|
1
|
Gaudino C, Cassoni A, Pisciotti ML, Pucci R, Veneroso C, Di Gioia CRT, De Felice F, Pantano P, Valentini V. High Field MRI in Parotid Gland Tumors: A Diagnostic Algorithm. Cancers (Basel) 2024; 17:71. [PMID: 39796701 PMCID: PMC11719534 DOI: 10.3390/cancers17010071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2024] [Revised: 12/24/2024] [Accepted: 12/24/2024] [Indexed: 01/13/2025] Open
Abstract
Backgrounds: Imaging of parotid tumors is crucial for surgery planning, but it cannot distinguish malignant from benign lesions with absolute reliability. The aim of the study was to establish a diagnostic MRI algorithm to differentiate parotid tumors. Methods: A retrospective study was conducted including all patients with parotid tumors, who underwent 3T-MRI and surgery. Morphological characteristics and normalized T2 and late postcontrast T1 signal intensities (SI) were assessed. "Ghosting sign" on late postcontrast T1 sequence was defined as indistinguishability of the tumor except for a thin peripheral enhancement. Patients were divided according to histology and imaging data were compared. A diagnostic MRI algorithm was established. Results: Thirty-six patients were included. The combination of normalized late T1 postcontrast SI, normalized T2 SI and "ghosting sign" allowed for the distinguishing of malignant from benign parotid tumors with high sensitivity (100%), specificity (93%), positive predictive value (80%), negative predictive value, (100%) and accuracy (94%). Moreover, pleomorphic adenomas often showed a homogeneous T2 signal and a complete capsule (p < 0.01), Warthin tumors protein-rich cysts and calcifications (p < 0.005 and p < 0.05), and malignant tumors an inhomogeneous contrast enhancement (p < 0.01). Conclusions: High field MRI represents a promising tool in parotid tumors, allowing for an accurate differentiation of malignant and benign lesions.
Collapse
Affiliation(s)
- Chiara Gaudino
- Department of Neuroradiology, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy
| | - Andrea Cassoni
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy; (C.V.); (V.V.)
- Department of Maxillo-Facial Surgery, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy
| | - Martina Lucia Pisciotti
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00180 Rome, Italy; (M.L.P.); (C.R.T.D.G.); (F.D.F.)
| | - Resi Pucci
- Department of Maxillo-Facial Surgery, Azienda Ospedaliera San Camillo Forlanini, Circonvallazione Gianicolense 87, 00152 Rome, Italy;
| | - Chiara Veneroso
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy; (C.V.); (V.V.)
| | - Cira Rosaria Tiziana Di Gioia
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00180 Rome, Italy; (M.L.P.); (C.R.T.D.G.); (F.D.F.)
| | - Francesca De Felice
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00180 Rome, Italy; (M.L.P.); (C.R.T.D.G.); (F.D.F.)
| | - Patrizia Pantano
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell’Univeristà 30, 00185 Rome, Italy;
- IRCCS Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
| | - Valentino Valentini
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy; (C.V.); (V.V.)
- Department of Maxillo-Facial Surgery, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy
| |
Collapse
|
|
2
|
Yang J, Bi Q, Jin Y, Yang Y, Du J, Zhang H, Wu K. Different MRI-based radiomics models for differentiating misdiagnosed or ambiguous pleomorphic adenoma and Warthin tumor of the parotid gland: a multicenter study. Front Oncol 2024; 14:1392343. [PMID: 38939335 PMCID: PMC11208325 DOI: 10.3389/fonc.2024.1392343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 05/28/2024] [Indexed: 06/29/2024] Open
Abstract
PURPOSE To evaluate the effectiveness of MRI-based radiomics models in distinguishing between Warthin tumors (WT) and misdiagnosed or ambiguous pleomorphic adenoma (PA). METHODS Data of patients with PA and WT from two centers were collected. MR images were used to extract radiomic features. The optimal radiomics model was found by running nine machine learning algorithms after feature reduction and selection. To create a clinical model, univariate logistic regression (LR) analysis and multivariate LR were used. The independent clinical predictors and radiomics were combined to create a nomogram. Two integrated models were constructed by the ensemble and stacking algorithms respectively based on the clinical model and the optimal radiomics model. The models' performance was evaluated using the area under the curve (AUC). RESULTS There were 149 patients included in all. Gender, age, and smoking of patients were independent clinical predictors. With the greatest average AUC (0.896) and accuracy (0.839) in validation groups, the LR model was the optimal radiomics model. In the average validation group, the radiomics model based on LR did not have a higher AUC (0.795) than the clinical model (AUC = 0.909). The nomogram (AUC = 0.953) outperformed the radiomics model in terms of discrimination performance. The nomogram in the average validation group had a highest AUC than the stacking model (0.914) or ensemble model (0.798). CONCLUSION Misdiagnosed or ambiguous PA and WT can be non-invasively distinguished using MRI-based radiomics models. The nomogram exhibited excellent and stable diagnostic performance. In daily work, it is necessary to combine with clinical parameters for distinguishing between PA and WT.
Collapse
Affiliation(s)
- Jing Yang
- Department of MRI, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Qiu Bi
- Department of MRI, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Yiren Jin
- Department of Radiation, The Cancer Hospital of Yunnan Province, The Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Yong Yang
- Department of MRI, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Ji Du
- Department of MRI, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Hongjiang Zhang
- Department of MRI, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Kunhua Wu
- Department of MRI, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
| |
Collapse
|
|
3
|
Friedman E, Cai Y, Chen B. Imaging of Major Salivary Gland Lesions and Disease. Oral Maxillofac Surg Clin North Am 2023:S1042-3699(23)00009-2. [PMID: 37032181 DOI: 10.1016/j.coms.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
Infectious and inflammatory disorders are the commonest pathologies to affect the major salivary glands however frequently overlap in clinical presentation. Imaging plays an important role in diagnosis, usually initially performed by CT or ultrasound. MRI, with its superior soft-tissue characterization compared with CT, provides a better evaluation of tumors and tumor-like conditions. Imaging features may suggest that a mass is more likely to be benign versus malignant, however, biopsy is often needed to establish a definitive histopathologic diagnosis. Imaging plays a key role in the staging of neoplastic disease.
Collapse
Affiliation(s)
- Elliott Friedman
- Department of Radiology, Houston Methodist Hospital, 6565 Fannin Street, Houston, TX 77030, USA.
| | - Yu Cai
- Ascension Seton Medical Center Austin, 1201 West 38th Street, Austin, TX 78705, USA
| | - Bo Chen
- Department of Diagnostic and Interventional Radiology, McGovern Medical School at the University of Texas HSC Houston, 6431 Fannin Street, MSB 2.130B, Houston, TX 77030, USA
| |
Collapse
|
|
4
|
The Value of Multiparametric Magnetic Resonance Imaging in the Preoperative Differential Diagnosis of Parotid Gland Tumors. Cancers (Basel) 2023; 15:cancers15041325. [PMID: 36831666 PMCID: PMC9954501 DOI: 10.3390/cancers15041325] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/09/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND The aim of the present study was to determine the value of multiparametric MRI in the preoperative differential diagnosis of parotid tumors, which is essential for therapeutic strategy selection. METHODS A three-year prospective study was conducted with 65 patients. Each patient was investigated preoperatively with multiparametric MRI and surgical excision of the tumor was performed. The preoperative imaging diagnosis was compared with the histopathological report. Several MRI parameters were analyzed, including T1 and T2 weighted image (WI), apparent diffusion coefficient (ADC), time to peak (TTP), and the time intensity curve (TIC). RESULTS In the differential diagnosis of benign from malignant tumors, T2WI and ADC showed statistically significant differences. Multiparametric MRI had a sensitivity, specificity, and accuracy of 81.8%, 88.6% and 92.3%, respectively. All of the studied parameters (T1, T2, TIC, TTP, ADC) were significantly different in the comparison between pleomorphic adenomas and Warthin tumors. With reference to the scope of this study, the conjunction of multiparametric and conventional MRI demonstrated a sensitivity, specificity, and accuracy of 94.1%, 100%, and 97.8%, respectively. CONCLUSIONS Morphological analysis using conventional MRI combined with diffusion-weighted imaging (DW) and dynamic contrast-enhanced (DCE) multiparametric MRI improved the preoperative differential diagnosis of parotid gland tumors.
Collapse
|
|
5
|
Gökçe E, Beyhan M. Advanced magnetic resonance imaging findings in salivary gland tumors. World J Radiol 2022; 14:256-271. [PMID: 36160835 PMCID: PMC9453317 DOI: 10.4329/wjr.v14.i8.256] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/22/2022] [Accepted: 08/07/2022] [Indexed: 02/08/2023] Open
Abstract
Salivary gland tumors (SGTs) make up a small portion (approximately 5%) of all head and neck tumors. Most of them are located in the parotid glands, while they are less frequently located in the submandibular glands, minor salivary glands or sublingual gland. The incidence of malignant or benign tumors (BTs) in the salivary glands varies according to the salivary gland from which they originate. While most of those detected in the parotid gland tend to be benign, the incidence of malignancy increases in other glands. The use of magnetic resonance imaging (MRI) in the diagnosis of SGTs is increasing every day. While conventional sequences provide sufficient data on the presence, localization, extent and number of the tumor, they are insufficient for tumor specification. With the widespread use of advanced techniques such as diffusion-weighted imaging, semi-quantitative and quantitative perfusion MRI, studies and data have been published on the differentiation of malignant or BTs and the specificity of their subtypes. With diffusion MRI, differentiation can be made by utilizing the cellularity and microstructural properties of tumors. For example, SGTs such as high cellular Warthin’s tumor (WT) or lymphoma on diffusion MRI have been reported to have significantly lower apparent diffusion values than other tumors. Contrast agent uptake and wash-out levels of tumors can be detected with semi-quantitative perfusion MRI. For example, it is reported that almost all of the pleomorphic adenomas show an increasing enhancement time intensity curve and do not wash-out. On quantitative perfusion MRI studies using perfusion parameters such as Ktrans, Kep, and Ve, it is reported that WTs can show higher Kep and lower Ve values than other tumors. In this study, the contribution of advanced MRI to the diagnosis and differential diagnosis of SGTs will be reviewed.
