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. 2017 Aug;46(6):20160434.
doi: 10.1259/dmfr.20160434. Epub 2017 Apr 7.

The value of combining conventional, diffusion-weighted and dynamic contrast-enhanced MR imaging for the diagnosis of parotid gland tumours

Xiaofeng Tao  1 , Gongxin Yang  1 , Pingzhong Wang  1 , Yingwei Wu  1 , Wenjing Zhu  1 , Huimin Shi  1 , Xin Gong  1 , Weiqing Gao  1 , Qiang Yu  1
Affiliations

The value of combining conventional, diffusion-weighted and dynamic contrast-enhanced MR imaging for the diagnosis of parotid gland tumours

Xiaofeng Tao et al. Dentomaxillofac Radiol. 2017 Aug.

Abstract

Objectives: The aim of this study was to determine the value of combining conventional MRI, diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE)-MRI in diagnosing solid neoplasms in the parotid gland.

Methods: A total of 148 subjects (101 subjects with benign and 47 subjects with malignant tumours) were evaluated with conventional MRI, DWI and DCE-MRI prior to surgery and pathologic verification. The items observed with conventional MRI included the shape, capsule and signal intensity of parotid masses. The apparent diffusion coefficient (ADC) was calculated from DWI that was obtained with a b-factor of 0 and 1000 s mm-2. A time-intensity curve (TIC) was obtained from DCE-MRI.

Results: There were significant differences (p < 0.01) in the shape, capsule, ADC and TIC between benign and malignant parotid tumours. Irregular neoplasms without a capsule, ADC <1.12 × 10-3 mm2 s-1 and a plateau enhancement pattern were valuable parameters for predicting malignant neoplasms. A combination of all of these parameters yielded sensitivity, specificity, accuracy, positive-predictive value and negative-predictive value of 85.1%, 94.1%, 91.2%, 87.0% and 93.1%, respectively.

Conclusions: A combined analysis using conventional MRI, DWI and DCE-MRI is helpful in distinguishing benign from malignant tumours in the parotid gland.

Keywords: diffusion-weighted MR imaging (DW-MRI); dynamic contrast enhanced MR imaging (DCE-MRI); magnetic resonance imaging (MRI); neoplasm; parotid gland.

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Figures

Figure 1
Figure 1
A pleomorphic adenoma of the right parotid gland in a 44-year-old female: (a) the axial T1 weighted MR image shows a hypointense mass (arrow) in the right parotid gland. (b) The axial T2 weighted MR image shows a heterogeneously hyperintense mass with an irregular shape (arrow). (c) The coronal T2 weighted MR image shows a hypointense capsule around the mass (arrow). (d) The round cursor marks the region of interest (ROI) selected for signal intensity (SI) measurement with dynamic MRI. (e) The time–intensity curve shows a persistent enhancement pattern (Type A). (f) The diffusion-weighted image shows a relatively high SI mass. The round cursor marks the ROI selected for measurement of the apparent diffusion coefficient (ADC) value. The mean ADC value of this parotid tumour is 1.75 × 10−3 mm2 s−1.
Figure 2
Figure 2
A Warthin's tumour of the right parotid gland in a 48-year-old male: (a) the axial T1 weighted MR image shows an isointense signal mass with a round shape (arrow) in the right parotid gland. (b) The axial T2 weighted MR image shows a relatively hyperintense mass (arrow). (c) The coronal T2 weighted MR image shows a hypointense capsule around the mass (arrow). (d) The round cursor marks the region of interest (ROI) selected for the signal intensity (SI) measurement with dynamic MRI. (e) The time–intensity curve shows a washout enhancement pattern (Type B). (f) The diffusion-weighted image shows a high SI mass. The round cursor marks the ROI selected for measurement of the apparent diffusion coefficient (ADC) value. The mean ADC value of this tumour is measured as 0.74 × 10−3 mm2 s−1.
Figure 3
Figure 3
A mucoepidermoid carcinoma of the right parotid gland in a 15-year-old male: (a) the axial T1 weighted MR image shows an isointense signal mass (arrow) in the right parotid gland with an irregular shape. (b) The axial T2 weighted MR image shows a heterogeneously hyperintense mass (arrow). (c) The coronal T2 weighted MR image shows no capsule around the mass (arrow). (d) The cursor marks the region of interest (ROI) selected for signal intensity (SI) measurement with dynamic MRI. (e) The time–intensity curve shows a plateau enhancement pattern (Type C). (f) The diffusion-weighted image shows a relatively high SI mass. The cursor marks the ROI selected for measurement of the apparent diffusion coefficient (ADC) value. The mean ADC value of this tumour is calculated as 1.01 × 10−3 mm2 s−1.
Figure 4
Figure 4
Discrimination of mean apparent diffusion coefficient (ADC) values between benign and malignant tumours: (a) the mean ADC value of malignant tumours [(0.91 ± 0.20) × 10−3 mm2 s−1] is significantly lower than that of benign masses [(1.16 ± 0.34) × 10−3 mm2 s−1] (p < 0.001). (b) The receiver-operating characteristic of mean ADC values for use in differentiating between malignancies and benign tumours. The area under the curve (AUC) is 0.71 ± 0.04, and a cut-off point of 1.12 × 10−3 mm2 s−1 for the ADC value is obtained.
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