Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India.
Department of Otorhinolaryngology & Head-Neck Surgery, All India Institute of Medical Sciences, New Delhi, India.
Head Neck. 2021 Sep;43(9):2611-2622. doi: 10.1002/hed.26732. Epub 2021 May 3.
Morphological assessment with conventional magnetic resonance imaging (MRI) sequences has limited specificity to distinguish between paragangliomas and schwannomas. Assessing the differences in microvascular properties through pharmacokinetic parameters of dynamic contrast-enhanced (DCE)-MRI can provide additional information to aid in this differentiation.
A prospective study on MR characterization of neck masses was performed between January 2017 and March 2019 in our department, out of which 40 patients with head and neck paragangliomas (HNPGLs) (33 lesions) and schwannomas (15 lesions) were included in this analysis. MR perfusion using dynamic axial T1WI fat suppressed fast spoiled gradient recalled sequence with parallel imaging was performed in all the patients, in addition to single-shot turbo spin-echo axial diffusion weighted imaging (DWI) and routine MRI. ROI-based method was used to obtain signal-time curves, permeability measurements, and mean apparent diffusion coefficient (ADC) to differentiate paragangliomas from schwannomas. Statistical analysis was done to assess the significance and establish a cutoff to distinguish between the two entities. The available images of DOTANOC PET/CT (34 lesions) were analyzed retrospectively. Correlations between the perfusion, diffusion, and molecular PET/CT parameters were done.
Paragangliomas had a higher wash-in rate, wash-out rate, K K , and V (p < 0.001); while schwannomas had a higher relative enhancement (p < 0.012), time to peak, time of onset, brevity of enhancement, and V (p < 0.001). Among the perfusion parameters, K (area under curve (AUC) 0.994) and V (AUC 0.992) were found to have the highest diagnostic value. In diffusion-weighted imaging, paragangliomas had a lower mean ADC compared to schwannomas (p < 0.001). The SUV and SUV were significantly associated with K , K , and V in paragangliomas.
DCE-MRI in addition to DWI-MRI can accurately distinguish HNPGL from schwannoma and may replace the need for any additional imaging and preoperative biopsy in most cases.
传统磁共振成像（MRI）序列的形态学评估对鉴别副神经节瘤和神经鞘瘤的特异性有限。通过动态对比增强（DCE）-MRI 的药代动力学参数评估微血管特性可以提供额外的信息，有助于鉴别。
2017 年 1 月至 2019 年 3 月，我们科室对颈部肿块的 MRI 特征进行了前瞻性研究，其中包括 40 例头颈部副神经节瘤（HNPGL）（33 个病灶）和神经鞘瘤（15 个病灶）患者。所有患者均行轴位 T1WI 脂肪抑制快速扰相梯度回波序列的磁共振灌注成像，并行单次激发涡轮自旋回波轴位弥散加权成像（DWI）和常规 MRI。采用 ROI 法获得信号时间曲线、渗透性测量值和平均表观弥散系数（ADC），以鉴别副神经节瘤和神经鞘瘤。统计学分析评估其鉴别诊断的显著性，并建立一个截止值。回顾性分析 34 个病灶的 DOTANOC PET/CT 图像。对灌注、弥散和分子 PET/CT 参数进行相关性分析。
副神经节瘤的达峰时间、流入率、流出率、K 、K 、V 更高（p < 0.001）；而神经鞘瘤的相对增强（p < 0.012）、峰值时间、起始时间、增强时间短、V 更高（p < 0.001）。在灌注参数中，K （曲线下面积（AUC）0.994）和 V （AUC 0.992）具有最高的诊断价值。在弥散加权成像中，副神经节瘤的平均 ADC 低于神经鞘瘤（p < 0.001）。在副神经节瘤中，SUV 和 SUV 与 K 、K 、V 显著相关。
DCE-MRI 结合 DWI-MRI 可以准确鉴别 HNPGL 与神经鞘瘤，在大多数情况下可以替代任何额外的影像学检查和术前活检。