Collapse
Affiliation(s)
- Erkan Gökçe
- Department of Radiology, Faculty of Medicine, Tokat Gaziosmanpasa University, Tokat 60100, Turkey
| | - Murat Beyhan
- Department of Radiology, Faculty of Medicine, Tokat Gaziosmanpasa University, Tokat 60100, Turkey
| |
Collapse
|
|
6
|
Abstract
Neoplasms of the salivary glands are characterized by their marked histologic diversity giving them nonspecific imaging findings. MR imaging is the best imaging modality to evaluate salivary gland tumors. Multiparametric MR imaging combines conventional imaging features, diffusion-weighted imaging, and perfusion imaging to help distinguish benign and low-grade neoplasms from malignant tumors; however, a biopsy is often needed to establish a definitive histopathologic diagnosis. An awareness of potential imaging pitfalls is important to prevent mistakes in salivary neoplasm imaging.
Collapse
Affiliation(s)
- Elliott Friedman
- Department of Neuroradiology, University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 2.130B, Houston, TX 77030, USA.
| | - Maria Olga Patino
- Department of Neuroradiology, University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 2.130B, Houston, TX 77030, USA
| | | |
Collapse
|
|
7
|
Value of dynamic contrast enhanced MRI in differential diagnostics of Warthin tumors and parotid malignancies. Sci Rep 2021; 11:16282. [PMID: 34381113 PMCID: PMC8357791 DOI: 10.1038/s41598-021-95820-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/29/2021] [Indexed: 11/09/2022] Open
Abstract
To define an algorithm for differential diagnostics of parotid malignancies and Warthin tumors (WTs) based on dynamic contrast enhanced MRI (DCE-MRI). 55 patients with parotid tumors treated surgically were analyzed. Of which, 19 had parotid malignancy and 36 had WTs confirmed with postoperative histopathological examination. Accuracy of DCE-MRI parameters (Tpeak and WR) was compared with the histopathological diagnosis. ROC analysis was performed to determine sensitivity and specificity of DCE-MRI with various Tpeak and WR cut-off values. WT showed significantly lower median Tpeak and higher median WR than malignant lesions. The cut-off values for Tpeak and WR providing maximum sensitivity (84.2%) and specificity (86.1%) for malignant tumors were Tpeak > 60 s and WR ≤ 30%. Different diagnostic algorithm, i.e., lower cut-off value for Tpeak (Tpeak = 60 s), increases sensitivity of DCE-MRI in differentiating parotid malignancies from WTs. However, WR > 30% seems to be a key diagnostic criterion for benign lesions. Precise and reliable preoperative diagnostics of parotid tumors aids in careful surgical planning, thereby assisting in achieving sufficient surgical resection margins and facial nerve preservation.
Collapse
|
|
8
|
Coudert H, Mirafzal S, Dissard A, Boyer L, Montoriol PF. Multiparametric magnetic resonance imaging of parotid tumors: A systematic review. Diagn Interv Imaging 2021; 102:121-130. [PMID: 32943368 DOI: 10.1016/j.diii.2020.08.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 08/05/2020] [Accepted: 08/11/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE The purpose of this systematic review was to provide an overview of the contribution of multiparametric magnetic resonance imaging (MRI) in the diagnosis of parotid tumors (PT) and recommendations based on current evidences. MATERIAL AND METHODS We performed a retrospective systematic search of PubMed, EMBASE, and Cochrane Library databases from inception to January 2020, using the keywords "magnetic resonance imaging" and "salivary gland neoplasms". RESULTS The initial search returned 2345 references and 90 were deemed relevant for this study. A total of 54 studies (60%) reported the use of diffusion-weighted imaging (DWI) and 28 studies (31%) the use of dynamic contrast-enhanced (DCE) imaging. Specific morphologic signs of frequent benign PT and suggestive signs of malignancy on conventional sequences were reported in 37 studies (41%). DWI showed significant differences in apparent diffusion coefficient (ADC) values between benign and malignant PT, and especially between pleomorphic adenomas and malignant PT, with cut-off ADC values between 1.267×10-3mm2/s and 1.60×10-3mm2/s. Perfusion curves obtained with DCE imaging allowed differentiating among pleomorphic adenomas, Warthin's tumors, malignant PT and cystic lesions. The combination of morphological MRI sequences, DCE imaging and DWI helped increase the diagnostic accuracy of MRI. CONCLUSION Multiparametric MRI, including morphological MRI sequences, DWI and DCE imaging, is the imaging modality of choice for the characterization of focal PT and provides features that are highly suggestive of a specific diagnosis.
Collapse
Affiliation(s)
- H Coudert
- Department of Neuroradiology, University Hospital Gabriel-Montpied, 63000 Clermont-Ferrand, France.
| | - S Mirafzal
- Department of Neuroradiology, University Hospital Gabriel-Montpied, 63000 Clermont-Ferrand, France
| | - A Dissard
- Department of Otolaryngology and Head and Neck Surgery, University Hospital Gabriel-Montpied, 63000 Clermont-Ferrand, France
| | - L Boyer
- Department of Vascular Radiology, University Hospital Gabriel-Montpied, UMR Auvergne CNRS 6284, 63000 Clermont-Ferrand, France
| | - P-F Montoriol
- Department of Radiology, Centre Jean-Perrin, 63000 Clermont-Ferrand, France
| |
Collapse
|
|
9
|
Karaman CZ, Tanyeri A, Özgür R, Öztürk VS. Parotid gland tumors: comparison of conventional and diffusion-weighted MRI findings with histopathological results. Dentomaxillofac Radiol 2020; 50:20200391. [PMID: 33237812 DOI: 10.1259/dmfr.20200391] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES The aim of this study was to investigate the relationship between pathological classification of parotid gland tumors and conventional MRI - diffusion-weighted imaging findings and also contribute the possible effect of apparent diffusion coefficient (ADC) to diagnosis. METHODS 60 patients with parotid masses diagnosed using histopathology and/or cytology were enrolled in this retrospective study. All patients were evaluated using a 1.5 T MRI. Demographic features, conventional MRI findings, and ADC values (mean, minimum, maximum, and relative) were recorded. MRI findings and ADC values were compared between benign-malignant groups and pleomorphic adenoma vs Warthin's tumor groups. RESULTS 60 tumors (48 benign, 12 malignant) were evaluated in a total of 60 patients (39 males, 21 females). The mean age was 59 (±14, 18-86) years old; the mean lesion size was 26 (±10, 11-61) mm. On the texture of conventional MRI, T2 dominantly hyperintense/with hypointensity signal was seen in 87% of pleomorphic adenomas and T2 dominantly hypointense/with hyperintesity signal was encountered in 64% of all Warthin's tumors. Seven (28%) Warthin's tumors were misdiagnosed as pleomorphic adenomas and two others (8%) as malignant tumors. The commonly used mean ADC value was 1.6 ± 0.6 × 10-3 mm2 s-1 for benign tumors, 0.8 ± 0.3 × 10-3 mm2 s-1 for malign tumors, 1 (0.9-1.8) × 10-3 mm2 s-1 for Warthin's tumors, and 1.9 ± 0.3 × 10-3 mm2 s-1 for pleomorphic adenomas. There was a statistically significant difference in ADC values between benign-malignant tumors and pleomorphic adenomas-Warthin's tumors. CONCLUSIONS Warthin's tumor may occasionally be misdiagnosed as pleomorphic adenoma and malignant tumor because of variable morphologic features. In addition to benign-malignant differentiation, the added ADC measurement may also be useful for differentiating Warthin's tumors from pleomorphic adenomas.
