Conventional, diffusion, and dynamic contrast-enhanced MRI findings for differentiating metaplastic Warthin's tumor of the parotid gland

Chuan-Hai Jia; Sheng-Yu Wang; Qin Li; Jia-Ming Qiu; Xin-Ping Kuai

doi:10.1177/00368504211018583

Conventional, diffusion, and dynamic contrast-enhanced MRI findings for differentiating metaplastic Warthin's tumor of the parotid gland

Sci Prog. 2021 Apr-Jun;104(2):368504211018583. doi: 10.1177/00368504211018583.

Authors

Chuan-Hai Jia¹, Sheng-Yu Wang², Qin Li¹, Jia-Ming Qiu³, Xin-Ping Kuai¹

Affiliations

¹ Department of Radiology, The Affiliated Changshu Hospital of Xuzhou Medical University, Changshu, Jiangsu, China.
² Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Jiading, Shanghai, China.
³ Department of Pathology, The Affiliated Changshu Hospital of Xuzhou Medical University, Changshu, Jiangsu, China.

Abstract

The purpose of this study was to explore conventional, diffusion, and dynamic contrast-enhanced MRI (DCE-MRI) characteristics for differentiating metaplastic Warthin's tumor (MWT) from other tumor types of the parotid gland, including non-metaplastic Warthin's tumor (non-MWT), pleomorphic adenoma (PA), and malignant tumor (MT). A total of 178 patients with histologically proven tumors of the parotid gland, including 21 MWTs, 49 non-MWTs, 66 PAs, and 42 MTs, were enrolled in the study. Conventional MRI was performed in all patients. One hundred and fifty patients had preoperative diffusion-weighted MR imaging (DWI), and 62 patients had preoperative DCE-MRI. The differences in the conventional, DCE-MRI, and DWI records between MWTs and the other three tumor types were statistically evaluated. Compared with non-MWTs and PAs, there was a statistically significant difference in circumscription (p < 0.01). The ill-defined circumscription was more common in MWTs than non-MWTs and PAs. Compared with PAs, there was a statistically significant difference in morphology (p < 0.05). The lobulated morphology was more common in PAs than MWTs. Compared with PAs and MTs, there was a statistically significant difference in the T₂ signal of the solid component (p < 0.01). The T₂ moderate intensity of solid components was more common in MWTs than PAs and MTs. The solid components of PAs mostly showed hyperintense on T₂-weighted imaging. Cyst/necrosis was more common in MWTs than PAs and MTs. Hyperintense of cyst/necrosis was more common in MWTs and non-MWTs. With respect to contrast enhancement, 52.4% MWTs exhibited moderate or marked enhancement, and most non-MWTs (81.6%) exhibited mild enhancement. Most PAs (84.8%) exhibited marked enhancement. The mean ADC value of MWTs (0.94 × 10^-3 ± 0.11 mm²/s) was signiﬁcantly lower than that of the PAs (1.60 × 10^-3 ± 0.17 mm²/s) (p < 0.001). On DCE-MRI, six of eight MWTs demonstrated TIC of type B. Although MWT is rare, conventional MRI characteristics, DWI and DCE-MRI can provide useful information for differentiating MWT from other parotid mass.

Keywords: Parotid neoplasms; diffusion-weighted imaging; dynamic contrast-enhanced MRI; magnetic resonance imaging; metaplastic Warthin’s tumor.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adenolymphoma* / diagnostic imaging
Adenolymphoma* / pathology
Cysts* / pathology
Diagnosis, Differential
Humans
Magnetic Resonance Imaging / methods
Metaplasia / pathology
Necrosis / pathology
Neuroblastoma* / pathology
Parotid Gland / diagnostic imaging
Parotid Gland / pathology
Parotid Neoplasms* / diagnostic imaging
Parotid Neoplasms* / pathology
Retrospective Studies