1
|
Wang Y, Hu H, Ban X, Jiang Y, Su Y, Yang L, Shi G, Yang L, Han R, Duan X. Evaluation of Quantitative Dual-Energy Computed Tomography Parameters for Differentiation of Parotid Gland Tumors. Acad Radiol 2024; 31:2027-2038. [PMID: 37730491 DOI: 10.1016/j.acra.2023.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/15/2023] [Accepted: 08/19/2023] [Indexed: 09/22/2023]
Abstract
RATIONALE AND OBJECTIVES To assess the diagnostic performance of quantitative parameters from dual-energy CT (DECT) in differentiating parotid gland tumors (PGTs). MATERIALS AND METHODS 101 patients with 108 pathologically proved PGTs were enrolled and classified into four groups: pleomorphic adenomas (PAs), warthin tumors (WTs), other benign tumors (OBTs), and malignant tumors (MTs). Conventional CT attenuation and DECT quantitative parameters, including iodine concentration (IC), normalized iodine concentration (NIC), effective atomic number (Zeff), electron density (Rho), double energy index (DEI), and the slope of the spectral Hounsfield unit curve (λHU), were obtained and compared between benign tumors (BTs) and MTs, and further compared among the four subgroups. Logistic regression analysis was used to assess the independent parameters and the receiver operating characteristic (ROC) curves were used to analyze the diagnostic performance. RESULTS Attenuation, Zeff, DEI, IC, NIC, and λHU in the arterial phase (AP) and venous phase (VP) were higher in MTs than in BTs (p < 0.001-0.047). λHU in VP and Zeff in AP were independent predictors with an area under the curve (AUC) of 0.84 after the combination. Furthermore, attenuation, Zeff, DEI, IC, NIC, and λHU in the AP and VP of MTs were higher than those of PAs (p < 0.001-0.047). Zeff and NIC in AP and λHU in VP were independent predictors with an AUC of 0.93 after the combination. Attenuation and Rho in the precontrast phase; attenuation, Rho, Zeff, DEI, IC, NIC, and λHU in AP; and the Rho in the VP of PAs were lower than those of WTs (p < 0.001-0.03). Rho in the precontrast phase and attenuation in AP were independent predictors with an AUC of 0.89 after the combination. MTs demonstrated higher Zeff, DEI, IC, NIC, and λHU in VP and lower Rho in the precontrast phase compared with WTs (p < 0.001-0.04); but no independent predictors were found. CONCLUSION DECT quantitative parameters can help to differentiate PGTs.
Collapse
Affiliation(s)
- Yu Wang
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong, China (Y.W., H.H., Y.J., Y.S., L.Y., G.S., L.Y., R.H., X.D.)
| | - Huijun Hu
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong, China (Y.W., H.H., Y.J., Y.S., L.Y., G.S., L.Y., R.H., X.D.)
| | - Xiaohua Ban
- Department of Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou 510060, Guangdong, China (X.B.)
| | - Yusong Jiang
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong, China (Y.W., H.H., Y.J., Y.S., L.Y., G.S., L.Y., R.H., X.D.)
| | - Yun Su
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong, China (Y.W., H.H., Y.J., Y.S., L.Y., G.S., L.Y., R.H., X.D.)
| | - Lingjie Yang
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong, China (Y.W., H.H., Y.J., Y.S., L.Y., G.S., L.Y., R.H., X.D.)
| | - Guangzi Shi
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong, China (Y.W., H.H., Y.J., Y.S., L.Y., G.S., L.Y., R.H., X.D.); Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, Guangdong, China (G.S., X.D.)
| | - Lu Yang
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong, China (Y.W., H.H., Y.J., Y.S., L.Y., G.S., L.Y., R.H., X.D.)
| | - Riyu Han
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong, China (Y.W., H.H., Y.J., Y.S., L.Y., G.S., L.Y., R.H., X.D.)
| | - Xiaohui Duan
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong, China (Y.W., H.H., Y.J., Y.S., L.Y., G.S., L.Y., R.H., X.D.); Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, Guangdong, China (G.S., X.D.).
| |
Collapse
|
2
|
Önder M, Evli C, Türk E, Kazan O, Bayrakdar İŞ, Çelik Ö, Costa ALF, Gomes JPP, Ogawa CM, Jagtap R, Orhan K. Deep-Learning-Based Automatic Segmentation of Parotid Gland on Computed Tomography Images. Diagnostics (Basel) 2023; 13:diagnostics13040581. [PMID: 36832069 PMCID: PMC9955422 DOI: 10.3390/diagnostics13040581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/23/2023] [Accepted: 02/02/2023] [Indexed: 02/08/2023] Open
Abstract
This study aims to develop an algorithm for the automatic segmentation of the parotid gland on CT images of the head and neck using U-Net architecture and to evaluate the model's performance. In this retrospective study, a total of 30 anonymized CT volumes of the head and neck were sliced into 931 axial images of the parotid glands. Ground truth labeling was performed with the CranioCatch Annotation Tool (CranioCatch, Eskisehir, Turkey) by two oral and maxillofacial radiologists. The images were resized to 512 × 512 and split into training (80%), validation (10%), and testing (10%) subgroups. A deep convolutional neural network model was developed using U-net architecture. The automatic segmentation performance was evaluated in terms of the F1-score, precision, sensitivity, and the Area Under Curve (AUC) statistics. The threshold for a successful segmentation was determined by the intersection of over 50% of the pixels with the ground truth. The F1-score, precision, and sensitivity of the AI model in segmenting the parotid glands in the axial CT slices were found to be 1. The AUC value was 0.96. This study has shown that it is possible to use AI models based on deep learning to automatically segment the parotid gland on axial CT images.