Collapse
Affiliation(s)
- Can Zafer Karaman
- Department of Radiology, Aydın Adnan Menderes University School of Medicine, Aydın, Turkey
| | - Ahmet Tanyeri
- Department of Radiology, Aydın Adnan Menderes University School of Medicine, Aydın, Turkey.,Department of Radiology, Yozgat City Hospital, Yozgat, Turkey
| | - Recep Özgür
- Department of Radiology, Aydın Adnan Menderes University School of Medicine, Aydın, Turkey.,Department of Radiology, Devrek State Hospital, Zonguldak, Turkey
| | - Veli Süha Öztürk
- Department of Radiology, Aydın Adnan Menderes University School of Medicine, Aydın, Turkey.,Department of Radiology, Salihli State Hospital, Manisa, Turkey
| |
Collapse
|
|
10
|
Mikaszewski B, Markiet K, Smugała A, Stodulski D, Szurowska E, Stankiewicz C. Clinical and demographic data improve diagnostic accuracy of dynamic contrast-enhanced and diffusion-weighted MRI in differential diagnostics of parotid gland tumors. Oral Oncol 2020; 111:104932. [PMID: 32739792 DOI: 10.1016/j.oraloncology.2020.104932] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 07/23/2020] [Accepted: 07/24/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To verify if differential diagnostic algorithms based on selected parameters of dynamic and diffusion-weighted MRI, clinical and demographic variables are accurate enough to differentiate between parotid malignancies, pleomorphic adenomas and Warthin tumors. MATERIALS AND METHODS The study included 84 patients, among them 19 (23%) with postoperative diagnosis of a parotid malignancy, 37 (44%) with Warthin tumors and 28 (33%) with pleomorphic adenomas. Accuracy of dynamic and diffusion-weighted MRI parameters (Tpeak, Tmax, WR and ADC), clinical parameters of the tumor (location in the superficial or deep parotid lobe, single vs. multiple lesion, concomitant lymphadenopathy) and demographic characteristics of the patient (age, sex) was determined on ROC analysis. RESULTS Compared to Warthin tumors, parotid malignancies showed higher Tpeak, Tmax and ADC, lower WR, were more often located in the deep lobe of the parotid and presented as single lesions with concomitant lymphadenopathy. Consideration of all these variables provided 100% sensitivity and 89.2% specificity of the differential diagnostic algorithm. Compared to pleomorphic adenomas, parotid malignancies presented with lower ADC and Tpeak, higher Tmax, were more often located in the deep lobe of the parotid, associated with concomitant lymphadenopathy, diagnosed in men and individuals older than 66 years. Consideration of all these variables provided 100% sensitivity and 96.4% specificity of the differential diagnostic algorithm. CONCLUSION Combined analysis of clinical data and results of dynamic and diffusion-weighted MRI may provide nearly ideal accuracy in differential diagnostics of parotid malignancies and the two most common histological types of benign tumors.
Collapse
Affiliation(s)
- Bogusław Mikaszewski
- Department of Otolaryngology, Medical University of Gdansk, 7 Dębinki St., 80-952 Gdansk, Poland.
| | - Karolina Markiet
- Second Department of Radiology, Medical University of Gdansk, 7 Dębinki St., 80-952 Gdansk, Poland
| | - Aneta Smugała
- Department of Radiology, University Clinical Center, 17 Smoluchowskiego St., 80-214 Gdansk, Poland
| | - Dominik Stodulski
- Department of Otolaryngology, Medical University of Gdansk, 7 Dębinki St., 80-952 Gdansk, Poland
| | - Edyta Szurowska
- Second Department of Radiology, Medical University of Gdansk, 7 Dębinki St., 80-952 Gdansk, Poland
| | - Czesław Stankiewicz
- Department of Otolaryngology, Medical University of Gdansk, 7 Dębinki St., 80-952 Gdansk, Poland
| |
Collapse
|
|
11
|
Simone M, Vesperini E, Viti C, Camaioni A, Lepanto L, Raso F. Intraparotid facial nerve schwannoma: two case reports and a review of the literature. ACTA OTORHINOLARYNGOLOGICA ITALICA 2019; 38:73-77. [PMID: 29756618 DOI: 10.14639/0392-100x-1170] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 10/22/2016] [Indexed: 11/23/2022]
Abstract
SUMMARY Schwannomas are rare benign tumours that arise from Schwann cells. The most known and studied is the intracranial vestibular schwannoma, even if it is not the most frequent. More often schwannomas arise from peripheral sensitive nerves, and the vagous is most involved among the cranial nerves. Intraparotid schwannomas account for just 10% of all facial involvement, so they are an extremely rare localisation. At present, there are less than 100 cases described in the literature. We performed a retrospective analysis of parotidectomy in two Italian hospitals and present two cases of intraparotid schwannoma and a review of the literature. In the first case, we performed a parotidectomy with a stripping of tumour from the nerve. In the other case, a hypoglossal-facial neurorrhaphy was performed. Follow-up was 24 months in the first (House-Brackmann II degree in temporal-ocular and III in facial-cervical branches) and 30 months in the second case (House-Brackmann III degree in both temporal-ocular and facial-cervical branches). Preoperative diagnosis of facial nerve schwannoma is a challenge; however, it is extremely important since post-operative palsy is common and often higher grade. Unfortunately, schwannoma has similar radiologic finding as more common pleomorphic adenoma and often FNAC is not helpful. Due to its rarity and benign nature, there is debate in the literature on the need for surgical removal. Wait-and-see is a valid option, but may could give problems in secondary surgery. Stripping or near-total removal can be useful in cases of limited involvement of the nerve. Neurorrhaphy can provide good functional results when facial sacrifice is needed.
Collapse
Affiliation(s)
- M Simone
- Department of Otorhinolaryngology, Head and Neck Surgery, San Giovanni Addolorata Hospital, Roma, Italy
| | - E Vesperini
- Department of Otorhinolaryngology, Head and Neck Surgery, San Giovanni Addolorata Hospital, Roma, Italy
| | - C Viti
- Department of Otorhinolaryngology, Head and Neck Surgery, San Giovanni Addolorata Hospital, Roma, Italy
| | - A Camaioni
- Department of Otorhinolaryngology, Head and Neck Surgery, San Giovanni Addolorata Hospital, Roma, Italy
| | - L Lepanto
- Department of Otorhinolaryngology, Head and Neck Surgery, Garibaldi Hospital, Palermo, Italy
| | - F Raso
- Department of Otorhinolaryngology, Head and Neck Surgery, Garibaldi Hospital, Palermo, Italy
| |
Collapse
|
|
12
|
Shimizu M, Weerawanich W. Sonographic diagnosis in the head and neck region: from an educational lecture presented at the 56th General Assembly and Annual Scientific Congress of the Japanese Society for Oral and Maxillofacial Radiology. Oral Radiol 2018; 35:101-126. [PMID: 30484212 DOI: 10.1007/s11282-018-0353-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 09/28/2018] [Indexed: 01/15/2023]
Abstract
Sonography is a simple, inexpensive, and non-invasive diagnostic modality. Although tissues behind bony structures and deep tissues are not delineated, sonography can depict superficial soft tissues very clearly. In the head and neck region, however, it has not yet been used widely, as the anatomical structures are complicated, and considerable experience is needed both to perform an examination and to make a diagnosis. To perform examinations efficiently, operators must be familiar with the sonographic system in use, and take images at standard planes. To make a correct diagnosis, operators require knowledge of the sonographic anatomy on standard planes, representative sonographic signs and artifacts, and common diseases and their typical sonographic findings. In this paper, we have explained the sonographic anatomy on standard planes, and the sonographic findings of common diseases in the oral and maxillofacial region.
Collapse
Affiliation(s)
- Mayumi Shimizu
- Department of Oral and Maxillofacial Radiology, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Warangkana Weerawanich
- Department of Oral and Maxillofacial Radiology, Faculty of Dental Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Mahidol University, 6 Yothi Road, Ratchathewi District, Bangkok, 10400, Thailand
| |
Collapse
|
|
13
|
Zhang W, Zuo Z, Huang X, Jin G, Su D. Value of Diffusion-Weighted Imaging Combined with Susceptibility-Weighted Imaging in Differentiating Benign from Malignant Parotid Gland Lesions. Med Sci Monit 2018; 24:4610-4616. [PMID: 29972148 PMCID: PMC6064192 DOI: 10.12659/msm.911185] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the diagnostic value of diffusion-weighted imaging (DWI) in combination with susceptibility-weighted imaging (SWI) for differentiating benign parotid gland lesions from malignant ones. MATERIAL AND METHODS This retrospective study was approved by the Ethics Committee of our hospital. A total of 36 patients (26 benign cases and 10 malignant cases) were confirmed by surgical pathology. The apparent diffusion coefficient (ADC), normalized ADC (ADCNormalized), intratumoral susceptibility signals (ITSS), and morphological characteristics were analyzed with SPSS 19.0 software. RESULTS The mean ADC values of parotid gland lesions was not different between malignant and benign lesions (P=0.07), while the differences between ADCNormalized (P=0.026) and ITSS grading (P=0.014) were statistically significant. Logistic regression analysis identified use of ADCNormalized and ITSS as the only independent predictor of malignant lesions (odds ratio 0.038; 95% confidence interval 0.001~0.988; P=0.011) and (odds ratio 4.867; 95% confidence interval 1.442~16.423; P=0.049), respectively. The optimum threshold of the ADCNormalized values was -0.45%, ITSS grade was 2, the corresponding areas under the receiver operating characteristic curve (AUC) were 0.750 and 0.787 respectively, and the combination of the 2 was 0.846. CONCLUSIONS DWI integrated with SWI can significantly improve the diagnostic efficacy in distinguishing benign from malignant parotid lesions.
