented at the European Congress of Radiology (ECR) in 2014. The scientific guarantor of this publication is Arnaud Attyé. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional review board approval was obtained. Written informed consent was waived by the institutional review board. Methodology: prospective, diagnostic study, performed at one institution.

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Authors and Affiliations

  1. Department of Neuroradiology and MRI, Grenoble University Hospital – SFR RMN Neurosciences, Grenoble, France

    Arnaud Attyé, Adrian Kastler & Alexandre Krainik

  2. Inserm, US 17, Grenoble, France

    Arnaud Attyé, Irène Troprès, Adrian Kastler, Laurent Lamalle & Alexandre Krainik

  3. University Grenoble Alpes, IRMaGe, F-38000, Grenoble, France

    Arnaud Attyé, Irène Troprès, Adrian Kastler, Laurent Lamalle, Félix Renard & Alexandre Krainik

  4. Department of Otolaryngology-Head and Neck Surgery, University Hospital of Grenoble, Grenoble, France

    Alexandre Karkas & Christian Righini

  5. CNRS, UMS 3552, Grenoble, France

    Irène Troprès & Laurent Lamalle

  6. Department of Statistics, University Hospital of Grenoble, Grenoble, France

    Matthieu Roustit

  7. Department of Maxillofacial Surgery, University Hospital of Grenoble, Grenoble, France

    Georges Bettega

  8. Albert Bonniot Institute, Grenoble, France

    Christian Righini

  9. Neuroradiology and MR Unit, CS 10217- Grenoble University Hospital, F-38043, Grenoble, Cedex 9, France

    Arnaud Attyé

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  1. Arnaud Attyé
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  2. Alexandre Karkas
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  9. Christian Righini
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Correspondence to Arnaud Attyé.

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Attyé, A., Karkas, A., Troprès, I. et al. Parotid gland tumours: MR tractography to assess contact with the facial nerve. Eur Radiol 26, 2233–2241 (2016). https://doi.org/10.1007/s00330-015-4049-9

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  • DOI: https://doi.org/10.1007/s00330-015-4049-9

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