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Salivary Gland Tumors: Diagnostic Value of Gadolinium-enhanced Dynamic MR Imaging with Histopathologic Correlation¹

¹ From the Departments of Radiology (H.Y., T.F., T.T., M.K.), Pathology (Y.H.), and Head and Neck Surgery (K.T.), National Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, Fukuoka 811-1395, Japan. From the 2000 RSNA scientific assembly. Received September 5, 2001; revision requested October 16; final revision received July 10, 2002; accepted July 31. Address correspondence to H.Y. (e-mail: hyabuu@nk-cc.go.jp).

View larger version (25K): [in a new window]   Figure 1. TIC constructed at dynamic gadolinium-enhanced MR imaging (left) and TIC parameter definitions (right).

View larger version (16K): [in a new window]   Figure 2. Plotted Tpeak values. The dots represent means, and the lines through the dots represent SDs. * = P value for comparison of pleomorphic adenomas and Warthin tumors. ** = P value for comparison of pleomorphic adenomas and malignant tumors. The Tpeak for the pleomorphic adenomas was significantly longer than those for the Warthin (P < .0001) and malignant (P < .001) tumors.

View larger version (15K): [in a new window]   Figure 3. Plotted WR values. The dots represent means, and the lines through the dots represent SDs. The WR data for pleomorphic adenomas were not applicable, because nine of the 12 pleomorphic adenomas showed gradual enhancement and one showed a flat TIC. * = P value indicates that the WR for Warthin tumors was significantly higher than that for the malignant tumors.

View larger version (13K): [in a new window]   Figure 4. Plotted slope values. The dots represent means, and the lines through the dots represent SDs. There was no statistically significant difference in slope among the histopathologic tumor subtypes.

View larger version (12K): [in a new window]   Figure 5. Plotted ER values. The dots represent means, and the lines through the dots represent SDs. There was no statistically significant difference in ER among the histopathologic tumor subtypes.

View larger version (24K): [in a new window]   Figure 6. TIC tumor type classifications.

View larger version (156K): [in a new window]   Figure 7a. Pleomorphic adenoma of the right parotid gland in a 70-year-old man. (a) Transverse T1-weighted spin-echo MR image (400/20) shows a well-defined hypointense mass (arrow) in the right parotid gland. (b) Transverse T1-weighted spin-echo MR image (150/16) obtained 90 seconds after contrast material administration shows moderate tumor enhancement. (c) Transverse T1-weighted spin-echo MR image (150/16) obtained 300 seconds after contrast material administration shows gradual tumor enhancement. (d) TIC (left) and corresponding transverse T1-weighted spin-echo MR image (150/16) (right) depict the gradual enhancement pattern (type A). The Tpeak is 180 seconds. Right: The round cursor marks the region of interest selected for signal intensity measurement at dynamic MR imaging. (e) Microscopic view of the adenoma specimen shows minimal epithelial elements and an abundant myxoid matrix (*); the cellularity-stromal grade is 1 (acellular). (Hematoxylin-eosin stain; original magnification, x40.) (f) Immunohistochemically stained microscopic section shows a scarcity of microvessels (arrow); the microvessel count is 3.6. (Anti-CD34 stain; original magnification, x200.)

View larger version (160K): [in a new window]   Figure 7b. Pleomorphic adenoma of the right parotid gland in a 70-year-old man. (a) Transverse T1-weighted spin-echo MR image (400/20) shows a well-defined hypointense mass (arrow) in the right parotid gland. (b) Transverse T1-weighted spin-echo MR image (150/16) obtained 90 seconds after contrast material administration shows moderate tumor enhancement. (c) Transverse T1-weighted spin-echo MR image (150/16) obtained 300 seconds after contrast material administration shows gradual tumor enhancement. (d) TIC (left) and corresponding transverse T1-weighted spin-echo MR image (150/16) (right) depict the gradual enhancement pattern (type A). The Tpeak is 180 seconds. Right: The round cursor marks the region of interest selected for signal intensity measurement at dynamic MR imaging. (e) Microscopic view of the adenoma specimen shows minimal epithelial elements and an abundant myxoid matrix (*); the cellularity-stromal grade is 1 (acellular). (Hematoxylin-eosin stain; original magnification, x40.) (f) Immunohistochemically stained microscopic section shows a scarcity of microvessels (arrow); the microvessel count is 3.6. (Anti-CD34 stain; original magnification, x200.)