Collapse
Affiliation(s)
- Wei Zhang
- Department of Radiology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Zhichao Zuo
- Department of Radiology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Xiangyang Huang
- Department of Radiology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Guanqiao Jin
- Department of Radiology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Danke Su
- Department of Radiology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| |
Collapse
|
|
14
|
Kato H, Kawaguchi M, Ando T, Mizuta K, Aoki M, Matsuo M. Pleomorphic adenoma of salivary glands: common and uncommon CT and MR imaging features. Jpn J Radiol 2018; 36:463-471. [PMID: 29845358 DOI: 10.1007/s11604-018-0747-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 05/22/2018] [Indexed: 01/05/2023]
Abstract
Pleomorphic adenoma (PA) is the most common salivary gland tumor and is characterized by cytomorphological and architectural diversity. On CT and MR images, PAs are shown as well-defined lesions occasionally accompanied by characteristic lobulated contours. On T2-weighted images, typical PAs show marked hyperintensity, which reflects the abundant myxochondroid stroma, with a hypointense rim indicating the fibrous capsule. However, intratumoral signal intensity varies according to the cellular density, proportion of epithelial and stromal components, and type of stromal components. In addition, a variety of secondary histological changes, including fibrosis, lipometaplasia, ossification, cystic degeneration, and infarction, occur rarely in PAs; therefore, they are associated with difficulty in differential diagnosis from other salivary gland tumors. This review article describes the common and uncommon CT and MR imaging features of PA of the salivary glands.
Collapse
Affiliation(s)
- Hiroki Kato
- Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan.
| | - Masaya Kawaguchi
- Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Tomohiro Ando
- Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Keisuke Mizuta
- Department of Otolaryngology, Gifu University School of Medicine, Gifu, Japan
| | - Mitsuhiro Aoki
- Department of Otolaryngology, Gifu University School of Medicine, Gifu, Japan
| | - Masayuki Matsuo
- Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| |
Collapse
|
|
15
|
Ginat DT. Imaging of Benign Neoplastic and Nonneoplastic Salivary Gland Tumors. Neuroimaging Clin N Am 2018; 28:159-169. [DOI: 10.1016/j.nic.2018.01.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
|
16
|
Matsusue E, Fujihara Y, Matsuda E, Tokuyasu Y, Nakamoto S, Nakamura K, Ogawa T. Vanishing Parotid Tumors on MR Imaging. Yonago Acta Med 2018. [PMID: 29599620 DOI: 10.33160/yam.2018.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background Of all parotid gland tumors, only oncocytoma has been reported to appear isointense to the parotid gland, namely vanishing, on fat-saturated T2 and T1 postcontrast gadolinium-enhanced magnetic resonance imaging (MRI). The purpose of this study was to evaluate vanishing of parotid tumors on conventional MRI with and/or without postcontrast gadolinium-enhancement and on diffusion weighted imaging (DWI). Methods In 8 of 51 patients, ten parotid gland tumors had homogeneously enhanced lesions and were retrospectively analysed. Comparisons of signal intensity between those parotid tumors and parotid glands and evaluations of vanishing were performed on T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), fat-suppressed T2WI (FS-T2WI), postcontrast gadolinium-enhanced T1WI (CE-T1WI) and fat-suppressed CE-T1WI (FS-CE-T1WI), DWI as well as apparent diffusion coefficient (ADC). Results Ten parotid gland tumors consisted of five Warthin tumors, two pleomorphic adenomas, two parotid carcinomas (small cell carcinoma and adenoid cystic carcinoma) and one oncocytoma. All tumors showed hypointensity on T1WI and hyperintensity on DWI. Nine of ten tumors showed vanishing on the other MR sequences. All Warthin tumors showed vanishing on FS-T2WI, FS-CE-T1WI and the ADC map. One oncocytoma showed vanishing on FS-T2WI and the ADC map and hyperintensity on FS-CE-T1WI. All pleomorphic adenomas showed vanishing on T2WI and CE-T1WI. One adenoid cystic carcinoma showed vanishing only on CE-T1WI. Conclusion Vanishing of parotid tumors can be observed not only on FS-T2WI and FS-CE-T1WI but also on T2WI, CE-T1WI and ADC mapping.
Collapse
Affiliation(s)
- Eiji Matsusue
- Department of Radiology, Tottori Prefectural Central Hospital, Tottori 680-0901, Japan
| | - Yoshio Fujihara
- Department of Radiology, Tottori Prefectural Central Hospital, Tottori 680-0901, Japan
| | - Eiken Matsuda
- †Department of Otorhinolaryngology, Tottori Prefectural Central Hospital, Tottori 680-0901, Japan
| | - Yusuke Tokuyasu
- ‡Department of Pathology, Tottori Prefectural Central Hospital, Tottori 680-0901, Japan
| | - Shu Nakamoto
- ‡Department of Pathology, Tottori Prefectural Central Hospital, Tottori 680-0901, Japan
| | - Kazuhiko Nakamura
- Department of Radiology, Tottori Prefectural Central Hospital, Tottori 680-0901, Japan
| | - Toshihide Ogawa
- §Division of Radiology, Department of Pathophysiological and Therapeutic Science, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
| |
Collapse
|
|
17
|
Matsusue E, Fujihara Y, Matsuda E, Tokuyasu Y, Nakamoto S, Nakamura K, Ogawa T. Differentiating parotid tumors by quantitative signal intensity evaluation on MR imaging. Clin Imaging 2017; 46:37-43. [DOI: 10.1016/j.clinimag.2017.06.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 06/19/2017] [Accepted: 06/28/2017] [Indexed: 12/25/2022]
|
|
18
|
Mikaszewski B, Markiet K, Smugała A, Stodulski D, Szurowska E, Stankiewicz C. Diffusion- and Perfusion-Weighted Magnetic Resonance Imaging—An Alternative to Fine Needle Biopsy or Only an Adjunct Test in Preoperative Differential Diagnostics of Malignant and Benign Parotid Tumors? J Oral Maxillofac Surg 2017; 75:2248-2253. [DOI: 10.1016/j.joms.2017.03.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 02/14/2017] [Accepted: 03/10/2017] [Indexed: 01/05/2023]
|
|
19
|
Diffusion-weighted MRI in the differential diagnosis of parotid malignancies and pleomorphic adenomas: can the accuracy of dynamic MRI be enhanced? Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 124:95-103. [DOI: 10.1016/j.oooo.2017.03.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 02/27/2017] [Accepted: 03/04/2017] [Indexed: 12/15/2022]
|
|
20
|
Mikaszewski B, Markiet K, Smugała A, Stodulski D, Szurowska E, Stankiewicz C. Parotid malignancies are not homogenous in terms of their presentation on dynamic MRI - a preliminary report. Acta Otolaryngol 2017; 137:215-220. [PMID: 27627686 DOI: 10.1080/00016489.2016.1225317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
CONCLUSION At least two groups of parotid malignancies exist, including one whose parameters of dynamic MRI closely resemble those of pleomorphic adenomas. Also tumors with long time to peak enhancement after administration of a contrast agent (Tpeak) and low washout rate (WR) should be considered malignant, especially single masses with concomitant lymphadenopathy located within the deep parotid lobe. OBJECTIVE To verify if malignant tumors of the parotid are homogeneous in terms of parameters of preoperative dynamic MRI: Tpeak and WR. METHODS The retrospective analysis included 221 surgical patients with parotid tumors. Aside from fine needle biopsy, pre-operative examination included dynamic and diffusion-weighted MRI. Final diagnosis was based on histopathological examination of the surgical specimen. RESULTS Twenty-four of 221 (10.8%) malignant lesions were identified. Using k-means clustering based on Tpeak and WR values, two distinct clusters of parotid malignancies were identified. The cut-off value for Tpeak optimally differentiating between the clusters was 140 s; the cut-off value for WR could not be identified. The two clusters did not differ in terms of dynamic and diffusion-weighted MRI parameters, patient age, sex and prevalence of lymphadenopathy. Significant inter-cluster differences were found in the prevalence of deep parotid lobe involvement and presence of a single mass.
