Share：
Share this content in WeChat
X
[Chinese][PDF]822
• Clinical Article •
Differential diagnostic value of arterial spin labeling combined with diffusion tensor imaging in parotid gland tumors
ZHOU Jinliang  CUI Yunfu  ZHANG Diming  REN Rui  DI ningning  SHEN Shanchang  JIANG Xingyue  WANG Shanshan 

Cite this article as: ZHOU J L, CUI Y F, ZHANG D M, et al. Differential diagnostic value of arterial spin labeling combined with diffusion tensor imaging in parotid gland tumors[J]. Chin J Magn Reson Imaging, 2024, 15(3): 50-55. DOI:10.12015/issn.1674-8034.2024.03.009.


[Abstract] Objective To evaluate the clinical value of multi-parameter MRI in distinguishing parotid tumors by arterial spin labeling (ASL) and diffusion tensor imaging (DTI).Materials and Methods A total of 66 patients with surgically and pathologically proven parotid gland tumors from Binzhou Medical University Hospital from June 2019 to November 2023 were retrospectively analyzed. 3D ASL imaging and DTI were perfomed before surgery, and the maximum tumor blood flow (TBFmax), minimum apparent diffusion coefficient (ADCmin) and fraction anisotropy (FA) were measured. The Mann-Whitney U test or Kruskal-Wallis test were used to compare the parameters of benign tumors (BT) and malignant tumors (MT). Receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic efficacy of each parameter and the combination of different parameters for parotid tumors.Results There were 66 patients with parotid gland tumors, including 55 BT [15 Warthin tumors (WT), 23 pleomorphic adenomas (PA), 17 others] and 11 MT. The FA value of BT was lower than that of MT (0.13±0.06 vs. 0.18±0.04, P=0.003). The TBFmax value of PA [(43.72±37.64) mL/(100 g·min-1)] was lower than that of MT [(92.56±58.26) mL/(100 g·min-1)] (P<0.001) and WT [(145.26±64.54) mL/(100 g·min-1)] (P=0.016). The ADCmin value of PA [(1.55±0.51)×10-3 mm2/s] was higher than that of MT [(1.11±0.28)×10-3 mm2/s] (P=0.016) and WT [(1.03±0.53)×10-3 mm2/s] (P<0.001). The FA value of MT (0.18±0.05) was higher than that of PA (0.11±0.04) (P<0.001) and WT (0.12±0.02) (P=0.015). The area under the curve (AUC) for distinguishing BT from MT by FA was 0.78, and the sensitivity and specificity were 81.82% and 70.18%, respectively. The AUC for distinguishing WT, PA from MT by FA were 0.85 and 0.87, the sensitivity were 72.73% and 100.00%, and the specificity were 94.12% and 65.22%, respectively. The AUC for distinguishing WT from PA by TBFmax and ADCmin were 0.90 and 0.85, the sensitivity were 94.12% and 95.65%, and the specificity were 91.30% and 82.35%, respectively. The AUC for distinguishing PA from MT by combining them could be increased to 0.98, the sensitivity was 100.00%, and the specificity was 86.96%.Conclusions The combination of ASL and DTI is helpful for the differential diagnosis of benign and malignant parotid tumors, and the comprehensive application of multiple parameters is helpful for the differentiation of WT, PA and MT. Combining the different parameters can significantly improve the diagnostic efficiency of distinguishing PA from MT.
[Keywords] parotid gland tumors；Warthin tumor；pleomorphic adenoma；malignant tumors；arterial spin labeling；diffusion tensor imaging；magnetic resonance imaging

ZHOU Jinliang1   CUI Yunfu1   ZHANG Diming1   REN Rui2   DI ningning1   SHEN Shanchang1   JIANG Xingyue1   WANG Shanshan1*  

1 Department of Radiology, Binzhou Medical University Hospital, Binzhou 256600, China

2 Department of Out-Patient, Binzhou Medical University Hospital, Binzhou 256600, China

Corresponding author: WANG S S, E-mail: wss3256590@126.com

Conflicts of interest   None.

Received  2023-10-12
Accepted  2024-02-26
DOI: 10.12015/issn.1674-8034.2024.03.009
Cite this article as: ZHOU J L, CUI Y F, ZHANG D M, et al. Differential diagnostic value of arterial spin labeling combined with diffusion tensor imaging in parotid gland tumors[J]. Chin J Magn Reson Imaging, 2024, 15(3): 50-55. DOI:10.12015/issn.1674-8034.2024.03.009.