Collapse
Affiliation(s)
- Merve Önder
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Ankara University, Ankara 06000, Turkey
| | - Cengiz Evli
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Ankara University, Ankara 06000, Turkey
| | - Ezgi Türk
- Dentomaxillofacial Radiology, Oral and Dental Health Center, Hatay 31040, Turkey
| | - Orhan Kazan
- Health Services Vocational School, Gazi University, Ankara 06560, Turkey
| | - İbrahim Şevki Bayrakdar
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Eskisehir Osmangazi University, Eskişehir 26040, Turkey
- Eskisehir Osmangazi University Center of Research and Application for Computer-Aided Diagnosis and Treatment in Health, Eskişehir 26040, Turkey
- Division of Oral and Maxillofacial Radiology, Department of Care Planning and Restorative Sciences, University of Mississippi Medical Center School of Dentistry, Jackson, MS 39216, USA
| | - Özer Çelik
- Eskisehir Osmangazi University Center of Research and Application for Computer-Aided Diagnosis and Treatment in Health, Eskişehir 26040, Turkey
- Department of Mathematics-Computer, Faculty of Science, Eskisehir Osmangazi University, Eskişehir 26040, Turkey
| | - Andre Luiz Ferreira Costa
- Postgraduate Program in Dentistry, Cruzeiro do Sul University (UNICSUL), São Paulo 01506-000, SP, Brazil
| | - João Pedro Perez Gomes
- Department of Stomatology, Division of General Pathology, School of Dentistry, University of São Paulo (USP), São Paulo 13560-970, SP, Brazil
| | - Celso Massahiro Ogawa
- Postgraduate Program in Dentistry, Cruzeiro do Sul University (UNICSUL), São Paulo 01506-000, SP, Brazil
| | - Rohan Jagtap
- Division of Oral and Maxillofacial Radiology, Department of Care Planning and Restorative Sciences, University of Mississippi Medical Center School of Dentistry, Jackson, MS 39216, USA
| | - Kaan Orhan
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Ankara University, Ankara 06000, Turkey
- Department of Dental and Maxillofacial Radiodiagnostics, Medical University of Lublin, 20-093 Lublin, Poland
- Ankara University Medical Design Application and Research Center (MEDITAM), Ankara 06000, Turkey
- Correspondence: ; Tel.: +48-81-448-50-00
| |
Collapse
|
3
|
Deng D, Dong H. Advantages of contrast-enhanced CT combined with DCE-MRI in identifying malignant parotid tumor. Am J Transl Res 2022; 14:9047-9056. [PMID: 36628209 PMCID: PMC9827335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 11/14/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To study the value of single and combined application of contrast-enhanced computerized tomography (CT) and dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) in diagnosing parotid tumors. METHODS In this retrospective study, 82 patients with parotid gland mass who received contrast-enhanced CT and DCE-MRI detection in The First People's Hospital of Huzhou from March 2018 to March 2022 were selected as study subjects. The nature of the parotid tumor was pathologically examined following the surgery. According to the pathological diagnosis results, these patients were divided into a benign group (n=59) and a malignant group (n=23). All patients underwent contrast-enhanced CT and DCE-MRI examinations. The diagnostic accuracy rates of contrast-enhanced CT, DCE-MRI and the joint application were compared. The CT or MRI images of benign and malignant parotid tumors were compared. The correlation of parotid cancer with the imaging features was analyzed. Diagnostic efficiency of contrast-enhanced CT, DCE-MRI and joint application for parotid cancer was assessed by receiver operating characteristic curve. RESULTS In terms of diagnostic accuracy, there was a significant difference between contrast-enhanced CT combined with DCE-MRI and contrast-enhanced CT alone (95.12% vs. 81.71%, P<0.001), and between the joint application and DCE-MRI alone (95.12% vs. 86.58%, P=0.004). Results of contrast-enhanced CT revealed statistical differences in tumor boundary, tumor size, calcification and cystic degeneration between benign and malignant tumors (P<0.05), but no obvious difference in lymph node enlargement between the two groups. MRI results showed that there were differences in the DCE-MRI time-signal intensity curve and ADC value between benign and malignant tumors (P<0.05). Correlation analysis results showed that the malignant tumor was negatively correlated with tumor boundary, calcification, cystic degeneration and ADC values, and it was positively correlated with DCE-MRI time-signal intensity curve and tumor size (P<0.05). Analysis of diagnostic efficacy showed that contrast-enhanced CT combined with DCE-MRI were significantly better than contrast-enhanced CT alone in terms of sensitivity and specificity (P<0.05). Moreover, the sensitivity of the joint application was also higher than that of MRI alone, while no obvious difference was found for specificity between joint application and MRI alone. The areas under the curve of contrast-enhanced CT combined with DCE-MRI in diagnosing malignant parotid tumor was remarkably greater than that of CT or MRI alone (P<0.05). CONCLUSION Contrast-enhanced CT combined with DCE-MRI can significantly improve the diagnostic accuracy, sensitivity and specificity for malignant parotid tumor, and the joint application was able to point out the direction of targeted surgical treatment plans.
Collapse
|
4
|
Distinguishing Parotid Polymorphic Adenoma and Warthin Tumor Based on the CT Radiomics Nomogram: A Multicenter Study. Acad Radiol 2022; 30:717-726. [PMID: 35953356 DOI: 10.1016/j.acra.2022.06.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 11/20/2022]
Abstract
RATIONALE AND OBJECTIVES To develop, validate, and test a comprehensive radiomics prediction model to distinguish parotid polymorphic adenomas (PAs) and warthin tumors (WTs) using clinical data and enhanced computed tomography (CT) from a multicenter cohort. MATERIALS AND METHODS A total of 267 patients with PAs (n =172) or WTs (n = 95) from two hospitals were randomly divided into training (n =188) and validation (n =79) datasets. Radiomics features were extracted from the enhanced CT (arterial phase) followed by dimensionality reduction. Clinical and CT features were combined to establish a prediction model. A radiomics nomogram was constructed by combining RadScore and clinical factors. Moreover, an independent dataset of 31 patients from a third hospital was employed to test the model. Thus, the performance of the nomogram, radiomics signature, and clinical models was evaluated on the training, validation, and the independent testing datasets. Receiver operating characteristic (ROC) curves were used to compare the performance, and decision curve analysis (DCA) was used to evaluate the clinical effectiveness of the model. RESULTS A total of 15 radiomics features were selected from CT data as the imaging markers to generate RadScores, and demographics or clinical data like age, sex, and smoking factors combined with RadScores were used to distinguish PAs and WTs based on multivariate logistic regression analyses. The results showed that radiomics nomograms combining clinical factors and RadScores provided satisfactory predictive values for distinguishing PAs from WTs, with areas under ROC curves (AUC) of 0.979, 0.922, and 0.903 for the training, validation, and the independent testing datasets, respectively. Decision curve analysis revealed that the radiomics nomogram outperformed the clinical factor models in terms of accuracy and effectiveness. CONCLUSION CT-based radiomics nomograms combining RadScores and clinical factors can be used to identify PAs and WTs, which may help tumor management by clinicians.
Collapse
|
5
|
Hu H, Chen L, Zhu LN, Chen W, Su GY, Dou W, Bu SS, Wu FY, Xu XQ. 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. Eur Radiol 2021; 32:1087-1094. [PMID: 34347158 DOI: 10.1007/s00330-021-08220-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/30/2021] [Accepted: 07/15/2021] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To evaluate the influence of post-label delay times (PLDs) on the performance of 3D pseudo-continuous arterial spin labeling (pCASL) magnetic resonance imaging for characterizing parotid gland tumors and to explore the optimal PLDs for the differential diagnosis. MATERIALS AND METHOD Fifty-eight consecutive patients with parotid gland tumors were enrolled, including 33 patients with pleomorphic adenomas (PAs), 16 patients with Warthin's tumors (WTs), and 9 patients with malignant tumors (MTs). 3D pCASL was scanned for each patient five times, with PLDs of 1025 ms, 1525 ms, 2025 ms, 2525 ms, and 3025 ms. Tumor blood flow (TBF) was calculated, and compared among different PLDs and tumor groups. Performance of TBF at different PLDs was evaluated using receiver operating characteristic analysis. RESULTS With an increasing PLD, TBF tended to gradually increase in PAs (p < 0.001), while TBF tended to slightly increase and then gradually decrease in WTs (p = 0.001), and PAs showed significantly lower TBF than WTs at all 5 PLDs (p < 0.05). PAs showed significantly lower TBF than MTs at 4 PLDs (p < 0.05), except at 3025 ms (p = 0.062). WTs showed higher TBF than MTs at all 5 PLDs; however, differences did not reach significance (p > 0.05). Setting a TBF of 64.350 mL/100g/min at a PLD of 1525 ms, or a TBF of 23.700 mL/100g/min at a PLD of 1025 ms as the cutoff values, optimal performance could be obtained for differentiating PAs from WTs (AUC = 0.905) or from MTs (AUC = 0.872). CONCLUSIONS Short PLDs (1025 ms or 1525 ms) are suggested to be used in 3D pCASL for characterizing parotid gland tumors in clinical practice. KEY POINTS • With 5 different PLDs, 3D pCASL can reflect the variation of blood flow in parotid gland tumors. • 3D pCASL is useful for characterizing PAs from WTs or MTs. • Short PLDs (1025 ms or 1525 ms) are suggested to be used in 3D pCASL for characterizing parotid gland tumors in clinical practice.
