Differentiation malignant from benign parotid tumors in children with diffusion-weighted MR imaging
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ORIGINAL ARTICLE
Differentiation malignant from benign parotid tumors in children with diffusion‑weighted MR imaging Ahmed Abdel Khalek Abdel Razek1 · Eman Mohamed Helmy1 Received: 30 June 2020 / Accepted: 24 August 2020 © Japanese Society for Oral and Maxillofacial Radiology and Springer Nature Singapore Pte Ltd. 2020
Abstract Purpose To differentiate pediatric solid malignant from the benign parotid tumors with diffusion-weighted MR imaging (DWI). Materials and methods A retrospective study comprising 38 children with parotid tumors (21 boys and 17 girls aged from 2 months to 17 years) was conducted using (DWI) of the parotid gland. Apparent diffusion coefficient (ADC) maps were generated. The ADC value of the parotid tumors was calculated. Results The mean ADC value of malignant parotid tumors (1.08 ± 0.1, 1.04 ± 0.1 × 10−3mm2/s) was significantly lower [P = 0.001] than that of benign lesions (1.69 ± 0.2, 1.72 ± 0.3 × 10−3mm2/s). A threshold of ADC of 1.40, 1.33 × 10−3mm2/s was used for differentiating malignant parotid tumors from benign lesions and led to the best results of the area under the curve of 0.940, 0.929, accuracy of 86, 89%, sensitivity of 94, 94%, specificity of 80, 85%, negative predictive value of 94.1, 94.4%, and positive predictive value of 81, 85%. There was insignificant difference in ADC values of malignant lesions (P = 0.23, 0.30) as well as within benign lesions (P = 0.25, 0.08). Conclusion DWI is an innovative anticipating imaging technique that can be used in the differentiation of pediatric solid malignant parotid tumors from benign lesions. Keywords Diffusion · MR imaging · Parotid · Tumor · Pediatrics
Introduction Pediatric salivary tumors are considered uncommon; about 80% of them arise from the parotid gland. Accurate discrimination of benign tumors of the parotid gland from malignant lesions is challenging and affecting patient management and prognosis [1–5]. The role of imaging in characterization of pediatric parotid gland tumors has been discussed by a few authors [6–11]. Although ultrasound is operator-dependent, it is still the initial method for diagnosis and distinguishing cystic from solid masses [10]. Routine and advanced magnetic resonance imaging techniques, such as dynamic susceptibility perfusion-contrast MR imaging and MR spectroscopy, are useful for a detailed assessment of parotid masses, but their results are overlapping [12, 13]. CT scan is insensitive and carries the hazards of radiation exposure * Ahmed Abdel Khalek Abdel Razek [email protected] 1
and contrast medium injection [7–9]. The biopsy is the gold standard for the characterization of pediatric parotid tumors but has a controversial role as it is an invasive procedure that needs sedation or even general anesthesia for children and may be associated with complications [14]. Diffusion-weighted imaging (DWI) is an innovative technique that can provide better discrimination between benign and malignant tissues by measuring the degree of random motion of water protons affected by the presence
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