Diagnostic value of dynamic contrast-enhanced MRI for submucosal palatal tumors
Introduction
The palate separates the oral cavity from the nasal cavity and is divided into two parts, the anterior bony hard palate, and the posterior soft palate. Palate tumors include a variety of pathological types, and approximately 50% of palate tumors are malignant tumors [1]. Squamous cell carcinoma is the most common malignancy in the palate and is relatively easy to identify as a malignant lesion by inspection and palpation. On the other hand, in palate tumors that present as a submucosal mass such as minor salivary gland tumors, imaging diagnosis could play an important role in distinguishing between benign and malignant lesions.
Magnetic resonance imaging (MRI) is used to diagnose palate tumors because it is the most useful modality for analyzing the internal structures of lesions due to its superior soft tissue contrast ability. However, palate tumors are often noticed by patients when they are still small as they occur at visible and palpable sites, and it is often difficult to observe the internal structures of small tumors on routine MR images. Several authors have reported that dynamic contrast-enhanced MRI (DCE-MRI) parameters and time signal intensity curves (TIC) are useful for diagnosing certain tumors of the head and neck region [2], [3], [4], [5], [6], [7]. Therefore, we considered that DCE-MRI, which is able to observe not only the internal structures of tumors, but also changes in their signal intensities over time, might provide useful information for the differential diagnosis of palate tumors.
We previously reported that the DCE-MRI parameters of minor salivary gland tumors in the oral cavity contributed little to their differential diagnosis, but this study included several tumors that arose at sites other than the palate [8]. As tumors are supplied with blood from the surrounding tissues, evaluating the DCE-MRI parameters of tumors arising at a single site might provide useful information for their diagnosis. However, there are few reports about the DCE-MRI parameters of tumors arising at a single site in the head and neck region, and the DCE-MRI findings of palate tumors have only been described in one report of 9 cases [7], [9], [10]. The purpose of the present study was to evaluate the diagnostic value of the DCE-MRI parameters of palate tumors.
Section snippets
Patients
Thirty-four patients who underwent DCE-MRI were histopathologically diagnosed with palate tumors at our hospital between February 1999 and August 2011. Of the 34 patients, six were excluded from this study because their MR examinations were performed with different MR devices from those of the other patients. Furthermore, we excluded one patient who underwent DCE-MRI using different sequence parameters from the other subjects and one patient whose lesion was too small to allow its signal
All cases
There was no significant difference between the mean CImax value (P = 0.562) of the benign tumors and that of the malignant tumors (Fig. 4a). A significant difference in Tmax (P < 0.001) was detected between the benign and malignant tumors (Fig. 4b). In ROC analysis, we found that a Tmax cutoff value of 165 s provided the best combination of sensitivity (100%), specificity (70.0%), and accuracy (88.5%) (Table 2).
Early enhancement group (Tmax < 300 s)
Table 3 summarizes the CImax, Tmax, WR300, and WR600 values of the early enhancement
Discussion
Among head and neck lesions, the TIC of malignant tumors commonly display rapid increases, whereas those of benign tumors show gradual increases. However, regardless of whether delayed images are obtained or the length of the period between contrast medium injection and the delayed images being obtained, clinicians can obtain various subjective impressions from the shapes of TIC. Takashima et al. classified the TIC of 79 head and neck lesions into five groups according to the time at which they
References (16)
- et al.
Analysis of 102 lesions diagnosed as palatal tumor in a spot diagnosis
International Journal of Oral Surgery
(1975) - et al.
Interest of diffusion-weighted and gadolinium-enhanced dynamic MR sequences for the diagnosis of parotid gland tumors
Journal of Neuroradiology
(2011) - et al.
Application of dynamic contrast-enhanced MRI to differentiate malignant lymphoma from squamous cell carcinoma in the head and neck
Oral Oncology
(2004) - et al.
Application of dynamic MRI to differentiating odontogenic myxomas from ameloblastomas
European Journal of Radiology
(2002) - et al.
Usefulness of MRI and dynamic contrast-enhanced MRI for differential diagnosis of simple bone cysts from true cysts in the jaw
Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontics
(2010) - et al.
Dynamic MR imaging in the head and neck
Radiology
(1993) - et al.
Parotid and parapharyngeal tumours: tissue characterization with dynamic magnetic resonance imaging
British Journal of Radiology
(1994) - et al.
Diagnostic value of dynamic magnetic resonance imaging for salivary gland diseases: a preliminary study
Dento-Maxillo-Facial Radiology
(2001)
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2015, Egyptian Journal of Radiology and Nuclear MedicineCitation Excerpt :So, there was also a need for a noninvasive quantitative method which enables the quantification of contrast agent exchange between the intravascular and the interstitial space (7). Few researches studied the role of either quantitative or semi quantitative analysis in specific region in head and neck, e.g. sinonasal (6), palate (8). The aim of our study was to present an overview of diagnostic accuracy of DCE-MRI in differentiation between benign and malignant head and neck tumors as a whole, and to compare specificity and sensitivity of both quantitative and semi quantitative analytical methods.
Dynamic contrast-enhanced magnetic resonance imaging in Head and Neck Cancer: Differentiation of new H&N cancer, recurrent disease, and benign post-treatment changes
2015, Clinical ImagingCitation Excerpt :PS is a measure of contrast medium exchange between intravascular plasma and interstitial compartment in a lesion, which shows leakiness and disorganization of blood vessels [7]. It has been reported to be useful in predicting tumor response to therapy and post-treatment prognosis and also to differentiate benign from malignant tumors [8–14]. We hypothesized that quantitative DCE-magnetic resonance (MR) parameters might be useful to differentiate post-treatment benign changes from tumor recurrence due to the difference in hemodynamic characteristics.
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