Evaluating of Parotid Gland Tumours According to Diffusion Weighted MRI

Yıl 2014, Cilt: 11 Sayı: 2, 77 - 84, 01.06.2014

Çınar Balçık Hüseyin Akan Lütfi İncesu

https://doi.org/10.15197/sabad.1.11.43

Öz

The aim of this study is evaluating the contribution of diffusion-weighted MR imaging (DWI) in the final diagnosis of patient that parotid gland tumours has been determined. Fourty patients with 41 parotid masses were included to this study. The mean Apparent Diffusion Coefficient (ADC) values were calculated for all of lesions by performing DWI. 28 benign and 13 malignant tumours were detected as a final diagnosis. ADC values of these lesions were compared. The optimal cutoff ADC value was determined for discrimination of these lesions by using ROC curve analysis. The most often benign and malignant tumours of parotid gland were pleomorphic adenoma and secondary tumours, respectively. The highest ADC value as 2.10±0.26×10-3 mm²/sec was belong to pleomorphic adenoma. The mean ADC value of pleomorphic adenoma was significantly higher than other lesions. As a result of ROC curve analysis, pleomorphic adenomas were differentiated from all other benign and malignant tumours with 1.60×10-3 mm²/sec cutoff ADC value that had sensitivity of 94.7% and specificity of 100%; and also malignant tumours were differentiated from Warthin\'s tumours with 1.01×10-3 mm²/sec cutoff ADC value that had sensitivity of 92.3% and specificity of 100%.We could differentiated pleomorphic adenomas, Warthin tumours and malignant tumours each other which are the most common parotid gland tumours by using the value of ADC.

Anahtar Kelimeler

Parotid gland, pleomorphic adenoma, magnetic resonance imaging, diffusion, ADC

Evaluating of Parotid Gland Tumours According to Diffusion Weighted MRI

Öz

Bu çalışmanın amacı, parotis bezi tümörü saptanan olgularda difüzyon ağırlıklı MRG (DAG)’nin son tanıya katkısını değerlendirmektir.Çalışmaya parotis bezinde toplam 41 lezyonu olan 40 hasta alındı. Tüm hastalara DAG yapılarak tüm lezyonların ortalama görünen difüzyon katsayısı (ADC) değerleri hesaplandı. Son tanıya göre 28 tane benin, 13 tane malin lezyon saptandı. Bu lezyonların ADC değerleri karşılaştırıldı. Ayrıca lezyonları ayırt etmek için ROC eğri analizi kullanılarak optimal cutoff ADC değerleri bulundu.Parotis bezinin en sık benin ve malin tümörleri sırasıyla pleomorfik adenom ve sekonder tümörler idi. En yüksek ADC değeri 2.10±0.26×10-3 mm²/sn ile pleomorfik adenomlara aitti. Pleomorfik adenomların ortalama ADC değeri diğer lezyonlardan anlamlı olarak yüksekti. ROC eğri analizi sonuçlarına göre pleomorfik adenom, diğer tüm benin ve malin tümörlerden 1.60x10-3 mm²/sn cutoff ADC değeri ile %94.7 duyarlılık ve %100 özgüllükle; malin tümörler, Whartin tümöründen ise 1.01x10-3 mm²/sn cutoff ADC değeri ile %92.3 duyarlılık ve %100 özgüllükle ayırt edildi. Biz çalışmamızda en sık görülen parotis bezi tümörleri olan pleomorfik adenom, Warthin tümörü ve malin tümörleri ADC değerlerini kullanarak ayırabildik