View larger version (159K): [in a new window]   Figure 7c. Pleomorphic adenoma of the right parotid gland in a 70-year-old man. (a) Transverse T1-weighted spin-echo MR image (400/20) shows a well-defined hypointense mass (arrow) in the right parotid gland. (b) Transverse T1-weighted spin-echo MR image (150/16) obtained 90 seconds after contrast material administration shows moderate tumor enhancement. (c) Transverse T1-weighted spin-echo MR image (150/16) obtained 300 seconds after contrast material administration shows gradual tumor enhancement. (d) TIC (left) and corresponding transverse T1-weighted spin-echo MR image (150/16) (right) depict the gradual enhancement pattern (type A). The Tpeak is 180 seconds. Right: The round cursor marks the region of interest selected for signal intensity measurement at dynamic MR imaging. (e) Microscopic view of the adenoma specimen shows minimal epithelial elements and an abundant myxoid matrix (*); the cellularity-stromal grade is 1 (acellular). (Hematoxylin-eosin stain; original magnification, x40.) (f) Immunohistochemically stained microscopic section shows a scarcity of microvessels (arrow); the microvessel count is 3.6. (Anti-CD34 stain; original magnification, x200.)

View larger version (46K): [in a new window]   Figure 7d. Pleomorphic adenoma of the right parotid gland in a 70-year-old man. (a) Transverse T1-weighted spin-echo MR image (400/20) shows a well-defined hypointense mass (arrow) in the right parotid gland. (b) Transverse T1-weighted spin-echo MR image (150/16) obtained 90 seconds after contrast material administration shows moderate tumor enhancement. (c) Transverse T1-weighted spin-echo MR image (150/16) obtained 300 seconds after contrast material administration shows gradual tumor enhancement. (d) TIC (left) and corresponding transverse T1-weighted spin-echo MR image (150/16) (right) depict the gradual enhancement pattern (type A). The Tpeak is 180 seconds. Right: The round cursor marks the region of interest selected for signal intensity measurement at dynamic MR imaging. (e) Microscopic view of the adenoma specimen shows minimal epithelial elements and an abundant myxoid matrix (*); the cellularity-stromal grade is 1 (acellular). (Hematoxylin-eosin stain; original magnification, x40.) (f) Immunohistochemically stained microscopic section shows a scarcity of microvessels (arrow); the microvessel count is 3.6. (Anti-CD34 stain; original magnification, x200.)

View larger version (142K): [in a new window]   Figure 7e. Pleomorphic adenoma of the right parotid gland in a 70-year-old man. (a) Transverse T1-weighted spin-echo MR image (400/20) shows a well-defined hypointense mass (arrow) in the right parotid gland. (b) Transverse T1-weighted spin-echo MR image (150/16) obtained 90 seconds after contrast material administration shows moderate tumor enhancement. (c) Transverse T1-weighted spin-echo MR image (150/16) obtained 300 seconds after contrast material administration shows gradual tumor enhancement. (d) TIC (left) and corresponding transverse T1-weighted spin-echo MR image (150/16) (right) depict the gradual enhancement pattern (type A). The Tpeak is 180 seconds. Right: The round cursor marks the region of interest selected for signal intensity measurement at dynamic MR imaging. (e) Microscopic view of the adenoma specimen shows minimal epithelial elements and an abundant myxoid matrix (*); the cellularity-stromal grade is 1 (acellular). (Hematoxylin-eosin stain; original magnification, x40.) (f) Immunohistochemically stained microscopic section shows a scarcity of microvessels (arrow); the microvessel count is 3.6. (Anti-CD34 stain; original magnification, x200.)

View larger version (124K): [in a new window]   Figure 7f. Pleomorphic adenoma of the right parotid gland in a 70-year-old man. (a) Transverse T1-weighted spin-echo MR image (400/20) shows a well-defined hypointense mass (arrow) in the right parotid gland. (b) Transverse T1-weighted spin-echo MR image (150/16) obtained 90 seconds after contrast material administration shows moderate tumor enhancement. (c) Transverse T1-weighted spin-echo MR image (150/16) obtained 300 seconds after contrast material administration shows gradual tumor enhancement. (d) TIC (left) and corresponding transverse T1-weighted spin-echo MR image (150/16) (right) depict the gradual enhancement pattern (type A). The Tpeak is 180 seconds. Right: The round cursor marks the region of interest selected for signal intensity measurement at dynamic MR imaging. (e) Microscopic view of the adenoma specimen shows minimal epithelial elements and an abundant myxoid matrix (*); the cellularity-stromal grade is 1 (acellular). (Hematoxylin-eosin stain; original magnification, x40.) (f) Immunohistochemically stained microscopic section shows a scarcity of microvessels (arrow); the microvessel count is 3.6. (Anti-CD34 stain; original magnification, x200.)

View larger version (50K): [in a new window]   Figure 8a. Warthin tumor of the left parotid gland in a 74-year-old woman. (a) TIC (left) and corresponding transverse T1-weighted spin-echo MR image (150/16) (right) depict an early peak of enhancement and a high washout pattern (type B). The Tpeak is 30 seconds, and the WR is 71%. Right: The round cursor marks the region of interest selected for signal intensity measurement at dynamic MR imaging. (b) Microscopic view of the tumor specimen shows a proliferation of eosinophilic cells in the cyst wall and lymph follicle formation (*); the cellularity-stromal grade is 4 (highly cellular). (Hematoxylin-eosin stain; original magnification, x40.) (c) Immunohistochemically stained section shows abundant microvessels (arrow); the microvessel count is 60. (Anti-CD34 stain; original magnification, x200.)

