Parotid pleomorphic adenomas: delayed CT enhancement

Abstract

Background and purpose: Weak or absent CT enhancement in pleomorphic adenomas of the parotid gland has been observed immediately after i.v. contrast administration. This feature can result in poor lesion conspicuity relative to both normal parotid tissue and other parotid abnormalities. The purpose of this study was to document the delayed CT enhancement characteristics of parotid pleomorphic adenomas and to preliminarily compare these results with the enhancement characteristics of other parotid gland tumors.

Methods: Preoperative CT scans from 18 pathologically proved parotid gland neoplasms were reviewed retrospectively. Lesions included eight pleomorphic adenomas, four Warthin's tumors, two squamous cell carcinomas, two mucoepidermoid cancers, one acinic cell carcinoma, and one melanoma metastasis. In all cases, axial CT was performed after the administration of 100 to 150 mL of i.v. contrast material, followed by delayed (average, 24 minutes; range, 13 to 34 minutes) coronal CT scanning. The mean normalized Hounsfield unit (HU) attenuation of each lesion was computed by drawing a region of interest around the entire mass and dividing the resulting HU value by that of the contralateral uninvolved parotid gland.

Results: For all eight pleomorphic adenomas, the degree of contrast enhancement increased and became progressively more uniform with time. Mean normalized axial lesion enhancement averaged 1.20 +/- 0.35 at 8 minutes, compared with 2.30 +/- 0.66 on the coronal scans at 24 minutes. For the 10 nonpleomorphic adenomas, no significant change was found in either the degree or pattern of contrast enhancement between the immediate and delayed CT scans. In these tumors, peak enhancement was reached early, during axial scanning.

Conclusion: Delayed CT contrast enhancement is observed in parotid pleomorphic adenomas, increasing in both degree and homogeneity with time. This feature may be useful in selecting an appropriate contrast delay when scanning possible pleomorphic adenomas to improve lesion conspicuity and, potentially, to better distinguish these tumors from other parotid abnormalities.