Anahtar Kelimeler

Parotis bezi, pleomorfik adenom, manyetik rezonans görüntüleme, difüzyon, ADC

Kaynakça

• Le Bihan D, Breton E, Lallemand D, Aubin ML, Vignaud J, Laval-Jeantet M. Separation of diffusion and perfusion in intravoxel incoherent motion MR imaging. Radiology 1988; 168: 497–505.
• Herneth AM, Guccione S, Bednarski M. Apparent diffusion coefficient: a quantitative parameter for in vivo tumor characterization. Eur J Radiol 2003; 45: 208-13.
• Batori M, Mariotta G, Giovannone G, Casella G, Casella MC. Warthin's tumor of parotid gland: treatment of a ret- roneural lesion by enucleation. Eur Rev Med Pharmacol Sci 2002; 6: 105–11.
• Zhang Y, Chen J, Shen J, Zhong J, Ye R, Liang B. Apparent diffusion coefficient values of necrotic and solid portion of lymph nodes: differential diagnostic value in cervical lymphadenopathy. Clin Radiol. 2013; 68(3): 224-31.
• Chawla S, Kim S, Dougherty L, et al. Pretreatment dif- fusion-weighted and dynamic contrast-enhanced MRI for prediction of local treatment response in squamous cell carcinomas of the head and neck. AJR Am J Roentgenol 2013; 200(1): 35-43.
• Baltzer PA, Benndorf M, Dietzel M, Gajda M, Camara O, Kaiser WA. Sensitivity and specificity of unenhanced MR mammography (DWI combined with T2-weighted TSE im- aging, ueMRM) for the differentiation of mass lesions. Eur Radiol 2010; 20: 1101-10.
• Öztekin O, Ozan E, Hilal Adıbelli Z, Ünal G, Abali Y. SSH- EPI diffusion-weighted MR imaging of the spine with low b values: is it useful in differentiating malignant metastatic tumor infiltration from benign fracture edema? Skeletal Radiol 2009; 38: 651-8.
• Nagata S, Nishimura H, Uchida M, Hayabuchi N. Diffusion- weighted MR Imaging in Musculoskeletal Radiology. Japanisch-Deutsche Medizinische Berichte 2005; 50: 640-51.
• Koh DM, Collins DJ. Diffusion-weighted MRI in the body: applications and challenges in oncology. Am J Roentgenol 2007; 188: 1622–35.
• Donovan DT, Conley JJ. Capsular significance in parotid tumor surgery: reality and myths of lateral lobectomy. Laryngoscope 1984; 94: 324–9.
• Friedman M, Rice DH, Spiro RH. Difficult decisions in pa- rotid surgery. Otolaryngol Clin North Am 1986; 19: 637-45
• Joe VQ, Westesson PL. Tumors of the parotid gland: MRimaging characteristics of various histologic types. AJR Am J Roentgenol 1994; 163: 433–8.
• Takashima S, Sone S, Takayama F, et al. Assessment of parotid masses: which MR pulse sequences are optimal? Eur J Radiol 1997; 24: 206–15.
• Das DK, Petkar MA, Al-Mane NM, Sheikh ZA, Mallik MK, Anim JT. Role of fine needle aspiration cytology in the di- agnosis of swellings in the salivary gland regions: a study of 712 cases. Med Princ Pract 2004; 13: 95–106.
• Behzatoğlu K, Bahadir B, Kaplan HH, Yücel Z, Durak H, Bozkurt ER. Fine needle aspiration biopsy of the parotid gland. Diagnostic problems and 2 uncommon cases. Acta Cytol 2004; 48: 149–54.
• King AD, Yeung DK, Ahuja AT, et al. Salivary gland tumors at in vivo proton MR spectroscopy. Radiology 2005; 237: 563–9.
• Eida S, Sumi M, Sakihama N, Takahashi H, Nakamura T. Apparent diffusion coefficient mapping of salivary gland tumors: prediction of the benignancy and malignancy. AJNR Am J Neuroradiol 2007; 28: 116–21.
• Habermann CR, Gossrau P, Graessner J, et al. Diffusion- weighted echo-planar MRI: a valuable tool for differenti- ating primary parotid gland tumors? Rofo 2005; 177: 940–5.
• Yoshino N, Yamada I, Ohbayashi N, et al. Salivary glands and lesions: evaluation of apparent diffusion coefficients with split-echo diffusion-weighted MR imaging--initial re- sults. Radiology 2001; 221: 837–42.
• Motoori K, Yamamoto S, Ueda T, Net al. Inter- and in- tratumoral variability in magnetic resonance imaging of pleomorphic adenoma: an attempt to interpret the vari- able magnetic resonance findings. J Comput Assist Tomogr 2004; 28: 233–46.
• Habermann CR, Arndt C, Graessner J, et al. Diffusion- Weighted Echo-Planar MR Imaging of Primary Parotid Gland Tumors: Is a Prediction of Different Histologic Subtypes Possible? AJNR Am J Neuroradiol 2009; 30(3): 591-6.
• Szafer A, Zhong J, Anderson AW, Gore JC. Diffusion- weighted imaging in tissues: theoretical models. NMR Biomed 1995; 8: 289–96.
• Chenevert TL, Meyer CR, Moffat BA, et al. Diffusion MRI: a new strategy for assessment of cancer therapeutic ef- ficacy. Mol Imaging 2002; 1: 336-43.
• Ross BD, Moffat BA, Lawrence TS, et al. Evaluation of cancer therapy using diffusion magnetic resonance imag- ing. Mol Cancer Ther 2003; 2: 581-7.
• Guo AC, Cummings TJ, Dash RC, Provenzale JM. Lymphomas and high-grade astrocytomas: compari- son of water diffusibility and histologic characteristics. Radiology 2002; 224: 177–83.
• Motoori K, Iida Y, Nagai Y, Yet al. MR imaging of salivary duct carcinoma. AJNR Am J Neuroradiol 2005; 26: 1201-6.
• Minami M, Tanioka H, Oyama K, et al. Warthin tumor of the parotid gland: MR-pathologic correlation. AJNR Am J Neuroradiol 1993; 14: 209–14.
• Ikeda M, Motoori K, Hanazawa T, et al. Warthin tumor of the parotid gland: diagnostic value of MR imaging with histopathologic correlation. AJNR Am J Neuroradiol 2004; 25: 1256-62.
• Yerli H, Agıldere M, Aydın E, et al. Value of apparent dif- fusion coefficient calculation in the differential diagnosis of parotid gland tumors. Acta Radiol 2007; 9: 980-7.
• Yerli H, Aydin E, Haberal N, Harman A, Kaskati T, Alibek S. Diagnosing common parotid tumours with magnetic resonance imaging including diffusion-weighted imaging vs fine-needle aspiration cytology: a comparative study. Dentomaxillofac Radiol 2010; 39(6) :349-55.
• Ikeda K, Katoh T, Ha-Kawa SK, Iwai H, Yamashita T, Tanaka Y. The usefulness of MR in establishing the diagnosis of parotid pleomorphic adenoma. AJNR Am J Neuroradiol 1996; 17: 555–9.