[1]
WEN B H, ZHANG Z X, ZHU J, et al. Apparent diffusion coefficient map-based radiomics features for differential diagnosis of pleomorphic adenomas and warthin tumors from malignant tumors[J/OL]. Front Oncol, 2022, 12: 830496 [2023-10-11]. https://pubmed.ncbi.nlm.nih.gov/35747827/. DOI: 10.3389/fonc.2022.830496.
[2]
FAGGIONI L, GABELLONI M, VIETRO F D, et al. Usefulness of MRI-based radiomic features for distinguishing Warthin tumor from pleomorphic adenoma: performance assessment using T2-weighted and post-contrast T1-weighted MR images[J/OL]. Eur J Radiol Open, 2022, 9: 100429 [2023-10-11]. https://pubmed.ncbi.nlm.nih.gov/35757232/. DOI: 10.1016/j.ejro.2022.100429.
[3]
GUNDUZ E, ALÇIN O F, KIZILAY A, et al. Deep learning model developed by multiparametric MRI in differential diagnosis of parotid gland tumors[J]. Eur Arch Otorhinolaryngol, 2022, 279(11): 5389-5399. DOI: 10.1007/s00405-022-07455-y.
[4]
HU Z B, GUO J J, FENG J J, et al. Value of T2-weighted-based radiomics model in distinguishing Warthin tumor from pleomorphic adenoma of the parotid[J]. Eur Radiol, 2023, 33(6): 4453-4463. DOI: 10.1007/s00330-022-09295-0.
[5]
MA G, XU X Q, ZHU L N, et al. Intravoxel incoherent motion magnetic resonance imaging for assessing parotid gland tumors: correlation and comparison with arterial spin labeling imaging[J]. Korean J Radiol, 2021, 22(2): 243-252. DOI: 10.3348/kjr.2020.0290.
[6]
KIM S Y, BORNER U, LEE J H, et al. Magnetic resonance imaging of parotid gland tumors: a pictorial essay[J/OL]. BMC Med Imaging, 2022, 22(1): 191 [2023-10-11]. https://pubmed.ncbi.nlm.nih.gov/36344914/. DOI: 10.1186/s12880-022-00924-0.
[7]
MARAGHELLI D, PIETRAGALLA M, CORDOPATRI C, et al. Magnetic resonance imaging of salivary gland tumours: key findings for imaging characterisation[J/OL]. Eur J Radiol, 2021, 139: 109716 [2023-10-11]. https://pubmed.ncbi.nlm.nih.gov/33866123/. DOI: 10.1016/j.ejrad.2021.109716.
[8]
GÖKÇE E. Multiparametric magnetic resonance imaging for the diagnosis and differential diagnosis of parotid gland tumors[J]. J Magn Reson Imaging, 2020, 52(1): 11-32. DOI: 10.1002/jmri.27061.
[9]
HUANG N, CHEN Y, SHE D J, et al. Diffusion kurtosis imaging and dynamic contrast-enhanced MRI for the differentiation of parotid gland tumors[J]. Eur Radiol, 2022, 32(4): 2748-2759. DOI: 10.1007/s00330-021-08312-y.
[10]
ZHU L, WANG C, YANG G X, et al. Imaging diagnosis and functional MRI of parotid tumors[J]. Chin J Radiol, 2022, 56(5): 587-590. DOI: 10.3760/cma.j.cn112149-20220310-00223.
[11]
ZHENG Y M, LI J, LIU S, et al. MRI-Based radiomics nomogram for differentiation of benign and malignant lesions of the parotid gland[J]. Eur Radiol, 2021, 31(6): 4042-4052. DOI: 10.1007/s00330-020-07483-4.
[12]
LIU S, SHI L X, YU B T, et al. Differential diagnosis of warthin tumor and malignant tumor based on magnetic resonance T1 sequence[J]. J Clin Radiol, 2023, 42(5): 739-742. DOI: 10.13437/j.cnki.jcr.2023.05.023.
[13]
YAN X L, YE D Q, CHEN J Y, et al. Clinical application of DWI combined with DKI and SWI in the diagnosis of parotid tumors[J]. Chin J Magn Reson Imag, 2023, 14(4): 41-45, 67. DOI: 10.12015/issn.1674-8034.2023.04.008.
[14]
LUNA L P, COFFEY W, ALVIN M D, et al. Parotid Warthin's tumor: novel MR imaging score as diagnostic indicator[J/OL]. Clin Imaging, 2022, 81: 9-14 [2023-10-11]. https://pubmed.ncbi.nlm.nih.gov/34598007/. DOI: 10.1016/j.clinimag.2021.09.005.