Collapse
Affiliation(s)
| | - Karolina Markiet
- 2nd Department of Radiology, Medical University of Gdańsk, Poland
| | - Aneta Smugała
- Department of Radiology, University Clinical Center, Gdańsk, Poland
| | | | - Edyta Szurowska
- 2nd Department of Radiology, Medical University of Gdańsk, Poland
| | | |
Collapse
|
|
21
|
Imaging of palatal lumps. Clin Radiol 2017; 72:97-107. [DOI: 10.1016/j.crad.2016.10.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 10/05/2016] [Accepted: 10/11/2016] [Indexed: 12/30/2022]
|
|
22
|
Watanabe A, Andrew NH, Ueda K, Kinoshita S, Katori N, Reid M, Pirbhai A, Selva D. Clinico-radiological features of primary lacrimal gland pleomorphic adenoma: an analysis of 37 cases. Jpn J Ophthalmol 2016; 60:286-93. [DOI: 10.1007/s10384-016-0451-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 04/13/2016] [Indexed: 12/22/2022]
|
|
23
|
Findings of parotid basal cell adenoma on magnetic resonance imaging. Oral Radiol 2015. [DOI: 10.1007/s11282-015-0209-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
|
24
|
Zaghi S, Hendizadeh L, Hung T, Farahvar S, Abemayor E, Sepahdari AR. MRI criteria for the diagnosis of pleomorphic adenoma: a validation study. Am J Otolaryngol 2014; 35:713-8. [PMID: 25128908 DOI: 10.1016/j.amjoto.2014.07.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Accepted: 07/18/2014] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To validate an MRI algorithm characteristic of pleomorphic adenoma (PA). STUDY DESIGN Cross-sectional analysis. SETTING Academic tertiary-care medical center. METHODS A radiologic algorithm for the MRI diagnosis of PA was developed on the basis of five "high probability" criteria that all must be fulfilled for the MRI to qualify as a positive test result: bright T2-signal, sharp margins, heterogeneous nodular enhancement, lobulated contours, T2-dark rim. We then identified MRI images from our institutional database to test the diagnostic accuracy of the proposed algorithm. RESULTS A total of 103 parotidectomy cases with adequate MRI studies were identified (pleomorphic adenoma n=41, mucoepidermoid carcinoma n=11, Warthin's tumor n=8, adenoid cystic carcinoma n=6, oncocytoma n=6, acinic cell carcinoma n=5, salivary duct carcinoma n=5, and other n=21). Eighteen of 21 cases that met all five "high probability" MRI criteria were consistent with PA on final histopathology; 3 were consistent with carcinoma. MRI had a specificity of 95.1% [95% confidence interval: 85.6-98.7%] and sensitivity of 43.9% [95% C.I.: 28.8-60.1%] for PA. The positive predictive value was 85.7% [95% C.I.: 70.4-100%] and the negative predictive value was 71.9% [95% C. I.: 62.0-81.9%]. The overall diagnostic accuracy was 74.8% [95% C.I.: 66.2-83.3%]. CONCLUSION A "high probability" MRI is about 95% specific for pleomorphic adenoma. A subset of patients with MRI imaging that is highly suggestive of PA may reliably avoid further workup. The value of MRI in this setting is especially useful if preoperative fine needle aspiration is not readily available. A significant proportion of PAs, however, have indeterminate imaging features that overlap considerably with other benign and malignant lesions.
Collapse
Affiliation(s)
- Soroush Zaghi
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | - Leenoy Hendizadeh
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Tony Hung
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Salar Farahvar
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Elliot Abemayor
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Ali R Sepahdari
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| |
Collapse
|
|
25
|
Tsegga TM, Britt JD, Ellwanger AR. Pleomorphic adenoma of the accessory parotid gland: case report and reappraisal of intraoral extracapsular dissection for management. J Oral Maxillofac Surg 2014; 73:564-70. [PMID: 25530278 DOI: 10.1016/j.joms.2014.09.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 09/22/2014] [Accepted: 09/23/2014] [Indexed: 11/30/2022]
Abstract
Pleomorphic adenoma is the most common tumor of the major and minor salivary glands. Rarely is it found evolving from an ectopic location of major salivary glandular tissue in the mid cheek. A healthy 56-year-old woman presented to our institution with a 20-year duration of a slowly growing right cheek soft tissue mass that was causing facial asymmetry. No significant functional or neurosensory dysfunction was appreciated. Radiologic examination showed a heterogeneous, hyperintense, well-delineated mass within the region of the right buccal fat pad. Fine-needle aspiration biopsy showed benign salivary gland elements consistent with pleomorphic adenoma. The decision was made to perform intraoral extracapsular dissection for removal. Discussion of the clinical assessment and magnetic resonance imaging evaluation with an emphasis on intraoral extracapsular dissection for definitive surgical therapy of longstanding benign salivary gland tumors is emphasized.
Collapse
Affiliation(s)
- Tibebu M Tsegga
- Attending, Oral and Maxillofacial Department, San Antonio Military Medical Center, San Antonio, TX.
| | - Jennifer D Britt
- Attending, Oral and Maxillofacial Pathology Department, San Antonio Military Medical Center, San Antonio, TX
| | - Aragon R Ellwanger
- Resident, Oral and Maxillofacial Department, San Antonio Military Medical Center, San Antonio, TX
| |
Collapse
|
|
26
|
Werner RL, Castle JT. Recurrent pleomorphic adenoma. Head Neck Pathol 2013; 8:303-6. [PMID: 24197723 PMCID: PMC4126920 DOI: 10.1007/s12105-013-0504-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 10/23/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Rachel L. Werner
- Department of Oral and Maxillofacial Pathology, Naval Postgraduate Dental School, Bethesda, MD 20889 USA
| | - James T. Castle
- Department of Anatomic Pathology, Naval Medical Center Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA 23704 USA
| |
Collapse
|
|
27
|
Heaton CM, Chazen JL, van Zante A, Glastonbury CM, Kezirian EJ, Eisele DW. Pleomorphic adenoma of the major salivary glands: Diagnostic utility of FNAB and MRI. Laryngoscope 2013; 123:3056-60. [DOI: 10.1002/lary.24247] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Revised: 05/02/2013] [Accepted: 05/06/2013] [Indexed: 11/07/2022]
Affiliation(s)
- Chase M. Heaton
- Department of Otolaryngology-Head and Neck Surgery; University of California-San Francisco; San Francisco CA
| | - J. Levi Chazen
- Department of Radiology and Biomedical Imaging; University of California-San Francisco; San Francisco CA
| | - Annemieke van Zante
- Department of Pathology and Laboratory Medicine; University of California-San Francisco; San Francisco CA
| | - Christine M. Glastonbury
- Department of Radiology and Biomedical Imaging; University of California-San Francisco; San Francisco CA
- Department of Otolaryngology-Head & Neck Surgery and Radiation Oncology; University of California-San Francisco; San Francisco CA
| | - Eric J. Kezirian
- Department of Otolaryngology-Head and Neck Surgery; University of California-San Francisco; San Francisco CA
| | - David W. Eisele
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins University School of Medicine; Baltimore Maryland U.S.A
| |
Collapse
|
|
28
|
Kashiwagi N, Murakami T, Nakanishi K, Maenishi O, Okajima K, Takahashi H, Sakai M, Tomita Y, Terao K, Tomiyama N. Conventional MRI findings for predicting submandibular pleomorphic adenoma. Acta Radiol 2013; 54:511-5. [PMID: 23436825 DOI: 10.1177/0284185113475922] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although pleomorphic adenomas account for over 90% of all benign submandibular gland tumors, the imaging features of submandibular pleomorphic adenomas have not been reported in a large number of cases. PURPOSE To assess the conventional magnetic resonance imaging (MRI) findings for predicting the submandibular pleomorphic adenoma. MATERIAL AND METHODS MR studies of 42 pleomorphic adenomas and 28 other types of tumor were reviewed. MR images were assessed for the presence of hyperintense areas on T2-weighted images (first sign), a well-defined margin (second sign), and presence of crescent-shaped compression of the ipsilateral normal submandibular gland (third sign). RESULTS For identifying submandibular pleomorphic adenoma, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 97.6%, 50.0%, 74.5%, 93.3%, and 78.6% for the first sign, 95.2%, 46.4% 72.7%, 86.7%, and 75.7% for the second sign, and 23.8%, 100%, 86.7%, 46.7%, and 54.3% for the third sign, respectively. Combining the first and second findings achieved to 85.7% specificity and 90.9% accuracy. CONCLUSION Although non-specific, submandibular pleomorphic adenomas usually have hyperintense areas on T2-weighted images and well-defined margins. In addition, crescent-shaped compression of the ipsilateral normal gland seems to represent a highly specific sign.
Collapse
Affiliation(s)
- Nobuo Kashiwagi
- Department of Radiology, Kinki University School of Medicine, Osaka
| | | | - Katsuyuki Nakanishi
- Department of Diagnostic Radiology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka
| | - Osamu Maenishi
- Department of Pathology, Kinki University School of Medicine, Osaka
| | - Kaoru Okajima
- Department of Radiology, Nara Hospital, Kinki University Faculty of Medicine, Osaka
| | - Hiroto Takahashi
- Department of Radiology, Kinki University School of Medicine, Osaka
| | - Mio Sakai
- Department of Diagnostic Radiology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka
| | - Yasuhiko Tomita
- Department of Pathology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka
| | - Kyoichi Terao
- Department of Otolaryngology, Kinki University School of Medicine, Osaka
| | - Noriyuki Tomiyama
- Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
| |
Collapse
|
|
29
|
Kashiwagi N, Murakami T, Chikugo T, Tomita Y, Kawano K, Nakanishi K, Mori K, Tomiyama N. Carcinoma ex pleomorphic adenoma of the parotid gland. Acta Radiol 2012; 53:303-6. [PMID: 22287150 DOI: 10.1258/ar.2011.110389] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Carcinoma ex pleomorphic adenoma (CXPA) is a rare aggressive epithelial malignancy arising from a primary or recurrent benign mixed tumor. Only a few case reports describing the radiologic features of CXPA have been published. PURPOSE To describe and characterize the magnetic resonance (MR) imaging findings of CXPA in the parotid gland and correlate them with pathologic findings. MATERIAL AND METHODS The MR images of surgically proven CXPA in the parotid gland of five men and five women ranging in age from 28 to 75 years (mean 52 years) were retrospectively reviewed. All MR images were evaluated with emphasis on the size, margin characteristics, extraparotid infiltration, the presence of an encapsulated component, and signal intensity on T2-weighted or short-inversion-time inversion recovery (STIR) images. RESULTS The average maximal diameter was 4.3 cm. All 10 tumors had ill-defined boundaries, and seven tumors showed extraparotid infiltration, reflecting invasive growth of the malignant component identified on histological examination. Eight tumors had a round encapsulated component and seven of those signal intensities were a mixture of hypo- and hyperintensity on T2-weighted or STIR images. Histological correlation of these components revealed fibrously encapsulated tumors containing hyalinization and myxoid tissue, suggesting degenerated pleomorphic adenoma. Invasive malignant components had non-specific and various signal intensities. CONCLUSION An invasive parotid mass co-existing with a round encapsulated component is suggestive of carcinoma ex pleomorphic adenoma.