Collapse
Affiliation(s)
- Hao Hu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd, Gulou District, Nanjing, People's Republic of China
| | - Lu Chen
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd, Gulou District, Nanjing, People's Republic of China
| | - Liu-Ning Zhu
- Department of Stomatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Wei Chen
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd, Gulou District, Nanjing, People's Republic of China
| | - Guo-Yi Su
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd, Gulou District, Nanjing, People's Republic of China
| | - Weiqiang Dou
- GE Healthcare, MR Research China, Beijing, People's Republic of China
| | - Shou-Shan Bu
- Department of Stomatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Fei-Yun Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd, Gulou District, Nanjing, People's Republic of China.
| | - Xiao-Quan Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd, Gulou District, Nanjing, People's Republic of China.
| |
Collapse
|
6
|
The Clinical Characteristics and CT Findings of Parotid and Submandibular Gland Tumours. JOURNAL OF ONCOLOGY 2021; 2021:8874100. [PMID: 34306079 PMCID: PMC8272666 DOI: 10.1155/2021/8874100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 06/21/2021] [Indexed: 11/17/2022]
Abstract
Objective To investigate the clinical characteristics and CT findings of parotid and submandibular gland tumours. Materials and methods. From May 2017 to April 2020, all patients with clinically proven parotid and submandibular gland enlargement and palpable masses underwent CT examinations. All patients were confirmed by pathology after surgery. The clinical characteristics and CT features were observed and evaluated. The mean density values before and after enhancement were measured and analyzed. The chi-square test, one-way ANOVA, and Student's t-test were used. Results Ninety-four patients with a total of 94 unilateral tumours in the parotid and submandibular glands were enrolled, including 38 pleomorphic adenomas (PAs), 27 Warthin's tumours (WTs), and 29 malignant tumours (MTs). The majority of the PAs (28/38) and MTs (23/29) were located in the parotid gland; the others were located in the submandibular gland. All the WTs were in the parotid gland. The most common benign tumours of the parotid gland were PAs (28/38, 73.7%) and WTs (27/27, 100%), and the most common MTs were mucoepidermoid carcinoma, acinic cell carcinoma, and squamous cell carcinoma (4/29, 13.8%). The most common benign and malignant tumours in the submandibular gland were PAs (10/38, 26.3%) and ductal adenocarcinomas (3/4, 75%). The majority of PA patients (28/38) were female, compared with WT (2/27) (P < 0.001) and malignant tumour patients (10/29) (P < 0.01). A significant difference was also found between WTs and MTs in female patients (P < 0.05). The mean age of PA patients was 43.4 ± 12.1 years, which was lower than that of WTs (62.1 ± 11.7) and MTs (58 ± 14.18) (P < 0.001, P < 0.001, and P=0.244, respectively). On CT imaging, the mean diameter of the PAs and WTs was significantly smaller than that of the MTs (P=0.001 and P < 0.001), and no difference was observed between the PAs and WTs (P=0.275). In the parotid gland, the superficial lobe was more frequently involved than the deep lobe (PAs, 22 : 6; WTs, 17 : 10; and MTs, 15 : 8). The majority of PAs and WTs demonstrated round shapes (25/38, 19/27) and were well defined (30/38, 24/27); by contrast, most MTs were lobulated, irregular shapes (24/29), and ill defined (25/29). On plain CT, the PAs were usually homogeneous, while MTs were frequently heterogeneous, with more necrosis, larger cystic areas, and more haemorrhage or calcification. The mean CT values of PAs, WTs, and MTs were 39.2 ± 3.9 HU, 39.1 ± 3.0 HU, and 37.6 ± 3.1 HU (P > 0.05), respectively. On contrast CT, the WTs were significantly enhanced compared with MTs and PAs, with mean CT values of 53.5 ± 4.0 HU, 84.4 ± 6.0 HU, and 65.2 ± 3.8 HU, respectively (all P < 0.001). The mean CT value changes for PAs, WTs, and MTs (∆) were 14.4 ± 3.0 HU, 45.3 ± 4.5 HU, and 27.7 ± 2.5 HU, respectively. Significant differences were observed between ∆PAs and ∆WTs, ∆PAs and ∆MTs, and ∆WTs and ∆MTs (all P < 0.001). Conclusion Parotid and submandibular gland tumours have some typical clinical characteristics and CT findings, and plain and early contrast-phase CT combined with clinical parameters may be helpful for diagnosis.
Collapse
|
7
|
Xu Y, Shu Z, Song G, Liu Y, Pang P, Wen X, Gong X. The Role of Preoperative Computed Tomography Radiomics in Distinguishing Benign and Malignant Tumors of the Parotid Gland. Front Oncol 2021; 11:634452. [PMID: 33777789 PMCID: PMC7988088 DOI: 10.3389/fonc.2021.634452] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 02/02/2021] [Indexed: 12/13/2022] Open
Abstract
Objective This study aimed to develop and validate an integrated prediction model based on clinicoradiological data and computed tomography (CT)-radiomics for differentiating between benign and malignant parotid gland (PG) tumors via multicentre cohorts. Materials and Methods A cohort of 87 PG tumor patients from hospital #1 who were diagnosed between January 2017 and January 2020 were used for prediction model training. A total of 378 radiomic features were extracted from a single tumor region of interest (ROI) of each patient on each phase of CT images. Imaging features were extracted from plain CT and contrast-enhanced CT (CECT) images. After dimensionality reduction, a radiomics signature was constructed. A combination model was constructed by incorporating the rad-score and CT radiological features. An independent group of 38 patients from hospital #2 was used to validate the prediction models. The model performances were evaluated by receiver operating characteristic (ROC) curve analysis, and decision curve analysis (DCA) was used to evaluate the clinical effectiveness of the models. The radiomics signature model was constructed and the rad-score was calculated based on selected imaging features from plain CT and CECT images. Results Analysis of variance and multivariable logistic regression analysis showed that location, lymph node metastases, and rad-score were independent predictors of tumor malignant status. The ROC curves showed that the accuracy of the support vector machine (SVM)-based prediction model, radiomics signature, location and lymph node status in the training set was 0.854, 0.772, 0.679, and 0.632, respectively; specificity was 0.869, 0.878, 0.734, and 0.773; and sensitivity was 0.731, 0.808, 0.723, and 0.742. In the test set, the accuracy was 0.835, 0.771, 0.653, and 0.608, respectively; the specificity was 0.741, 0.889, 0.852, and 0.812; and the sensitivity was 0.818, 0.790, 0.731, and 0.716. Conclusions The combination model based on the radiomics signature and CT radiological features is capable of evaluating the malignancy of PG tumors and can help clinicians guide clinical tumor management.