[15]
FRIEDMAN E, PATINO M O, ABDEL RAZEK A A K. MR imaging of salivary gland tumors[J]. Magn Reson Imaging Clin N Am, 2022, 30(1): 135-149. DOI: 10.1016/j.mric.2021.07.006.
[16]
WEN B H, CHENG J L. Application and progress of advanced MRI techniques in differentiating malignant from benign parotid gland tumors[J]. Chin J Magn Reson Imag, 2023, 14(1): 178-182, 188. DOI: 10.12015/issn.1674-8034.2023.01.033.
[17]
XIANG S Y, REN J L, XIA Z P, et al. Histogram analysis of dynamic contrast-enhanced magnetic resonance imaging in the differential diagnosis of parotid tumors[J/OL]. BMC Med Imaging, 2021, 21(1): 194 [2023-10-11]. https://pubmed.ncbi.nlm.nih.gov/34802576/. DOI: 10.1186/s12880-021-00724-y.
[18]
PÂRIS P, FATH L, SCHULTZ P, et al. Diffusion-weighted and gadolinium-enhanced dynamic MRI in parotid gland tumors[J]. Eur Arch Otorhinolaryngol, 2023, 280(1): 391-398. DOI: 10.1007/s00405-022-07590-6.
[19]
MARKIET K, GLINSKA A, NOWICKI T, et al. Feasibility of intravoxel incoherent motion (IVIM) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in differentiation of benign parotid gland tumors[J/OL]. Biology, 2022, 11(3): 399 [2023-10-11]. https://pubmed.ncbi.nlm.nih.gov/35336773/. DOI: 10.3390/biology11030399.
[20]
HU H, CHEN L, ZHU L N, et al. Influence of post-label delay time on the performance of 3D pseudo-continuous arterial spin labeling magnetic resonance imaging in the characterization of parotid gland tumors[J]. Eur Radiol, 2022, 32(2): 1087-1094. DOI: 10.1007/s00330-021-08220-1.
[21]
ABDEL RAZEK A A K, GADELHAK B N, ZAHABEY I A EL, et al. Diffusion-weighted imaging with histogram analysis of the apparent diffusion coefficient maps in the diagnosis of parotid tumours[J]. Int J Oral Maxillofac Surg, 2022, 51(2): 166-174. DOI: 10.1016/j.ijom.2021.03.019.
[22]
JIA C H, WANG S Y, LI Q, et al. Conventional, diffusion, and dynamic contrast-enhanced MRI findings for differentiating metaplastic Warthin's tumor of the parotid gland[J/OL]. Sci Prog, 2021, 104(2): 368504211018583 [2023-10-11]. https://pubmed.ncbi.nlm.nih.gov/34003684/. DOI: 10.1177/00368504211018583.
[23]
CHANG Y J, HUANG T Y, LIU Y J, et al. Classification of parotid gland tumors by using multimodal MRI and deep learning[J/OL]. NMR Biomed, 2021, 34(1): e4408 [2023-10-11]. https://pubmed.ncbi.nlm.nih.gov/32886955/. DOI: 10.1002/nbm.4408.
[24]
TAKUMI K, FUKUKURA Y, HAKAMADA H, et al. Value of diffusion tensor imaging in differentiating malignant from benign parotid gland tumors[J]. Eur J Radiol, 2017, 95: 249-256 [2023-10-11]. https://pubmed.ncbi.nlm.nih.gov/28987676/. DOI: 10.1016/j.ejrad.2017.08.013.
[25]
ZHANG G Z B, TIAN M T, DING C W, et al. Clinical value of arterial spin labeling imaging in the diagnosis of early parotid gland injury in Sj? gren's syndrome[J]. Chin J Magn Reson Imag, 2023, 14(5): 92-95, 131. DOI: 10.12015/issn.1674-8034.2023.05.017.
[26]
CHEN J, LIU S X, TANG Y D, et al. Performance of diffusion-weighted imaging for the diagnosis of parotid gland malignancies: a meta-analysis[J/OL]. Eur J Radiol, 2021, 134: 109444 [2023-10-11]. https://pubmed.ncbi.nlm.nih.gov/33310422/. DOI: 10.1016/j.ejrad.2020.109444.
[27]
YAMAMOTO T, KIMURA H, HAYASHI K, et al. Pseudo-continuous arterial spin labeling MR images in Warthin tumors and pleomorphic adenomas of the parotid gland: qualitative and quantitative analyses and their correlation with histopathologic and DWI and dynamic contrast enhanced MRI findings[J]. Neuroradiology, 2018, 60(8): 803-812. DOI: 10.1007/s00234-018-2046-9.
