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Characterization of parotid gland tumors: added value of permeability MR imaging to DWI and DCE-MRI

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Abstract

Objectives

To determine added value of permeability MRI in parotid tumor characterization to T2-weighted imaging (T2WI), semi-quantitative analysis of time-intensity curve (TIC), and intra-voxel incoherent motion diffusion-weighted imaging (IVIM-DWI).

Methods

This retrospective study was approved by the institutional review board, and the informed consent was waived. Sixty-one parotid tumors in 61 patients were examined using T2WI, IVIM-DWI, and permeability MRI. TIC patterns were categorized as persistent, washout, or plateau. Signal intensity ratio of lesion-to-muscle on T2WI, apparent diffusion coefficients (ADCs), D and f values from IVIM-DWI, and Ktrans, kep, Ve, and Vp values from permeability MRI were measured. Multiple comparisons were applied to determine whether any differences among 4 histopathologic types (pleomorphic adenomas, Warthin’s tumors, other benign tumors, and malignant tumors) existed. Diagnostic accuracy was compared before and after modification diagnosis referring to permeability MRI. In a validation study, 60 parotid tumors in 60 patients were examined.

Results

ADC and D values of malignant tumors were significantly lower than those of benign tumors other than Warthin’s tumors, but higher than those of Warthin’s tumors. kep and Vp values of Warthin’s tumors were significantly higher than those of malignant tumors. Multivariate analyses showed that TIC pattern, D, and kep values were suitable parameters. McNemar’s test showed a significant increase of sensitivity (11/12, 92%) and specificity (46/49, 94%) with adding kep. The validation study yielded high sensitivity (14/16, 88%) and specificity (41/44, 93%).

Conclusion

Permeability MRI offers added value to IVIM-MRI and semi-quantitative TIC analysis of DCE-MRI in characterization of parotid tumors

Key Points

• Permeability MR imaging offers added value in the characterization of parotid gland tumors in combination with semi-quantitative TIC analysis and IVIM analyses with D parameter.

• The combination of TIC pattern, D, and k ep might facilitate accurate characterization of parotid gland tumor, thereby avoiding unnecessary surgery for benign tumors or delayed treatment for malignant tumors.

• A combination of permeability and diffusion MR imaging can be used to guide the selection of an appropriate biopsy site.

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Abbreviations

ADC:

Apparent diffusion coefficient

AIF:

Arterial input function

ASL:

Arterial spin labeling

D :

True diffusion coefficient

DWI:

Diffusion-weighted imaging

FFE:

Fast field echo

FNA:

Fine-needle aspiration

IVIM:

Intra-voxel incoherent motion

k ep :

Rate constant from extracellular extravascular space to plasma

K trans :

Rate constant from plasma to extracellular extravascular space

MRI:

Magnetic resonance imaging

ROI:

Region of interest

SI:

Signal intensity

T2WI:

T2-weighted imaging

TIC:

Time-intensity curve

V e :

Extracellular extravascular volume fraction

V p :

Plasma fraction

WR:

Washout ratio

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Authors and Affiliations

  1. Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Hidetake Yabuuchi

  2. Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Takeshi Kamitani, Koji Sagiyama, Yuzo Yamasaki, Tomoyuki Hida, Yuko Matsuura, Takuya Hino & Yuriko Murayama

  3. Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka, 812-8582, Japan

    Ryuji Yasumatsu

  4. Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka, 812-8582, Japan

    Hidetaka Yamamoto

Authors
  1. Hidetake Yabuuchi
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  2. Takeshi Kamitani
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Correspondence to Hidetake Yabuuchi.

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The scientific guarantor of this publication is Hidetake Yabuuchi.

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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.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Informed consent was waived.

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Institutional review board approval was obtained.

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• retrospective

• diagnostic or prognostic study

• performed at one institution

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Yabuuchi, H., Kamitani, T., Sagiyama, K. et al. Characterization of parotid gland tumors: added value of permeability MR imaging to DWI and DCE-MRI. Eur Radiol 30, 6402–6412 (2020). https://doi.org/10.1007/s00330-020-07004-3

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  • DOI: https://doi.org/10.1007/s00330-020-07004-3

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