View larger version (178K): [in a new window]   Figure 8b. Warthin tumor of the left parotid gland in a 74-year-old woman. (a) TIC (left) and corresponding transverse T1-weighted spin-echo MR image (150/16) (right) depict an early peak of enhancement and a high washout pattern (type B). The Tpeak is 30 seconds, and the WR is 71%. Right: The round cursor marks the region of interest selected for signal intensity measurement at dynamic MR imaging. (b) Microscopic view of the tumor specimen shows a proliferation of eosinophilic cells in the cyst wall and lymph follicle formation (*); the cellularity-stromal grade is 4 (highly cellular). (Hematoxylin-eosin stain; original magnification, x40.) (c) Immunohistochemically stained section shows abundant microvessels (arrow); the microvessel count is 60. (Anti-CD34 stain; original magnification, x200.)

View larger version (177K): [in a new window]   Figure 8c. Warthin tumor of the left parotid gland in a 74-year-old woman. (a) TIC (left) and corresponding transverse T1-weighted spin-echo MR image (150/16) (right) depict an early peak of enhancement and a high washout pattern (type B). The Tpeak is 30 seconds, and the WR is 71%. Right: The round cursor marks the region of interest selected for signal intensity measurement at dynamic MR imaging. (b) Microscopic view of the tumor specimen shows a proliferation of eosinophilic cells in the cyst wall and lymph follicle formation (*); the cellularity-stromal grade is 4 (highly cellular). (Hematoxylin-eosin stain; original magnification, x40.) (c) Immunohistochemically stained section shows abundant microvessels (arrow); the microvessel count is 60. (Anti-CD34 stain; original magnification, x200.)

View larger version (46K): [in a new window]   Figure 9a. High-grade mucoepidermoid carcinoma of the right parotid gland in a 70-year-old man. (a) TIC (left) and corresponding transverse T1-weighted spin-echo MR image (150/16) (right) depict an early peak of enhancement and a low washout pattern (type C). The Tpeak is 60 seconds, and the WR is 21%. Right: The round cursor marks the region of interest selected for signal intensity measurement at dynamic MR imaging. (b) Microscopic view of the carcinoma specimen shows a proliferation of spindle-shaped cells (arrow) with a high nucleus-cytoplasm ratio. An abundance of fibrous stromal tissue and a glandular formation (arrowhead) also are seen. The cellularity-stromal grade is 2. (Hematoxylin-eosin stain; original magnification, x40.) (c) Immunohistochemically stained section shows abundant microvessels (arrow); the microvessel count is 23. (Anti-CD34 stain; original magnification, x200.)

View larger version (167K): [in a new window]   Figure 9b. High-grade mucoepidermoid carcinoma of the right parotid gland in a 70-year-old man. (a) TIC (left) and corresponding transverse T1-weighted spin-echo MR image (150/16) (right) depict an early peak of enhancement and a low washout pattern (type C). The Tpeak is 60 seconds, and the WR is 21%. Right: The round cursor marks the region of interest selected for signal intensity measurement at dynamic MR imaging. (b) Microscopic view of the carcinoma specimen shows a proliferation of spindle-shaped cells (arrow) with a high nucleus-cytoplasm ratio. An abundance of fibrous stromal tissue and a glandular formation (arrowhead) also are seen. The cellularity-stromal grade is 2. (Hematoxylin-eosin stain; original magnification, x40.) (c) Immunohistochemically stained section shows abundant microvessels (arrow); the microvessel count is 23. (Anti-CD34 stain; original magnification, x200.)

View larger version (145K): [in a new window]   Figure 9c. High-grade mucoepidermoid carcinoma of the right parotid gland in a 70-year-old man. (a) TIC (left) and corresponding transverse T1-weighted spin-echo MR image (150/16) (right) depict an early peak of enhancement and a low washout pattern (type C). The Tpeak is 60 seconds, and the WR is 21%. Right: The round cursor marks the region of interest selected for signal intensity measurement at dynamic MR imaging. (b) Microscopic view of the carcinoma specimen shows a proliferation of spindle-shaped cells (arrow) with a high nucleus-cytoplasm ratio. An abundance of fibrous stromal tissue and a glandular formation (arrowhead) also are seen. The cellularity-stromal grade is 2. (Hematoxylin-eosin stain; original magnification, x40.) (c) Immunohistochemically stained section shows abundant microvessels (arrow); the microvessel count is 23. (Anti-CD34 stain; original magnification, x200.)

View larger version (21K): [in a new window]   Figure 10. Graph illustrates the correlation between Tpeak and microvessel count. The correlation was significantly different from zero (P < .0001, = -0.800).

View larger version (24K): [in a new window]   Figure 11. Graph illustrates the correlation between WR and cellularity-stromal grade. The correlation was significantly different from zero (P = .0105, = 0.572).