Collapse
Affiliation(s)
- Yuyun Xu
- Department of Radiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Zhenyu Shu
- Department of Radiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Ge Song
- Department of Radiology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Yijun Liu
- Department of Radiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Peipei Pang
- Department of Pharmaceuticals Diagnosis, GE Healthcare, Hangzhou, China
| | - Xuehua Wen
- Department of Radiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Xiangyang Gong
- Department of Radiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, China.,Institute of Artificial Intelligence and Remote Imaging, Hangzhou Medical College, Hangzhou, China
| |
Collapse
|
8
|
Stoia S, Băciuț G, Lenghel M, Badea R, Csutak C, Rusu GM, Băciuț M, Tamaș T, Boțan E, Armencea G, Bran S, Dinu C. Cross-sectional imaging and cytologic investigations in the preoperative diagnosis of parotid gland tumors - An updated literature review. Bosn J Basic Med Sci 2021; 21:19-32. [PMID: 32893758 PMCID: PMC7861630 DOI: 10.17305/bjbms.2020.5028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 09/01/2020] [Indexed: 02/07/2023] Open
Abstract
An accurate preoperative diagnosis of parotid tumors is essential for the selection and planning of surgical treatment. Various modern cross-sectional imaging and cytologic investigations can support the differential diagnosis of parotid tumors. The aim of this study was to achieve a comprehensive and updated review of modern imaging and cytologic investigations used in parotid tumor diagnosis, based on the latest literature data. This literature review could serve as a guide for clinicians in selecting different types of investigations for the preoperative differential diagnosis of parotid tumors. Magnetic resonance imaging (MRI) with its dynamic and advanced sequences is the first-line imaging investigation used in differentiating parotid tumors. Computed tomography (CT) and positron emission tomography (PET)-CT provide limited indications in differentiating parotid tumors. Fine needle aspiration biopsy and core needle biopsy can contribute with satisfactory results to the cytological diagnosis of parotid tumors. Dynamic MRI with its dynamic contrast-enhanced and diffusion-weighted sequences provides the best accuracy for the preoperative differential diagnosis of parotid tumors. CT allows the best evaluation of bone invasion, being useful when MRI cannot be performed, and PET-CT has value in the follow-up of cancer patients. The dual cytological and imaging approach is the safest method for an accurate differential diagnosis of parotid tumors.
Collapse
Affiliation(s)
- Sebastian Stoia
- Department of Maxillofacial Surgery and Implantology, Faculty of Dentistry, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Grigore Băciuț
- Department of Maxillofacial Surgery and Implantology, Faculty of Dentistry, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Manuela Lenghel
- Department of Radiology, Faculty of Medicine, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Radu Badea
- Department of Medical Imaging, Faculty of Medicine, "Iuliu Hațieganu" University of Medicine and Pharmacy, Department of Medical Imaging, "Prof. Dr. Octavian Fodor" Regional Institute of Gastroenterology, Cluj-Napoca, Romania
| | - Csaba Csutak
- Department of Radiology, Faculty of Medicine, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Georgeta Mihaela Rusu
- Department of Radiology, Faculty of Medicine, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Mihaela Băciuț
- Department of Maxillofacial Surgery and Implantology, Faculty of Dentistry, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Tiberiu Tamaș
- Department of Maxillofacial Surgery and Implantology, Faculty of Dentistry, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Emil Boțan
- Department of Pathology, Emergency County Hospital, Cluj-Napoca, Romania
| | - Gabriel Armencea
- Department of Maxillofacial Surgery and Implantology, Faculty of Dentistry, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Simion Bran
- Department of Maxillofacial Surgery and Implantology, Faculty of Dentistry, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Cristian Dinu
- Department of Maxillofacial Surgery and Implantology, Faculty of Dentistry, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| |
Collapse
|
9
|
Ma G, Xu XQ, Zhu LN, Jiang JS, Su GY, Hu H, Bu SS, Wu FY. Intravoxel Incoherent Motion Magnetic Resonance Imaging for Assessing Parotid Gland Tumors: Correlation and Comparison with Arterial Spin Labeling Imaging. Korean J Radiol 2020; 22:243-252. [PMID: 32932565 PMCID: PMC7817638 DOI: 10.3348/kjr.2020.0290] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 04/14/2020] [Accepted: 06/06/2020] [Indexed: 12/26/2022] Open
Abstract
Objective To compare and correlate the findings of intravoxel incoherent motion (IVIM) magnetic resonance (MR) imaging and arterial spin labeling (ASL) imaging in characterizing parotid gland tumors. Materials and Methods We retrospectively reviewed 56 patients with parotid gland tumors evaluated by MR imaging. The true diffusion coefficient (D), pseudo-diffusion coefficient (D*), and fraction of perfusion (f) values of IVIM imaging and tumor-to-parotid gland signal intensity ratio (SIR) on ASL imaging were calculated. Spearman rank correlation coefficient, chi-squared, Mann-Whitney U, and Kruskal-Wallis tests with the post-hoc Dunn-Bonferroni method and receiver operating characteristic curve assessments were used for statistical analysis. Results Malignant parotid gland tumors showed significantly lower D than benign tumors (p = 0.019). Within subgroup analyses, pleomorphic adenomas (PAs) showed significantly higher D than malignant tumors (MTs) and Warthin's tumors (WTs) (p < 0.001). The D* of WTs was significantly higher than that of PAs (p = 0.031). The f and SIR on ASL imaging of WTs were significantly higher than those of MTs and PAs (p < 0.05). Significantly positive correlation was found between SIR on ASL imaging and f (r = 0.446, p = 0.001). In comparison with f, SIR on ASL imaging showed a higher area under curve (0.853 vs. 0.891) in discriminating MTs from WTs, although the difference was not significant (p = 0.720). Conclusion IVIM and ASL imaging could help differentiate parotid gland tumors. SIR on ASL imaging showed a significantly positive correlation with f. ASL imaging might hold potential to improve the ability to discriminate MTs from WTs.