Collapse
Affiliation(s)
- Nobuo Kashiwagi
- Department of Radiology, Kinki University School of Medicine, Osaka
| | | | - Takaaki Chikugo
- Department of Pathology, Kinki University School of Medicine, Osaka
| | - Yasuhiko Tomita
- Department of Pathology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka
| | - Kiyoshi Kawano
- Department of Pathology, Belland General Hospital, Sakai City, Osaka
| | - Katsuyuki Nakanishi
- Department of Diagnostic Radiology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka
| | - Kazunori Mori
- Department of Otolaryngology, Kinki University School of Medicine, Osakasayama City, Osaka
| | - Noriyuki Tomiyama
- Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
| |
Collapse
|
|
30
|
Difficulty of the differential diagnosis of basal cell adenoma and basal cell adenocarcinoma of parotid gland by magnetic resonance imaging: case reports and literature review. Oral Radiol 2011. [DOI: 10.1007/s11282-011-0076-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
|
31
|
Sharma N. Pleomorphic adenoma of the buccal salivary gland: magnetic resonance imaging findings with differential diagnoses. ACTA ACUST UNITED AC 2011; 3:228-31. [PMID: 22887907 DOI: 10.1111/j.2041-1626.2011.00091.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The majority of minor salivary gland tumors are malignant. Of the benign tumors, pleomorphic adenomas are most common. The cheeks, lips, and gingiva are rarely sites of occurrence. A case of pleomorphic adenoma of the buccal salivary gland is presented here with a discussion of the importance of magnetic resonance imaging in demonstrating the extent of the lesion and establishing a differential diagnoses.
Collapse
Affiliation(s)
- Neeraj Sharma
- Department of Oral Medicine and Radiology, Dr HSJ Institute of Dental Sciences, Panjab University, Chandigarh, India.
| |
Collapse
|
|
32
|
Christe A, Waldherr C, Hallett R, Zbaeren P, Thoeny H. MR imaging of parotid tumors: typical lesion characteristics in MR imaging improve discrimination between benign and malignant disease. AJNR Am J Neuroradiol 2011; 32:1202-7. [PMID: 21724574 DOI: 10.3174/ajnr.a2520] [Citation(s) in RCA: 157] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE The surgical approach to parotid tumors is different for benign and malignant neoplasms, but the clinical symptoms do not correlate well with histology. Difficulties in tumor classification also arise in imaging modalities, in which sonography has the lowest and MR imaging, the highest accuracy. The purpose of this study was to review our experience using conventional MR imaging of the neck in the evaluation of parotid tumors and to evaluate which MR imaging findings are best able to predict malignant histology. MATERIALS AND METHODS Eighty-four consecutive patients (43 males, 41 females; median age, 56 years; range, 9-85 years) with parotid gland tumors who underwent MR imaging before surgery were prospectively included in the present study and retrospectively analyzed. Histology was available for all tumors. We analyzed the following MR imaging parameters: signal intensity, contrast enhancement, lesion margins (well-defined versus ill-defined), lesion location (deep/superficial lobe), growth pattern (focal, multifocal, or diffuse), and extension into neighboring structures, perineural spread, and lymphadenopathy. RESULTS The 57 (68%) benign and 27 (32%) malignant tumors consisted of 29 pleomorphic adenomas, 17 Warthin tumors, 11 various benign tumors, 5 mucoepidermoid carcinomas, 3 adenoid cystic carcinomas, 1 acinic cell carcinoma, 1 carcinoma ex pleomorphic adenoma, 9 metastases, and 8 various malignant neoplasms. Specific signs predictive of malignancy were the following: T2 hypointensity of the parotid tumor (P = .048), ill-defined margins (P = .001), diffuse growth (P = .012), infiltration of subcutaneous tissue (P = .0034), and lymphadenopathy (P = .012). CONCLUSIONS Low signal intensity on T2-weighted images and postcontrast ill-defined margins of a parotid tumor are highly suggestive of malignancy.
Collapse
Affiliation(s)
- A Christe
- Department of Diagnostic, Interventional and Pediatric Radiology, University Hospital, University of Bern, Bern, Switzerland.
| | | | | | | | | |
Collapse
|
|
33
|
Lechner Goyault J, Riehm S, Neuville A, Gentine A, Veillon F. Interest of diffusion-weighted and gadolinium-enhanced dynamic MR sequences for the diagnosis of parotid gland tumors. J Neuroradiol 2011; 38:77-89. [DOI: 10.1016/j.neurad.2009.10.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Accepted: 10/13/2009] [Indexed: 01/05/2023]
|
|
34
|
Pleomorphic adenoma (benign mixed tumour) of the salivary glands: its diverse clinical, radiological, and histopathological presentation. Br J Oral Maxillofac Surg 2011; 49:14-20. [DOI: 10.1016/j.bjoms.2009.09.014] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2009] [Accepted: 09/29/2009] [Indexed: 11/19/2022]
|
|
35
|
Prades JM, Oletski A, Faye MB, Dumollard JM, Timoshenko AP, Veyret C, Peoc'h M, Martin C. [Parotid gland masses: diagnostic value of MR imaging with histopathologic correlations]. Morphologie 2008; 91:44-51. [PMID: 17652005 DOI: 10.1016/j.morpho.2007.05.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of our study has been to describe the pre-operatively MR Imaging appearance of masses in the parotid gland which may be sources of clinical and radiological confusion. METHODS Sixty-eight adults patients with a parotid mass (39 female, 29 male) has been prospectively investigated. T1-weighted, T2-weighted, diffusion-weighted and contrast-enhanced dynamic MR images were performed by using a 1.5 or 1 T MR Imaging unit (Philips Gyroscan Intera 1.5 T. Siemens Expert 1 T). All patients underwent a parotidectomy with histopathologic analysis. RESULTS-CONCLUSIONS In case of pleomorphic adenoma (N=30) MR imaging sensibility, specificity and accuracy were respectively 87.5, 80.5 and 83%. In case of Warthin tumors (N=13) the same values were respectively 45.5, 93 and 85%. In case of malignant tumors (N=13) theses values were respectively 71, 89 and 87%. Our routine MR Imaging study appears excellent not only for assessing the type and extent of benign salivary gland tumors and the relationship to adjacent structures, but also for determining whether the tumor is benign or malignant.
Collapse
Affiliation(s)
- J-M Prades
- Laboratoire d'anatomie, faculté de médecine, Saint-Etienne, France.
| | | | | | | | | | | | | | | |
Collapse
|
|
36
|
CT and MR images of pleomorphic adenoma in major and minor salivary glands. Eur J Radiol 2008; 69:464-72. [PMID: 18093776 DOI: 10.1016/j.ejrad.2007.11.021] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2006] [Revised: 06/21/2007] [Accepted: 11/09/2007] [Indexed: 12/13/2022]
Abstract
PURPOSE To investigate the CT and MR imaging features of pleomorphic adenoma in the head and neck area. MATERIALS AND METHODS Our materials of this study consisted of 50 pleomorphic adenomas from 50 patients which were all histopathologically diagnosed. The CT and MR images were retrospectively evaluated. The following features were evaluated: the detectability of the lesion, the tumor margin, the border of the lesion, the aspect of the lesion, the contrast between the lesion and surrounding tissue, the signal intensity of the lesion, the enhancement of contrast medium, the aspect of the lesion after the injection of contrast medium, the detectability of the capsule, and the detectability of bone resorption of the lesion. RESULTS The tumor detectabilities were 77% on axial plain CT images and 90% on axial CE CT images, respectively. On CT images, pleomorphic adenoma tended to show a well-defined margin, a smooth border, an inhomogeneous aspect, a low or high contrast, and intermediate or high signal intensity. After contrast medium administration, pleomorphic adenoma tended to show a slightly high enhancement and either an inhomogeneous or a periphery enhancement on the CE CT images. The capsule could be hardly detected on CT images. The tumor detectabilities were 86% on axial T1-weighted MR images, 88% on axial T2-weighted MR images, and 85% on axial CE T1-weighted MR images, respectively. On MR images, pleomorphic adenomas tended to show well-defined margin, a lobulate border, an inhomogeneous aspect, a high contrast, and intermediate or high signal intensity. After contrast medium administration, pleomorphic adenoma tended to show a high enhancement and either an inhomogeneous or a periphery enhancement on MR images. The capsule could be detected in many cases on MR images. CONCLUSIONS It was possible to detect the capsule in pleomorphic adenoma using MR images. The pleomorphic adenomas in head and neck area should be evaluated with MR images.
