Characterization of parotid gland tumors: added value of permeability MR imaging to DWI and DCE-MRI
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HEAD AND NECK
Characterization of parotid gland tumors: added value of permeability MR imaging to DWI and DCE-MRI Hidetake Yabuuchi 1 & Takeshi Kamitani 2 & Koji Sagiyama 2 & Yuzo Yamasaki 2 & Tomoyuki Hida 2 & Yuko Matsuura 2 & Takuya Hino 2 & Yuriko Murayama 2 & Ryuji Yasumatsu 3 & Hidetaka Yamamoto 4 Received: 19 January 2020 / Revised: 25 April 2020 / Accepted: 3 June 2020 # European Society of Radiology 2020
Abstract Objectives To determine added value of permeability MRI in parotid tumor characterization to T2-weighted imaging (T2WI), semiquantitative 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. Sixtyone 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 semiquantitative TIC analysis and IVIM analyses with D parameter. • The combination of TIC pattern, D, and kep 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. Keywords Parotid gland . Neoplasms . Magnetic resonance imaging . Perfusion . Diffusion
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00330-020-07004-3) contains supplementary material, which is available to authorized users. * Hidetake Yabuuchi [email protected].
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