Collapse
Affiliation(s)
- Gao Ma
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiao Quan Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Liu Ning Zhu
- Department of Stomatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jia Suo Jiang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Guo Yi Su
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hao Hu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shou Shan Bu
- Department of Stomatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Fei Yun Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
| |
Collapse
|
10
|
Zhang D, Li X, Lv L, Yu J, Yang C, Xiong H, Liao R, Zhou B, Huang X, Liu X, Tang Z. Improving the diagnosis of common parotid tumors via the combination of CT image biomarkers and clinical parameters. BMC Med Imaging 2020; 20:38. [PMID: 32293304 PMCID: PMC7161241 DOI: 10.1186/s12880-020-00442-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 04/07/2020] [Indexed: 01/10/2023] Open
Abstract
Background Our study aims to develop and validate diagnostic models of the common parotid tumors based on whole-volume CT textural image biomarkers (IBMs) in combination with clinical parameters at a single institution. Methods The study cohort was composed of 51 pleomorphic adenoma (PA) patients and 42 Warthin tumor (WT) patients. Clinical parameters and conventional image features were scored retrospectively and textural IBMs were extracted from CT images of arterial phase. Independent-samples t test or Chi-square test was used for evaluating the significance of the difference among clinical parameters, conventional CT image features, and textural IBMs. The diagnostic performance of univariate model and multivariate model was evaluated via receiver operating characteristic (ROC) curve and area under ROC curve (AUC). Results Significant differences were found in clinical parameters (age, gender, disease duration, smoking), conventional image features (site, maximum diameter, time-density curve, peripheral vessels sign) and textural IBMs (mean, uniformity, energy, entropy) between PA group and WT group (P<0.05). ROC analysis showed that clinical parameter (age) and quantitative textural IBMs (mean, energy, entropy) were able to categorize the patients into PA group and WT group, with the AUC of 0.784, 0.902, 0.910, 0.805, respectively. When IBMs were added in clinical model, the multivariate models including age-mean and age-energy performed significantly better than the univariate models with the improved AUC of 0.940, 0.944, respectively (P<0.001). Conclusions Both clinical parameter and CT textural IBMs can be used for the preoperative, noninvasive diagnosis of parotid PA and WT. The diagnostic performance of textural IBM model was obviously better than that of clinical model and conventional image model in this study. While the multivariate model consisted of clinical parameter and textural IBM had the optimal diagnostic performance, which would contribute to the better selection of individualized surgery program.
Collapse
Affiliation(s)
- Dan Zhang
- Department of Radiology, Chongqing General Hospital, University of Chinese Academy of Sciences, No.104 Pipashan Main St, Yuzhong District, Chongqing, 400014, China.,Molecular and Functional Imaging Laboratory, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, 400014, China
| | - Xiaojiao Li
- Department of Radiology, Chongqing General Hospital, University of Chinese Academy of Sciences, No.104 Pipashan Main St, Yuzhong District, Chongqing, 400014, China.,Molecular and Functional Imaging Laboratory, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, 400014, China
| | - Liang Lv
- Department of Radiology, Chongqing General Hospital, University of Chinese Academy of Sciences, No.104 Pipashan Main St, Yuzhong District, Chongqing, 400014, China
| | - Jiayi Yu
- Department of Radiology, Chongqing General Hospital, University of Chinese Academy of Sciences, No.104 Pipashan Main St, Yuzhong District, Chongqing, 400014, China.,Molecular and Functional Imaging Laboratory, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, 400014, China
| | - Chao Yang
- Department of Radiology, Chongqing General Hospital, University of Chinese Academy of Sciences, No.104 Pipashan Main St, Yuzhong District, Chongqing, 400014, China.,Molecular and Functional Imaging Laboratory, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, 400014, China
| | - Hua Xiong
- Department of Radiology, Chongqing General Hospital, University of Chinese Academy of Sciences, No.104 Pipashan Main St, Yuzhong District, Chongqing, 400014, China.,Molecular and Functional Imaging Laboratory, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, 400014, China
| | - Ruikun Liao
- Department of Radiology, Chongqing General Hospital, University of Chinese Academy of Sciences, No.104 Pipashan Main St, Yuzhong District, Chongqing, 400014, China.,Molecular and Functional Imaging Laboratory, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, 400014, China
| | - Bi Zhou
- Department of Radiology, Chongqing General Hospital, University of Chinese Academy of Sciences, No.104 Pipashan Main St, Yuzhong District, Chongqing, 400014, China.,Molecular and Functional Imaging Laboratory, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, 400014, China
| | - Xianlong Huang
- Department of Radiology, Chongqing General Hospital, University of Chinese Academy of Sciences, No.104 Pipashan Main St, Yuzhong District, Chongqing, 400014, China
| | - Xiaoshuang Liu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Zhuoyue Tang
- Department of Radiology, Chongqing General Hospital, University of Chinese Academy of Sciences, No.104 Pipashan Main St, Yuzhong District, Chongqing, 400014, China. .,Molecular and Functional Imaging Laboratory, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, 400014, China.
| |
Collapse
|
11
|
Niazi M, Mohammadzadeh M, Aghazadeh K, Sharifian H, Karimi E, Shakiba M, Baniasadi M, Rahmaty B, Adel S, Moharreri M. Perfusion Computed Tomography Scan Imaging in Differentiation of Benign from Malignant Parotid Lesions. Int Arch Otorhinolaryngol 2020; 24:e160-e169. [PMID: 32256836 PMCID: PMC6828566 DOI: 10.1055/s-0039-1697005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 07/08/2019] [Indexed: 12/03/2022] Open
Abstract
Introduction
The most common site of salivary gland tumors is the parotid gland. Computed tomography (CT), magnetic resonance imaging (MRI), and sonography are imaging modalities to differentiate benign from malignant parotid tumors.
Objective
The aim of this study is the evaluation of the diagnostic value of perfusion CT for differentiating histological categorization of benign and malignant parotid tumors.
Methods
A total of 29 patients with parotid neoplasms were enrolled in this study. Mean age and all CT perfusion variables (gradient and permeability, blood flow [BF], blood volume [BV], mean transit time [MTT], permeability surface [PS], maximum intensity projection [MIP], time-density curve [TDC], and time to peak [TTP]) were compared among three groups (malignant tumors [MTs], Warthin's tumor [WT] and pleomorphic adenomas [PA]).
Results
The mean age of the patients was 55.9 ± 14.1 (26–77), and 15 of them were male (51.7%). Eleven lesions were PAs [37.9%], 8 lesions were WTs (27.6%0 and 10 lesions (34.5%) were MTs (6 acinic cell carcinomas [ACCs], 3 adenocystic carcinomas [AdCCs], and 1 mucoepidermoid carcinoma [MEC]). The mean age of the patients with WTs was 62 ± 7.5 years; 52 ± 14.2 for patients with Pas, and 55.2 ± 17.2 for those with MTs (
p
= 0.32). The mean MIP was 122.7 ± 12.2 in WT, while it was 80.5 ± 19.5 in PA, and 76.2 ± 27.1 in MTs (
p
< 0.001); The mean MIP for WT was higher than for PAs and MTs; the values of MTs and PAs were not statistically different. The average of BF, BV, and curve peak were higher in WTs in comparison with the other two groups, and curve time 2 and TTP were higher in PAs in comparison with MTs.
Conclusion
Based on this study, perfusion CT of the parotid gland and its parameters can distinguish between benign and malignant parotid masses.