[28]
TANAKA F, UMINO M, MAEDA M, et al. Tumor blood flow and apparent diffusion coefficient histogram analysis for differentiating malignant salivary tumors from pleomorphic adenomas and Warthin's tumors[J/OL]. Sci Rep, 2022, 12(1): 5947 [2023-10-11]. https://pubmed.ncbi.nlm.nih.gov/35396374/. DOI: 10.1038/s41598-022-09968-2.
[29]
TAKUMI K, NAGANO H, KIKUNO H, et al. Differentiating malignant from benign salivary gland lesions: a multiparametric non-contrast MR imaging approach[J/OL]. Sci Rep, 2021, 11(1): 2780 [2023-10-11]. https://pubmed.ncbi.nlm.nih.gov/33531644/. DOI: 10.1038/s41598-021-82455-2.
[30]
RAZEK A A K A. Multi-parametric MR imaging using pseudo-continuous arterial-spin labeling and diffusion-weighted MR imaging in differentiating subtypes of parotid tumors[J/OL]. Magn Reson Imaging, 2019, 63: 55-59 [2023-10-11]. https://pubmed.ncbi.nlm.nih.gov/31422165/. DOI: 10.1016/j.mri.2019.08.005.
[31]
LYU H Y, LUO N B, LAI S L, et al. Preliminary study of 3.0T MR arterial spin labeling in the diagnosis of parotid gland tumors[J]. Radiol Pract, 2021, 36(3): 346-350. DOI: 10.13609/j.cnki.1000-0313.2021.03.011.
[32]
HOU J L, CHEN L, YE D H, et al. Clinical study by using pseudo-continuous arterial spin labeling and diffusion weighted imaging in differentiating parotid gland tumors[J]. J Pract Radiol, 2023, 39(1): 17-20, 36. DOI: 10.3969/j.issn.1002-1671.2023.01.005.
[33]
GÖKÇE E, BEYHAN M. Diagnostic efficacy of diffusion-weighted imaging and semiquantitative and quantitative dynamic contrast-enhanced magnetic resonance imaging in salivary gland tumors[J]. World J Radiol, 2023, 15(1): 20-31. DOI: 10.4329/wjr.v15.i1.20.
[34]
STOIA S, LENGHEL M, DINU C, et al. The value of multiparametric magnetic resonance imaging in the preoperative differential diagnosis of parotid gland tumors[J/OL]. Cancers, 2023, 15(4): 1325 [2023-10-11]. https://pubmed.ncbi.nlm.nih.gov/36831666/. DOI: 10.3390/cancers15041325.
[35]
ORHAN SOYLEMEZ U P, ATALAY B. Differentiation of benign and malignant parotid gland tumors with MRI and diffusion weighted imaging[J]. Medeni Med J, 2021, 36(2): 138-145. DOI: 10.5222/MMJ.2021.84666.
[36]
KARAMAN C Z, TANYERI A, ÖZGÜR R, et al. Parotid gland tumors: comparison of conventional and diffusion-weighted MRI findings with histopathological results[J/OL]. Dentomaxillofac Radiol, 2021, 50(4): 20200391 [2023-10-11]. https://pubmed.ncbi.nlm.nih.gov/33237812/. DOI: 10.1259/dmfr.20200391.
[37]
WEN B H, ZHU J, ZHANG Z X, et al. T2 mapping and readout segmentation of long variable echo-train diffusion-weighted imaging for the differentiation of parotid gland tumors[J/OL]. Eur J Radiol, 2022, 151: 110265 [2023-10-11]. https://pubmed.ncbi.nlm.nih.gov/35472650/. DOI: 10.1016/j.ejrad.2022.110265.
[38]
KHALEK ABDEL RAZEK A A. Characterization of salivary gland tumours with diffusion tensor imaging[J/OL]. Dentomaxillofac Radiol, 2018, 47(5): 20170343 [2023-10-11]. https://pubmed.ncbi.nlm.nih.gov/29412748/. DOI: 10.1259/dmfr.20170343.

PREV Multimodal study of resting state functional MRI in patients with acute mild traumatic brain injury
NEXT Value of 4D-Flow MRI in evaluating left ventricular outflow tract peak velocity in hypertrophic cardiomyopathy: A proof-of-concept study
  


LINK


Tel & Fax: +8610-67113815    E-mail: editor@cjmri.cn