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Parotid Masses

Prediction of Malignancy Using Magnetization Transfer and MR Imaging Findings

¹ Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan.
² Department of Otolaryngology, Shinshu University School of Medicine, Matsumoto 390-8621, Japan.

View larger version (9K): [in a new window]   Fig. 1. —Scatter diagram shows lesion-to-muscle magnetization transfer ratios (MTRs) for mixed tumors (n = 15), Warthin's tumors (n = 26), and malignant tumors (n = 20). Mean lesion-to-muscle MTR in malignant tumors (1.05 ± 0.28) was statistically significantly greater (p < 0.001) than that in mixed tumors (0.46 ± 0.09) and that in Warthin's tumors (0.57 ± 0.23) (p < 0.001).

View larger version (155K): [in a new window]   Fig. 2A. —Parotid gland mucoepidermoid carcinoma with true-positive findings in 56-year-old man. Fast spin-echo T2-weighted MR image (TR/TE, 3000/85; number of excitations, 2) shows mass (arrows) in left parotid gland.

View larger version (157K): [in a new window]   Fig. 2B. —Parotid gland mucoepidermoid carcinoma with true-positive findings in 56-year-old man. Unenhanced spin-echo T1-weighted MR image (800/13; 2 excitations) shows mass (arrows) with poorly defined margins.

View larger version (108K): [in a new window]   Fig. 2C. —Parotid gland mucoepidermoid carcinoma with true-positive findings in 56-year-old man. Premagnetization transfer pulse MR image obtained with spoiled gradient-recalled acquisition in steady state sequence (45/7; excitations, 2; flip angle, 20°). Signal intensities of lesion (cursor 2), muscle (cursor 1), and background noise (cursor 3) were calculated using electronic cursor to define regions of interest.

View larger version (122K): [in a new window]   Fig. 2D. —Parotid gland mucoepidermoid carcinoma with true-positive findings in 56-year-old man. MR image obtained with same pulse sequence as C after application of 1-kHz off-resonance pulses. Lesion-to-muscle magnetization transfer ratio for this tumor was 0.92, which exceeded threshold of 0.71. Tumor was correctly diagnosed as malignant using combined criteria of poorly defined margins and lesion-to-muscle magnetization transfer ratio of greater than 0.71.

View larger version (155K): [in a new window]   Fig. 3A. —Parotid gland basal cell adenoma with true-negative findings in 75-year-old woman. Fast spin-echo T2-weighted MR image (TR/TE, 3000/85; number of excitations, 2) shows mass (arrows) in right parotid gland.

View larger version (144K): [in a new window]   Fig. 3B. —Parotid gland basal cell adenoma with true-negative findings in 75-year-old woman. Unenhanced spin-echo T1-weighted MR image (800/13; 2 excitations) shows mass (arrows) with well-defined margins. On magnetization transfer images (not shown), tumor had lesion-to-muscle magnetization transfer ratio of 0.88, which exceeded threshold of 0.71. However, tumor was correctly diagnosed as benign using combined criteria.

View larger version (188K): [in a new window]   Fig. 3C. —Parotid gland basal cell adenoma with true-negative findings in 75-year-old woman. Photomicrograph of microscopic examination reveals hypercellularity. (H and E, x200)

View larger version (122K): [in a new window]   Fig. 4A. —Parotid gland metastatic squamous cell carcinoma with false-negative findings in 64-year-old woman. Fast spin-echo T2-weighted MR image (TR/TE, 3000/85; number of excitations, 2) shows mass (arrows) in right parotid gland.

View larger version (137K): [in a new window]   Fig. 4B. —Parotid gland metastatic squamous cell carcinoma with false-negative findings in 64-year-old woman. Unenhanced spin-echo T1-weighted MR image (800/13; 2 excitations) show mass (arrows) with well-defined margins. On magnetization transfer images (not shown), tumor had lesion-to-muscle magnetization transfer ratio of 1.02, which exceeded threshold. Tumor was incorrectly diagnosed as benign using combined criteria. Metastatic squamous cell carcinoma in parotid node was identified at surgical resection.

View larger version (92K): [in a new window]   Fig. 5A. —Parotid gland actinomycosis with false-positive finding in 60-year-old woman. Fast spin-echo T2-weighted MR image (TR/TE, 3000/85; number of excitations, 2) shows mass (arrows) with poorly defined margins in right parotid gland.

View larger version (91K): [in a new window]   Fig. 5B. —Parotid gland actinomycosis with false-positive findings in 60-year-old woman. Unenhanced spin-echo T1-weighted MR image (800/13; 2 excitations) shows mass (arrows) in site corresponding to A. On magnetization transfer images (not shown), tumor had lesion-to-muscle magnetization transfer ratio of 1.59, which exceeded threshold. Lesion was incorrectly diagnosed as malignant tumor using combined criteria.

View larger version (179K): [in a new window]   Fig. 5C. —Parotid gland actinomycosis with false-positive findings in 60-year-old woman. Photomicrograph of microscopic examination reveals intense infiltration with inflammatory cells. Conspicuous increase in collagen is also seen. (H and E, x200)

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