Collapse
|
|
37
|
Matsushima N, Maeda M, Takamura M, Takeda K. Apparent diffusion coefficients of benign and malignant salivary gland tumors. Comparison to histopathological findings. J Neuroradiol 2007; 34:183-9. [PMID: 17568674 DOI: 10.1016/j.neurad.2007.04.002] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To evaluate the apparent diffusion coefficient (ADC) of benign and malignant salivary gland tumors in comparison to histopathological findings. MATERIALS AND METHODS This study included 32 patients with a wide spectrum of major salivary gland tumors (17 benign, 15 malignant). Diffusion-weighted imaging (DWI) and ADC measurements were performed in all patients. The degrees of extracellular components (myxoid and chondroid matrices, microcysts and hyalinization), were histopathologically classified as mild, moderate and conspicuous. Comparisons were made of mean ADC values between benign and malignant tumors, and among tumors showing different degrees of extracellular components. RESULTS Mean ADC values were 1.09+/-0.34 x 10(-3) mm(2)/s in malignant salivary gland tumors and 1.40+/-0.43 x 10(-3) mm(2)/s in benign salivary gland tumors. No significant difference in mean ADC values was found between benign and malignant tumors (P>0.05). However, mean ADC values increased with the degree of extracellular components. Mean ADC values were significantly different between mild and moderate degrees (P<0.05) of extracellular components, and between mild and conspicuous degrees (P<0.05), in both benign and malignant tumor groups. CONCLUSION In this study, ADC values alone did not allow differentiation between benign and malignant salivary gland tumors. Comparison with histopathological findings suggests a correlation between the amount of extracellular components and mean ADC values in salivary gland tumors.
Collapse
Affiliation(s)
- N Matsushima
- Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | | | | | | |
Collapse
|
|
38
|
Moonis G, Patel P, Koshkareva Y, Newman J, Loevner LA. Imaging characteristics of recurrent pleomorphic adenoma of the parotid gland. AJNR Am J Neuroradiol 2007; 28:1532-6. [PMID: 17846206 PMCID: PMC8134383 DOI: 10.3174/ajnr.a0598] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND PURPOSE Pleomorphic adenoma is the most common parotid neoplasm. It has a relatively high rate of recurrence after surgery. Imaging features of recurrent parotid pleomorphic adenoma have been infrequently reported in the radiology literature. In the present study, we reviewed our institutional experience with imaging of recurrent parotid pleomorphic adenomas. MATERIALS AND METHODS Retrospective imaging and chart review of 24 patients (9 men, 15 women; age, 29-63 years) with recurrent pleomorphic adenoma of the parotid were performed. Images were reviewed as to the margins, site, multiplicity, signal intensity, and enhancement pattern of the recurrent lesions by 2 neuroradiologists. RESULTS We found a high incidence of multiple lesions in the operative bed, most of which were extremely bright on T2-weighted images; some of the lesions demonstrated a cystic appearance with peripheral enhancement. We also noted tiny lesions in the subcutaneous fat and in regions distant from the immediate operative bed. CONCLUSION Although recurrent disease is usually clinically apparent, sometimes prior surgical history is lacking or recurrence may be detected on routine surveillance imaging after initial surgery. The presence of solitary or multiple subcutaneous T2 hyperintense lesions in the operative bed, subcutaneous fat, and/or spaces adjacent to the parotid in patients with prior parotidectomy for pleomorphic adenoma is consistent with the diagnosis of neoplastic recurrence. The radiologist should maintain a high index of suspicion for recurrent pleomorphic adenoma with this characteristic imaging appearance.
Collapse
Affiliation(s)
- G Moonis
- Department of Radiology, Neuroradiology Division, Hospital of the University of Pennsylvania, Philadelphia, USA.
| | | | | | | | | |
Collapse
|
|
39
|
Alibek S, Zenk J, Bozzato A, Lell M, Grunewald M, Anders K, Rabe C, Iro H, Bautz W, Greess H. The value of dynamic MRI studies in parotid tumors. Acad Radiol 2007; 14:701-10. [PMID: 17502260 DOI: 10.1016/j.acra.2007.03.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2007] [Revised: 03/05/2007] [Accepted: 03/05/2007] [Indexed: 11/19/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate the ability of dynamic contrast-enhanced magnetic resonance imaging (MRI) to differentiate several tumor entities of the parotid gland in a prospective clinical trial. MATERIALS AND METHODS A total of 112 patients with parotid tumors were examined with dynamic contrast-enhanced 1.5 T MRI. Precontrast axial T1-weighted imaging was used to select five slices for the dynamic study. Subsequently, a T1-weighted FLASH sequence was used for the dynamic contrast study (0.2 ml Gd/kg x body weight). Contrast agent application and the FLASH sequence were started simultaneously. Ten acquisitions of 10 seconds' scan time each were performed (total acquisition time 1:40 minutes). Signal intensity versus time (SIvT) curves was obtained for all tumors. After correlation of the categorized SIvT curves, these were compared with histopathology. Finally, all MRIs together with the tumor specific SIvT curves were re-read and correlated with histopathologic diagnosis. All reading sessions were done by three experienced radiologists. RESULTS Four characteristic intensity-time curves were observed: pleomorphic adenoma showed a gradual increase in signal intensity, followed by a plateau phase on a low intensity level. Cysts showed a vacillating course at a low signal intensity level. Adenolymphomas as well as carcinomas showed a rapid increase in signal intensity followed by a plateau phase. Statistic significance was found for the time-to-peak values for adenolymphomas and pleomorphic adenomas and for the maximum peak signal intensity values for carcinomas. Together with other morphologic MRI criteria (contrast enhancement, border characteristics) and clinical features, a differentiation between adenolymphoma and carcinoma was possible. CONCLUSIONS With additional dynamic contrast-enhanced MRI, a more reliable differentiation between common parotid tumors is possible before surgery.
Collapse
Affiliation(s)
- Sedat Alibek
- Institute of Radiology, University of Erlangen/Nuremberg, Maximiliansplatz 1 - 91054 Erlangen, Germany.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
|
40
|
Yerli H, Aydin E, Coskun M, Geyik E, Ozluoglu LN, Haberal N, Kaskati T. Dynamic multislice computed tomography findings for parotid gland tumors. J Comput Assist Tomogr 2007; 31:309-16. [PMID: 17414771 DOI: 10.1097/01.rct.0000236418.82395.b3] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Our aim was to research the enhancement features of parotid gland masses in detail and characterize if the masses were Warthin tumors, adenomas, or malignant tumors. METHODS The prospective study included 25 parotid tumors in 21 patients. Neck computed tomography (CT) was performed using a multislice CT unit. A full-neck CT examination was done at 30 seconds after completion of contrast injection, and then tumor-level images were obtained at 90 seconds and at 5 and 25 minutes. Computed tomography number (lesion density in Hounsfield units) was determined at each phase, and differences within and among tumor groups were statistically analyzed. Diagnoses were confirmed by histopathology. RESULTS There were 11 Warthin tumors, 8 pleomorphic adenomas, 5 malignant tumors, and 1 basal cell adenoma. Ten Warthin tumors showed rapid contrast enhancement at 30 seconds and rapid reduction of enhancement from the first to the fourth phase. The basal cell adenoma showed also a peak enhancement at 30 seconds. Seven pleomorphic adenomas showed increased enhancement through the first 3 phases. Four malignant tumors showed peak enhancement at 90 seconds. Statistically significant differences within and among tumor groups were determined. CONCLUSIONS The data suggest that peak tumor enhancement at 30 and 90 seconds, respectively, might identify Warthin and malignant tumors. Increased enhancement through all phases might be an indicator for diagnosing pleomorphic adenomas.
Collapse
Affiliation(s)
- Hasan Yerli
- Department of Radiology, Baskent University Medical School, Ankara, Turkey.
| | | | | | | | | | | | | |
Collapse
|
|
41
|
Gibson A, Mavrikakis I, Rootman J, Dolman P. Lacrimal Gland Pleomorphic Adenomas With Low-density Zones Resembling Cystic Change on Computed Tomography. Ophthalmic Plast Reconstr Surg 2007; 23:234-5. [PMID: 17519667 DOI: 10.1097/iop.0b013e31803eb18a] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report 2 cases of pleomorphic adenoma with unusual radiologic findings. CT showed lacrimal gland masses dominated by low-density areas resembling cysts. Pathology revealed the lesions to be pleomorphic adenomas with myxomatous and/or cartilaginous features.
Collapse
Affiliation(s)
- Andrew Gibson
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, BC, Canada
| | | | | | | |
Collapse
|
|
42
|
Indo H, Suenaga S, Nozoe E, Nakamura N, Tanuma J, Semba I, Majima HJ. Pleomorphic adenoma presenting lowT2signal-intensity on magnetic resonance imaging. Dentomaxillofac Radiol 2006; 35:380-2. [PMID: 16940488 DOI: 10.1259/dmfr/21157218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We report an unusual case of pleomorphic adenoma of the submandibular gland in a 48-year-old female. The present case appeared as a relatively homogeneous, low to intermediate signal-intensity on the T(2) weighted magnetic resonance (MR) images. To our knowledge, the MR feature of low T(2) signal-intensity of pleomorphic adenoma has not been reported in the literature.