Collapse
Affiliation(s)
- Masume Niazi
- Department of Otorhinolaryngology, Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Mohammadzadeh
- Division of Neuroradiology, Department of Radiology, Amir Aalam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Kayvan Aghazadeh
- Department of Otorhinolaryngology, Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hashem Sharifian
- Department of Radiology, Amir Aalam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ebrahim Karimi
- Department of Otorhinolaryngology, Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Madjid Shakiba
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Maria Baniasadi
- Department of Radiology, Amir Aalam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Benyamin Rahmaty
- Department of Otorhinolaryngology, Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Suzan Adel
- Department of Otorhinolaryngology, Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Melorina Moharreri
- Department of Otorhinolaryngology, Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
12
|
Vivino FB, Bunya VY, Massaro-Giordano G, Johr CR, Giattino SL, Schorpion A, Shafer B, Peck A, Sivils K, Rasmussen A, Chiorini JA, He J, Ambrus JL. Sjogren's syndrome: An update on disease pathogenesis, clinical manifestations and treatment. Clin Immunol 2019; 203:81-121. [PMID: 31022578 DOI: 10.1016/j.clim.2019.04.009] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 04/19/2019] [Indexed: 12/23/2022]
Affiliation(s)
- Frederick B Vivino
- Penn Sjögren's Center, Penn Presbyterian Medical Center, University of Pennsylvania Perelman School of Medicine, 3737 Market Street, Philadelphia, PA 19104, USA.
| | - Vatinee Y Bunya
- Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, 51 N. 39(th) Street, Philadelphia, PA 19104, USA.
| | - Giacomina Massaro-Giordano
- Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, 51 N. 39(th) Street, Philadelphia, PA 19104, USA.
| | - Chadwick R Johr
- Penn Sjögren's Center, Penn Presbyterian Medical Center, University of Pennsylvania Perelman School of Medicine, 3737 Market Street, Philadelphia, PA 19104, USA.
| | - Stephanie L Giattino
- Penn Sjögren's Center, Penn Presbyterian Medical Center, University of Pennsylvania Perelman School of Medicine, 3737 Market Street, Philadelphia, PA 19104, USA.
| | - Annemarie Schorpion
- Penn Sjögren's Center, Penn Presbyterian Medical Center, University of Pennsylvania Perelman School of Medicine, 3737 Market Street, Philadelphia, PA 19104, USA.
| | - Brian Shafer
- Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, 51 N. 39(th) Street, Philadelphia, PA 19104, USA.
| | - Ammon Peck
- Department of Infectious Diseases and Immunology, University of Florida College of Veterinary Medicine, PO Box 100125, Gainesville, FL 32610, USA.
| | - Kathy Sivils
- Oklahoma Medical Research Foundation, Arthritis and Clinical Immunology Program, 825 NE 13th Street, OK 73104, USA.
| | - Astrid Rasmussen
- Oklahoma Medical Research Foundation, Arthritis and Clinical Immunology Program, 825 NE 13th Street, OK 73104, USA.
| | - John A Chiorini
- NIH, Adeno-Associated Virus Biology Section, National Institute of Dental and Craniofacial Research, Building 10, Room 1n113, 10 Center DR Msc 1190, Bethesda, MD 20892-1190, USA.
| | - Jing He
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing 100044, China
| | - Julian L Ambrus
- Division of Allergy, Immunology and Rheumatology, SUNY at Buffalo School of Medicine, 100 High Street, Buffalo, NY 14203, USA.
| |
Collapse
|
13
|
Elmokadem AH, Abdel Khalek AM, Abdel Wahab RM, Tharwat N, Gaballa GM, Elata MA, Amer T. Diagnostic Accuracy of Multiparametric Magnetic Resonance Imaging for Differentiation Between Parotid Neoplasms. Can Assoc Radiol J 2019; 70:264-272. [PMID: 30922790 DOI: 10.1016/j.carj.2018.10.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 08/25/2018] [Accepted: 10/08/2018] [Indexed: 01/05/2023] Open
Abstract
PURPOSE This study was designed to evaluate the role of multiparametric magnetic resonance imaging (MRI) for differentiation of parotid gland neoplasms. METHODS Prospective study was conducted upon 52 consecutive patients (30 men, 22 women; aged 24-78 years; mean, 51 years) with parotid tumours that underwent multiparametric MRI using combined static MRI, dynamic contrast enhanced (DCE) MRI, and diffusion-weighted imaging (DWI). The static MRI parameter, time signal intensity curves (TIC) derived from DCE-MRI, and apparent diffusion coefficient (ADC) values of parotid tumours were correlated with histopathological findings. RESULTS Static MRI revealed a significant difference between both benign and malignant lesions in regards to margin definition (P < .001) and T2 hypointensity (P < .013), with a diagnostic accuracy 95% and 78.33% respectively. Study of the TIC type on DCE-MRI revealed statistically significant difference between benign and malignant lesions (P < .001) and diagnostic accuracy 96.55%. There was no statistically significant difference (P = .181) between the ADC values of benign and malignant lesions. ROC curve analysis revealed that by using ADC cut-off value of 1 × 10-3 mm2/s had accuracy of 84.62% respectively for differentiating Warthin from malignant tumours that could be modified to higher value (94.28%) by excluding lymphoma from malignant lesions. By using cutoff value of 1.3 × 10-3 mm2/s to differentiate pleomorphic adenoma from malignancy, ROC curve analysis had high accuracy of 97.06%. CONCLUSION Multiparametric MRI can be used for differentiation of malignant from benign parotid tumours and characterization of some benign parotid tumours.
Collapse
Affiliation(s)
- Ali H Elmokadem
- Departments of Diagnostic and Interventional Radiology, Mansoura University, Dakahlia, Egypt.
| | - Ahmed M Abdel Khalek
- Departments of Diagnostic and Interventional Radiology, Mansoura University, Dakahlia, Egypt
| | - Rihame M Abdel Wahab
- Departments of Diagnostic and Interventional Radiology, Mansoura University, Dakahlia, Egypt
| | - Nehal Tharwat
- Departments of Diagnostic and Interventional Radiology, Mansoura University, Dakahlia, Egypt
| | - Ghada M Gaballa
- Departments of Diagnostic and Interventional Radiology, Mansoura University, Dakahlia, Egypt
| | - Mohamed Abo Elata
- Departments of Diagnostic and Interventional Radiology, Mansoura University, Dakahlia, Egypt
| | - Talal Amer
- Departments of Diagnostic and Interventional Radiology, Mansoura University, Dakahlia, Egypt
| |
Collapse
|
14
|
Li L, Zhao Y, Luo D, Yang L, Hu L, Zhao X, Wang Y, Liu W. Diagnostic value of single-source dual-energy spectral computed tomography in differentiating parotid gland tumors: initial results. Quant Imaging Med Surg 2018; 8:588-596. [PMID: 30140621 DOI: 10.21037/qims.2018.07.07] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background An accurate preoperative diagnosis that helps distinguish between benign and malignant parotid gland tumors is very important because the results strongly affect surgical procedures. We aimed to evaluate the value of single-source dual-energy computed tomography (ssDECT) in differentiating malignant from benign parotid gland tumors. Methods Fifty patients underwent enhanced neck ssDECT scanning before surgery. The images were analyzed using the gemstone spectral imaging (GSI) viewer software. Results Fifty-two tumors (43 patients) were confirmed histopathologically, comprising of 12 pleomorphic adenomas (PAs), 24 Warthin tumors (WTs) (15 patients), and 16 malignant tumors (MTs). The iodine concentration (IC), normalized iodine concentration to common carotid artery (NICA) and slope value of the spectral curve (λHU) of the WTs were significantly higher than those of MTs and PAs (all P<0.05). The optimal IC, NICA and λHU thresholds for differentiating PAs from MTs were 0.91 mg/mL, 0.15 and 1.09, respectively, achieving sensitivities of 91.7%, 91.7% and 91.7%, specificities of 95.0%, 85.0% and 95.0%, and accuracies of 94.2%, 86.5% and 94.2%, respectively for distinguishing PAs from MTs. The optimal IC, NICA and λHU thresholds for distinguishing WTs from MTs were 1.46 mg/mL, 0.20 and 1.72, achieving sensitivities of 91.7%, 95.8% and 91.7%, and specificities of 89.3%, 85.7% and 89.3%, respectively. The accuracy was 90.4%, 90.4% and 90.4%, respectively. Conclusions The parameters of ssDECT in enhanced CT scans are useful in the differential diagnosis of parotid tumors.
