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Characterization of parotid gland tumors: added value of permeability MR imaging to DWI and DCE-MRI

Hidetake Yabuuchi¹, Takeshi Kamitani², Koji Sagiyama²

¹Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. h-yabu@med.kyushu-u.ac.jp.

European Radiology

|July 3, 2020

Abstract

Objectives:

To determine added value of permeability MRI in parotid tumor characterization to T2-weighted imaging (T2WI), semi-quantitative 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. Sixty-one 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 K_trans, k_ep, V_e, and V_p 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. k_ep and V_p values of Warthin's tumors were significantly higher than those of malignant tumors. Multivariate analyses showed that TIC pattern, D, and k_ep values were suitable parameters. McNemar's test showed a significant increase of sensitivity (11/12, 92%) and specificity (46/49, 94%) with adding k_ep. 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 semi-quantitative TIC analysis and IVIM analyses with D parameter. • The combination of TIC pattern, D, and k_ep 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.

Insights

Permeability MRI enhances parotid tumor characterization beyond standard imaging techniques. Combining permeability (k_ep) with diffusion (D) and time-intensity curve (TIC) analysis improves diagnostic accuracy for benign and malignant tumors.

Area of Science:

Radiology and Imaging Science
Oncology Imaging
Medical Diagnostics

Background:

Parotid tumors require accurate characterization for appropriate management.
Conventional MRI sequences like T2-weighted imaging (T2WI) and intra-voxel incoherent motion diffusion-weighted imaging (IVIM-DWI) have limitations in differentiating tumor types.
Dynamic contrast-enhanced MRI (DCE-MRI) with time-intensity curve (TIC) analysis offers semi-quantitative insights.

Purpose of the Study:

To evaluate the added diagnostic value of permeability MRI in parotid tumor characterization.
To compare permeability MRI against T2WI, semi-quantitative TIC analysis, and IVIM-DWI.
To assess the combined utility of these advanced MRI techniques for improved diagnostic accuracy.

Main Methods:

Retrospective analysis of 61 parotid tumors using T2WI, IVIM-DWI, and permeability MRI.
Measurement of quantitative parameters including apparent diffusion coefficients (ADCs), D, f, K_trans, k_ep, V_e, and V_p.
Comparison of diagnostic accuracy before and after incorporating permeability MRI data, with a validation study on 60 additional tumors.

Main Results:

Malignant tumors showed significantly lower ADC and D values compared to most benign tumors, except Warthin's tumors.
Warthin's tumors exhibited significantly higher k_ep and V_p values than malignant tumors.
The combination of TIC pattern, D, and k_ep values demonstrated high diagnostic sensitivity (92%) and specificity (94%), significantly improving accuracy.

Conclusions:

Permeability MRI provides significant added value to IVIM-MRI and semi-quantitative TIC analysis for parotid tumor characterization.
The integration of TIC pattern, D, and k_ep parameters facilitates accurate tumor differentiation, potentially reducing unnecessary surgeries and enabling timely treatment.
Combined permeability and diffusion MRI can guide biopsy site selection for improved diagnostic yield.

Read full analysis

Keywords:

Diffusion Magnetic resonance imaging Neoplasms Parotid gland Perfusion

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