Collapse
Affiliation(s)
- H Indo
- Department of Maxillofacial Radiology, Field of Oncology, Kagoshima University Graduate School of Medicine and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan.
| | | | | | | | | | | | | |
Collapse
|
|
43
|
Yerli H, Teksam M, Aydin E, Coskun M, Ozdemir H, Agildere AM. Basal cell adenoma of the parotid gland: dynamic CT and MRI findings. Br J Radiol 2005; 78:642-5. [PMID: 15961849 DOI: 10.1259/bjr/32453517] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Imaging findings in basal cell adenoma (BCA) of the parotid gland have been rarely reported. We report dynamic CT and MRI findings of BCA in the parotid gland in a 78-year-old woman. Dynamic CT study demonstrated strong multinodular contrast enhancement in the early phase which decreased gradually in the later phases. The mass was isointense on T(1) weighted and hyperintense on T(2) weighted MR images with a central haemorrhagic-necrotic component. The microscopic findings were consistent with membranous type BCA.
Collapse
Affiliation(s)
- H Yerli
- Department of Radiology, Baskent University Medical School, Ankara 06490, Turkey
| | | | | | | | | | | |
Collapse
|
|
44
|
Abstract
Diagnostic imaging of salivary glands has been revolutionized with the advent of cross-sectional imaging modalities like CT and MR imaging. In the era before CT, imaging of the salivary glands was relatively unrewarding and was used uncommonly by ear-nose-throat surgeons. Early diagnostic tests like plain films and sialography evaluated dilated parotid ducts and calculus disease within ducts or glands. Full evaluation of salivary glands, especially deep lobes of parotid gland and masses of minor salivary glands, was not possible by these methods, however. Imaging of the parotid glands has developed significantly since that time. CT and MR imaging greatly compliment physical and endoscopic examinations (and previous favorites like sialography) by direct visualization of previously blind areas of the salivary glands and extension of the disease process in surrounding tissue planes.
Collapse
Affiliation(s)
- Gaurang V Shah
- Department of Radiology, University of Michigan, Room B1G308, 1500 East Medical Center Drive, Ann Arbor, MI 48105, USA
| |
Collapse
|
|
45
|
Abstract
Parotid cancers are infrequently encountered. These tumors carry a prolonged risk of recurrence and metastasis. Controversies surrounding pre-treatment evaluation by imaging and fine needle aspiration, utility of operative frozen section are partly resolved. Though surgery remains the mainstay of treatment, radiation is being recognized as a useful adjuvant. Facial nerve preservation is one of the important goals at surgery. The role of chemotherapy is still investigational. The prognosis and necessity of elective neck treatment are mainly guided by the tumor grade and stage.
Collapse
Affiliation(s)
- K Harish
- Department of Surgical Oncology, M.S. Ramaiah Medical College & Hospital, Bangalore 560054, India.
| |
Collapse
|
|
46
|
Okahara M, Kiyosue H, Hori Y, Matsumoto A, Mori H, Yokoyama S. Parotid tumors: MR imaging with pathological correlation. Eur Radiol 2004; 13 Suppl 4:L25-33. [PMID: 15018162 DOI: 10.1007/s00330-003-1999-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Most parotid tumors grow slowly, whether benign or malignant; thus, it is difficult to predict the malignant or benign nature of a tumor clinically. Magnetic resonance imaging may have a place in the diagnostic work-up of parotid tumors. The purpose of this article is to illustrate the MR imaging findings of parotid tumors and to correlate them to pathologic findings. The MR imaging may be helpful in differentiation of benign and malignant tumors of the parotid gland, and can provide important clues in the diagnosis of their histologies.
Collapse
Affiliation(s)
- Mika Okahara
- Department of Radiology, Oita Medical University, 1-1 Hasama-machi, 87955 Oita, Japan.
| | | | | | | | | | | |
Collapse
|
|
47
|
Sakamoto M, Sasano T, Higano S, Takahashi S, Iikubo M, Kakehata S. Usefulness of heavily T(2) weighted magnetic resonance images for the differential diagnosis of parotid tumours. Dentomaxillofac Radiol 2004; 32:295-9. [PMID: 14709603 DOI: 10.1259/dmfr/32387150] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To evaluate the usefulness of heavily T(2) weighted (T2W) magnetic resonance (MR) images for the differential diagnosis of parotid tumours. METHODS Conventional T2W and heavily T2W images obtained from 43 patients with parotid tumours were reviewed retrospectively. Tumours were classified pathologically into three types: pleomorphic adenoma (25 cases), Warthin's tumour (7 cases) and malignant tumour (11 cases). During interpretation of each MR image, special attention was paid to the homogeneity and signal intensity displayed by the solid portions of the tumours. RESULTS Heavily T2W images could distinguish pleomorphic adenoma from Warthin's tumour and malignant tumours based on the homogeneity and signal intensity of the solid portions, whereas conventional T2W images could not. On conventional T2W images, neither homogeneity nor signal intensity differed significantly among these three tumour types. On heavily T2W images, malignant and Warthin's tumours appeared more homogeneous than pleomorphic adenoma (P<0.0061); signal intensity from pleomorphic adenoma was significantly different to signal intensity from malignant tumours (P<0.05) and Warthin's tumour (P<0.005). CONCLUSIONS Heavily T2W MR images can be useful in distinguishing pleomorphic adenoma from Warthin's tumour and malignant tumours.
Collapse
Affiliation(s)
- M Sakamoto
- Department of Oral Diagnosis & Radiology, Tohoku University Graduate School of Dentistry, Japan.
| | | | | | | | | | | |
Collapse
|
|
48
|
Kinoshita T, Ishii K, Naganuma H, Okitsu T. MR imaging findings of parotid tumors with pathologic diagnostic clues. Clin Imaging 2004; 28:93-101. [PMID: 15050220 DOI: 10.1016/s0899-7071(03)00120-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2003] [Accepted: 03/27/2003] [Indexed: 11/26/2022]
Abstract
This pictorial essay depicts MR features of benign and malignant parotid tumors. Increased T2 signal intensity is suggestive of pleomorphic adenoma. Tumors with relatively low signal intensity on T2-weighted images are more likely to be malignant even when they are well-demarcated. Fat suppression technique improves the ability to define the boundaries of neoplatic or inflammatory lesions.
Collapse
Affiliation(s)
- Toshibumi Kinoshita
- Department of Radiology, Sendai City Hospital, 3-1 Shimizukouji, Wakabayashi-ku, Sendai 984-0075, Japan.
| | | | | | | |
Collapse
|
|
49
|
Motoori K, Yamamoto S, Ueda T, Nakano K, Muto T, Nagai Y, Ikeda M, Funatsu H, Ito H. Inter- and Intratumoral Variability in Magnetic Resonance Imaging of Pleomorphic Adenoma. J Comput Assist Tomogr 2004; 28:233-46. [PMID: 15091129 DOI: 10.1097/00004728-200403000-00014] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The purpose of our study was to describe the various magnetic resonance (MR) findings of pleomorphic adenoma and to interpret these findings. METHODS MR studies of 33 pleomorphic adenomas and 13 malignant tumors in the major salivary glands were reviewed. RESULTS High signal intensity on short-inversion-time inversion recovery (STIR) and T2-weighted (T2W) images, progressive enhancement on dynamic MR images, and high apparent diffusion coefficient (ADC) values on diffusion-weighted (DW) images reflected myxoid-dominant components in pleomorphic adenomas. Hypercellularity with less-myxoid stroma showed reduced signal intensity on STIR and T2W images and also reduced ADC values on DW images, and the peak of time versus signal intensity curves (TICs) was reached earlier on dynamic MR images. CONCLUSIONS The MR images of hypercellularity components in pleomorphic adenoma overlap with those of malignant parotid tumors. Detecting myxoid components by STIR, T2W, DW, and dynamic MR images is useful for predicting whether salivary gland tumors are pleomorphic adenoma or not.
Collapse
Affiliation(s)
- Ken Motoori
- Departments of Radiology and Otolaryngology, Chiba University Hospital, Chiba, Japan.
| | | | | | | | | | | | | | | | | |
Collapse
|
|
50
|
Hisatomi M, Asaumi JI, Yanagi Y, Konouchi H, Matsuzaki H, Honda Y, Kishi K. Assessment of pleomorphic adenomas using MRI and dynamic contrast enhanced MRI. Oral Oncol 2003; 39:574-9. [PMID: 12798400 DOI: 10.1016/s1368-8375(03)00040-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
We evaluated magnetic resonance images (MRI) and the value of dynamic contrast enhanced MRI (DCE-MRI) of pleomorphic adenomas retrospectively. MRI was performed for 18 pleomorphic adenomas, including 11 cases with DCE-MRI. We obtained the following results on the MRI and DCE-MRI. (a). Pleomorphic adenomas showed a predilection for homogeneous intermediate signal intensity on T1-weighted images (T1WI), heterogeneous high signal intensity on T2-weighted images, and heterogeneous enhancement on Gd-T1WI. (b). Of 11 contrast index (CI) curves of pleomorphic adenomas, nine CI curves (81.8%) increased gradually to 600 s or increased gradually, reached a plateau, and sustained the plateau to 600 s. The remaining two (18.2%) increased gradually and decreased gradually thereafter. (c). CI curves reached the maximum CI index at 135-300 s.
Collapse
Affiliation(s)
- Miki Hisatomi
- Department of Oral and Maxillofacial Radiology, Okayama University, 2-5-1, Shikata-cho, Okayama-city, Okayama 700-8525, Japan.
| | | | | | | | | | | | | |
Collapse
|