Collapse
Affiliation(s)
- Lin Li
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yanfeng Zhao
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Dehong Luo
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Liang Yang
- Department of Diagnostic Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Lei Hu
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Xinming Zhao
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yong Wang
- Department of Ultrasonography, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Wensheng Liu
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| |
Collapse
|
15
|
Khalek Abdel Razek AA. Characterization of salivary gland tumours with diffusion tensor imaging. Dentomaxillofac Radiol 2018; 47:20170343. [PMID: 29412748 PMCID: PMC6196043 DOI: 10.1259/dmfr.20170343] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 01/31/2018] [Accepted: 02/05/2018] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To characterize salivary glands tumours with diffusion tensor imaging. METHODS This study was conducted upon 53 patients (aged 18-81 years: mean 37 years) with salivary gland tumours that underwent diffusion tensor imaging was obtained using a single-shot echoplanar imaging sequence with parallel imaging at 1.5 T scanner. 48 slices were obtained, with a thickness of 2.5 mm, with no gap and the total scan duration was 7-8 min. The fractional anisotropy (FA) and the mean diffusivity (MD) value of the salivary gland tumours was calculated and correlated with pathological findings. Image analysis was performed by one radiologist. The receiver operating characteristic curve was drawn to detect the cut-off point of FA and MD used to characterize salivary gland tumours. RESULTS The mean FA and MD of malignant salivary gland tumours (n = 17) (0.41 ± 0.07 and 0.89 ± 0.15 × 10-3 mm2 s-1) was significantly different (p = 0.001) than that of benign tumours (n = 36) (0.19 ± 0.07 and 1.28 ± 0.42 × 10-3 mm2 s-1), respectively. Combined FA and MD used to differentiate malignant from benign tumours has an area under the curve (AUC) of 0.974, and an accuracy of 86%. There was a significant difference in FA between Warthin tumours and malignant tumours (p = 0.001). Selection FA of 0.35 to differentiate malignant tumours from Warthin tumours revealed AUC of 0.878 and an accuracy of 80%. There was a significant difference in FA and MD of malignant tumours and pleomorphic adenomas (p = 0.001). Combined FA and MD used to differentiate malignant tumours from pleomorphic adenomas revealed AUC of 0.993, and an accuracy of 93%. There was a significant difference in FA and MD of Warthin tumours and pleomorphic adenomas (p = 0.001). Combined FA and MD used to differentiate Warthin tumours from pleomorphic adenomas revealed AUC of 0.978, and an accuracy of 86%. CONCLUSIONS Diffusion-weighed imaging is a promising non-invasive method and it may be useful for the characterization and differentiation of benign and malignant salivary gland tumours.
Collapse
|
16
|
Abdel Razek AAK, Mukherji SK. State-of-the-Art Imaging of Salivary Gland Tumors. Neuroimaging Clin N Am 2018; 28:303-317. [DOI: 10.1016/j.nic.2018.01.009] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
17
|
Cicero G, D'angelo T, Racchiusa S, Salamone I, Visalli C, Bottari A, Blandino A, Mazziotti S. Cross-sectional Imaging of Parotid Gland Nodules: A Brief Practical Guide. J Clin Imaging Sci 2018; 8:14. [PMID: 29770262 PMCID: PMC5939036 DOI: 10.4103/jcis.jcis_8_18] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 03/13/2018] [Indexed: 12/22/2022] Open
Abstract
Clinical evaluation and ultrasound examination are the first steps in the evaluation of a patient with a swelling of the parotid region. After the detection of a nodular lesion, cytological or histological confirmation is usually performed to achieve the diagnosis, while the choice of cross-sectional imaging (computed tomography scan and magnetic resonance imaging) may significantly vary from one physician to another, on the basis of the degree of confidence that both radiologist and surgeon have with this kind of imaging. This work focuses on some essential “reporting points” in cross-sectional imaging evaluation of parotid nodules, chiefly helpful to the radiologist when the ultrasonography assessment is considered incomplete and requires a further evaluation.
Collapse
Affiliation(s)
- Giuseppe Cicero
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino", Messina, Italy
| | - Tommaso D'angelo
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino", Messina, Italy
| | - Sergio Racchiusa
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino", Messina, Italy
| | - Ignazio Salamone
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino", Messina, Italy
| | - Carmela Visalli
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino", Messina, Italy
| | - Antonio Bottari
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino", Messina, Italy
| | - Alfredo Blandino
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino", Messina, Italy
| | - Silvio Mazziotti
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino", Messina, Italy
| |
Collapse
|
18
|
Abstract
RATIONALE Lymphoepithelial carcinoma (LEC) is a rare malignancy with the histopathological feature of undifferentiated carcinoma and an intermixed reactive lymphoplasmacytic infiltration. Although clinically significant because of its malignant nature, it is difficult to make a differential diagnosis by preoperative imaging. Here, we report 3 cases of primary LEC arising in the major salivary glands, which showed unusual imaging features unlike other malignant tumors. PATIENT CONCERNS Our first case is a 44-year-old man with LEC in the right parotid gland, the second case is a 71-year-old woman with LEC in the right submandibular gland, and the third case is a 35-year-old woman with LEC in the right parotid gland. All of the patients presented with a palpable mass of variable duration. DIAGNOSES Computed tomography (CT) scans revealed a relatively well-defined, slightly hyperattenuated exophytic solid mass that had homogeneous well-enhanced regions. Ultrasonography (US) in the first 2 cases showed well-defined, hypoechoic solid masses with posterior enhancement. The CT findings seem to be benign tumors, but US features are compatible with highly cellular and hypervascular tumors. INTERVENTIONS The resection of the involved salivary gland with postoperative radiation therapy was performed. OUTCOMES There was no evidence of recurrence or metastasis after 5 years in all 3 patients. LESSONS Understanding these unusual imaging findings may be helpful in detecting LEC, and may also help clinicians provide adequate management to patients, such as surgery with adjuvant radiotherapy, because of its malignant entity.
