Lechner Goyault J, Riehm S, Neuville A, Gentine A, Veillon F
Department of radiology, hôpital de Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France.
Department of radiology, hôpital de Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France.
J Neuroradiol. 2011 May;38(2):77-89. doi: 10.1016/j.neurad.2009.10.005. Epub 2010 Jun 9.
This study aimed to evaluate the value of diffusion-weighted imaging (DWI) and gadolinium-enhanced dynamic magnetic resonance imaging (MRI) for differentiating benign and malignant parotid gland tumors, and for characterizing the various histological types (pleomorphic adenoma, and Warthin's and malignant tumors).
This retrospective study involved 60 patients with suspected parotid gland tumors (mean age: 59.4 years), and was carried out from April 2005 to February 2008. All had undergone pathological examination. All MRI examinations were performed using the Siemens Magnetom Avanto 1.5T MRI system. Non-enhanced T1-weighted (T1W), gadolinium-enhanced fat-suppressed T1W and T2-weighted (T2W) images were obtained for all 60 patients, with diffusion-weighted echoplanar imaging (DW-EPI) and apparent diffusion coefficient (ADC) evaluation in 59 patients, and gadolinium-enhanced dynamic MRI sequences in 51 patients. Interpretation was carried out by two experienced radiologists (the first evaluation used T1W, gadolinium-enhanced fat-suppressed T1W and T2W images; the second evaluation used T1W, T2W, DWI and dynamic MRI) and, for each case, the benign/malignant nature of the tumor and its histological type were determined.
After the second reading, increases were noted in sensitivity, specificity, malignant positive predictive value (PPV) and negative predictive value (NPV), as well as in accuracy (90-100% for the first observer, and 90-97% for the second observer). Interobserver reliability also showed a significant increase from the first to the second reading (kappa=0.63 to 0.87, respectively).
Gadolinium-enhanced dynamic MRI and DW-EPI with ADC evaluation improved the performance of MRI in distinguishing between benign and malignant parotid gland tumors, and characterizing the different histological types of benign tumors (pleomorphic adenoma and Warthin's), thus leading to greater consensus in interpretation of the images.
本研究旨在评估扩散加权成像（DWI）和钆增强动态磁共振成像（MRI）在鉴别腮腺良恶性肿瘤以及对不同组织学类型（多形性腺瘤、沃辛瘤和恶性肿瘤）进行特征性诊断方面的价值。
本回顾性研究纳入了60例疑似腮腺肿瘤患者（平均年龄：59.4岁），研究时间为2005年4月至2008年2月。所有患者均接受了病理检查。所有MRI检查均使用西门子Magnetom Avanto 1.5T MRI系统进行。对所有60例患者均采集了非增强T1加权（T1W）、钆增强脂肪抑制T1W和T2加权（T2W）图像，对59例患者进行了扩散加权回波平面成像（DW-EPI）和表观扩散系数（ADC）评估，对51例患者进行了钆增强动态MRI序列检查。由两名经验丰富的放射科医生进行解读（第一次评估使用T1W、钆增强脂肪抑制T1W和T2W图像；第二次评估使用T1W、T2W、DWI和动态MRI），并针对每例病例确定肿瘤的良恶性性质及其组织学类型。
在第二次阅片后，敏感性、特异性、恶性肿瘤阳性预测值（PPV）和阴性预测值（NPV）以及准确性均有所提高（第一位观察者的准确率为90%-100%，第二位观察者的准确率为90%-97%）。观察者间可靠性从第一次阅片到第二次阅片也有显著提高（kappa值分别从0.63提高到0.87）。
钆增强动态MRI以及结合ADC评估的DW-EPI提高了MRI在鉴别腮腺良恶性肿瘤以及对良性肿瘤的不同组织学类型（多形性腺瘤和沃辛瘤）进行特征性诊断方面的性能，从而在图像解读上达成了更高的共识。
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