Collapse
Affiliation(s)
| | | | | | | | - Min J. Jung
- Department of Pathology, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| |
Collapse
|
19
|
Characterization of Parotid Tumors With Dynamic Susceptibility Contrast Perfusion-Weighted Magnetic Resonance Imaging and Diffusion-Weighted MR Imaging. J Comput Assist Tomogr 2017; 41:131-136. [DOI: 10.1097/rct.0000000000000486] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
|
20
|
Can lymphovascular invasion be predicted by preoperative multiphasic dynamic CT in patients with advanced gastric cancer? Eur Radiol 2016; 27:3383-3391. [PMID: 27999983 DOI: 10.1007/s00330-016-4695-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 11/21/2016] [Accepted: 12/05/2016] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To determine whether multiphasic dynamic CT can preoperatively predict lymphovascular invasion (LVI) in advanced gastric cancer (AGC). METHODS 278 patients with AGC who underwent preoperative multiphasic dynamic CT were retrospectively recruited. Tumour CT attenuation difference between non-contrast and arterial (ΔAP), portal (ΔPP) and delayed phase (ΔDP), tumour-spleen attenuation difference in the portal phase (ΔT-S), tumour contrast enhancement ratios (CERs), tumour-to-spleen ratio (TSR) and tumour volumes were obtained. All CT-derived parameters and clinicopathological variables associated with LVI were analysed by univariate analysis, followed by multivariate and receiver operator characteristics (ROC) analysis. Associations between CT predictors for LVI and histopathological characteristics were evaluated by the chi-square test. RESULTS ΔPP (OR, 1.056; 95% CI: 1.032-1.080) and ΔT-S (OR, 1.043; 95% CI: 1.020-1.066) are independent predictors for LVI in AGC. ΔPP, ΔT-S and their combination correctly predicted LVI in 74.8% (AUC, 0.775; sensitivity, 88.6%; specificity, 54.1%), 68.7% (AUC, 0.747; sensitivity, 68.3%; specificity, 69.4%) and 71.7% (AUC, 0.800; sensitivity, 67.6%; specificity, 77.8%), respectively. There were significant associations between CT predictors for LVI with tumour histological differentiation and Lauren classification. CONCLUSION Multiphasic dynamic CT provides a non-invasive method to predict LVI in AGC through quantitative enhancement measurement. KEY POINTS • Lymphovascular invasion rarely can be evaluated preoperatively in advanced gastric cancer (AGC). • Δ PP and Δ T-S were independent predictors for LVI in patients with AGC. • Δ PP and Δ T-S showed acceptable predictive performance for LVI. • Combination of Δ PP and Δ T-S improved predictive performance for LVI. • Multiphasic dynamic CT may be a useful adjunct for detecting LVI preoperatively.
Collapse
|
21
|
Dynamic Contrast-Enhanced CT in Patients with Pancreatic Cancer. Diagnostics (Basel) 2016; 6:diagnostics6030034. [PMID: 27608045 PMCID: PMC5039568 DOI: 10.3390/diagnostics6030034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 08/22/2016] [Accepted: 08/24/2016] [Indexed: 12/18/2022] Open
Abstract
The aim of this systematic review is to provide an overview of the use of Dynamic Contrast-enhanced Computed Tomography (DCE-CT) in patients with pancreatic cancer. This study was composed according to the PRISMA guidelines 2009. The literature search was conducted in PubMed, Cochrane Library, EMBASE, and Web of Science databases to identify all relevant publications. The QUADAS-2 tool was implemented to assess the risk of bias and applicability concerns of each included study. The initial literature search yielded 483 publications. Thirteen articles were included. Articles were categorized into three groups: nine articles concerning primary diagnosis or staging, one article about tumor response to treatment, and three articles regarding scan techniques. In exocrine pancreatic tumors, measurements of blood flow in eight studies and blood volume in seven studies were significantly lower in tumor tissue, compared with measurements in pancreatic tissue outside of tumor, or normal pancreatic tissue in control groups of healthy volunteers. The studies were heterogeneous in the number of patients enrolled and scan protocols. Perfusion parameters measured and analyzed by DCE-CT might be useful in the investigation of characteristic vascular patterns of exocrine pancreatic tumors. Further clinical studies are desired for investigating the potential of DCE-CT in pancreatic tumors.
Collapse
|
22
|
Wang J, Tang Z, Wang S, Zeng W, Qian W, Wu L, Wang W, Luo J. Differential diagnostic value of computed tomography perfusion combined with vascular endothelial growth factor expression in head and neck lesions. Oncol Lett 2016; 11:3342-3348. [PMID: 27123114 PMCID: PMC4840932 DOI: 10.3892/ol.2016.4413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 03/08/2016] [Indexed: 12/22/2022] Open
Abstract
There are numerous types of head and neck lesions (HNLs), and conventional computed tomography (CT) has low specificity and sensitivity in the definitive and differential diagnosis of HNLs. The aim of the present study was to evaluate the value of perfusion CT (CTP) combined with vascular endothelial growth factor (VEGF) expression in the differentiation between malignant and benign HNLs. In total, 41 HNLs, which were pathologically confirmed, underwent CTP and VEGF expression analysis. All lesions were divided into three groups: Group A, benign hypovascular lesions; Group B, benign hypervascular lesions; and Group C, malignant lesions. Time density curve (TDC) and CTP parameters [maximum intensity projection (MIP), blood volume (BV), blood flow (BF), mean transit time and capillary permeability] were analyzed. The association between perfusion measurements and VEGF was assessed using Pearson's correlation. TDCs were classified into three types, and type I was more frequently identified in benign tumors (Groups A and B) compared with malignant tumors (Group C) (P=0.003). Malignant tumors primarily had a TDC of type II and III. MIP, BF and BV were all significantly higher in Groups B and C compared to Group A (P<0.01). VEGF expression of malignant tumors was significantly higher than benign tumors (P=0.007). No correlation was identified between VEGF and any CTP parameter. The present findings suggest that CTP combined with VEGF may differentiate between malignant and benign HNLs, and between benign hypovascular and hypervascular lesions.
Collapse
Affiliation(s)
- Jie Wang
- Department of Radiology, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai 200031, P.R. China
| | - Zuohua Tang
- Department of Radiology, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai 200031, P.R. China
| | - Shuyi Wang
- Department of Pathology, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai 200031, P.R. China
| | - Wenjiao Zeng
- Department of Pathology, Shanghai Medical School of Fudan University, Shanghai 200032, P.R. China
| | - Wen Qian
- Department of Radiology, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai 200031, P.R. China
| | - Lingjie Wu
- Department of Radiology, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai 200031, P.R. China
| | - Wenzhong Wang
- Department of Radiology, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai 200031, P.R. China
| | - Jianfeng Luo
- Department of Health Statistics and Social Medicine, School of Public Health, Fudan University, Shanghai 200032, P.R. China
| |
Collapse
|
23
|
|
24
|
Afzelius P, Nielsen MY, Ewertsen C, Bloch KP. Imaging of the major salivary glands. Clin Physiol Funct Imaging 2014; 36:1-10. [DOI: 10.1111/cpf.12199] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 09/18/2014] [Indexed: 02/04/2023]
Affiliation(s)
- Pia Afzelius
- Department of Diagnostic Imaging; North Zealand Hospital; Copenhagen Denmark
| | - Ming-Yuan Nielsen
- Department of Diagnostic Imaging; North Zealand Hospital; Copenhagen Denmark
| | - Caroline Ewertsen
- Department of Radiology, Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - Klaus Poulsen Bloch
- Department of Diagnostic Imaging; North Zealand Hospital; Copenhagen Denmark
| |
Collapse
|