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Salivary Gland Tumors at in Vivo Proton MR Spectroscopy¹

¹ From the Department of Diagnostic Radiology and Organ Imaging (A.D.K., D.K.W.Y., A.T.A., H.Y.Y., K.T.W.), Department of Anatomical and Cellular Pathology (G.M.K.T.), and Department of Surgery (A.C.v.H.), Faculty of Medicine, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China. Received July 28, 2004; revision requested October 6; revision received October 20; accepted December 10. Address correspondence to A.D.K. (e-mail: b834756{at}mailserv.cuhk.hk).

View larger version (24K): [in a new window]   Figure 1a. (a) Spectrum acquired at echo time of 136 msec in a 72-year-old woman with a Warthin tumor of the right parotid gland shows Cho (3.2 ppm), Cr (3.02 ppm), and unresolved lipids (0.90–2.02 ppm). The nominal voxel volume was 3.1 cm3. Residual water resonance (4.65 ppm) and lipids were removed from the spectrum with time-domain Hankel-Lanczos singular value decomposition filtering. The bottom trace shows the result of a fitted spectrum with prior knowledge. (b) Transverse T1-weighted (425/18) MR image shows the positioning of the volume of interest (box) that was selected for 1H MR spectroscopy. (c) Coronal T2-weighted (2500/120) and (d) contrast-enhanced transverse T1-weighted (425/18) MR images show the tumor (arrows).

View larger version (171K): [in a new window]   Figure 1b. (a) Spectrum acquired at echo time of 136 msec in a 72-year-old woman with a Warthin tumor of the right parotid gland shows Cho (3.2 ppm), Cr (3.02 ppm), and unresolved lipids (0.90–2.02 ppm). The nominal voxel volume was 3.1 cm3. Residual water resonance (4.65 ppm) and lipids were removed from the spectrum with time-domain Hankel-Lanczos singular value decomposition filtering. The bottom trace shows the result of a fitted spectrum with prior knowledge. (b) Transverse T1-weighted (425/18) MR image shows the positioning of the volume of interest (box) that was selected for 1H MR spectroscopy. (c) Coronal T2-weighted (2500/120) and (d) contrast-enhanced transverse T1-weighted (425/18) MR images show the tumor (arrows).

View larger version (114K): [in a new window]   Figure 1c. (a) Spectrum acquired at echo time of 136 msec in a 72-year-old woman with a Warthin tumor of the right parotid gland shows Cho (3.2 ppm), Cr (3.02 ppm), and unresolved lipids (0.90–2.02 ppm). The nominal voxel volume was 3.1 cm3. Residual water resonance (4.65 ppm) and lipids were removed from the spectrum with time-domain Hankel-Lanczos singular value decomposition filtering. The bottom trace shows the result of a fitted spectrum with prior knowledge. (b) Transverse T1-weighted (425/18) MR image shows the positioning of the volume of interest (box) that was selected for 1H MR spectroscopy. (c) Coronal T2-weighted (2500/120) and (d) contrast-enhanced transverse T1-weighted (425/18) MR images show the tumor (arrows).

View larger version (109K): [in a new window]   Figure 1d. (a) Spectrum acquired at echo time of 136 msec in a 72-year-old woman with a Warthin tumor of the right parotid gland shows Cho (3.2 ppm), Cr (3.02 ppm), and unresolved lipids (0.90–2.02 ppm). The nominal voxel volume was 3.1 cm3. Residual water resonance (4.65 ppm) and lipids were removed from the spectrum with time-domain Hankel-Lanczos singular value decomposition filtering. The bottom trace shows the result of a fitted spectrum with prior knowledge. (b) Transverse T1-weighted (425/18) MR image shows the positioning of the volume of interest (box) that was selected for 1H MR spectroscopy. (c) Coronal T2-weighted (2500/120) and (d) contrast-enhanced transverse T1-weighted (425/18) MR images show the tumor (arrows).

View larger version (19K): [in a new window]   Figure 2a. (a) Spectrum acquired at echo time of 136 msec in a 39-year-old woman with a pleomorphic adenoma of the left parotid gland shows Cho (3.2 ppm), Cr (3.02 ppm), and broad lipid signals (0.90–2.02 ppm). The nominal voxel volume was 4.8 cm3. Lipids and residual water were removed from the spectrum with time-domain Hankel-Lanczos singular value decomposition filtering. The bottom trace shows the result of a fitted spectrum with prior knowledge. (b) Transverse T1-weighted MR image (425/18) shows the positioning of the volume of interest (box) that was selected for 1H MR spectroscopy. (c) Coronal T2-weighted (2500/120) and (d) contrast-enhanced transverse T1-weighted (425/18) MR images show the tumor (arrows).

View larger version (193K): [in a new window]   Figure 2b. (a) Spectrum acquired at echo time of 136 msec in a 39-year-old woman with a pleomorphic adenoma of the left parotid gland shows Cho (3.2 ppm), Cr (3.02 ppm), and broad lipid signals (0.90–2.02 ppm). The nominal voxel volume was 4.8 cm3. Lipids and residual water were removed from the spectrum with time-domain Hankel-Lanczos singular value decomposition filtering. The bottom trace shows the result of a fitted spectrum with prior knowledge. (b) Transverse T1-weighted MR image (425/18) shows the positioning of the volume of interest (box) that was selected for 1H MR spectroscopy. (c) Coronal T2-weighted (2500/120) and (d) contrast-enhanced transverse T1-weighted (425/18) MR images show the tumor (arrows).

View larger version (124K): [in a new window]   Figure 2c. (a) Spectrum acquired at echo time of 136 msec in a 39-year-old woman with a pleomorphic adenoma of the left parotid gland shows Cho (3.2 ppm), Cr (3.02 ppm), and broad lipid signals (0.90–2.02 ppm). The nominal voxel volume was 4.8 cm3. Lipids and residual water were removed from the spectrum with time-domain Hankel-Lanczos singular value decomposition filtering. The bottom trace shows the result of a fitted spectrum with prior knowledge. (b) Transverse T1-weighted MR image (425/18) shows the positioning of the volume of interest (box) that was selected for 1H MR spectroscopy. (c) Coronal T2-weighted (2500/120) and (d) contrast-enhanced transverse T1-weighted (425/18) MR images show the tumor (arrows).

View larger version (136K): [in a new window]   Figure 2d. (a) Spectrum acquired at echo time of 136 msec in a 39-year-old woman with a pleomorphic adenoma of the left parotid gland shows Cho (3.2 ppm), Cr (3.02 ppm), and broad lipid signals (0.90–2.02 ppm). The nominal voxel volume was 4.8 cm3. Lipids and residual water were removed from the spectrum with time-domain Hankel-Lanczos singular value decomposition filtering. The bottom trace shows the result of a fitted spectrum with prior knowledge. (b) Transverse T1-weighted MR image (425/18) shows the positioning of the volume of interest (box) that was selected for 1H MR spectroscopy. (c) Coronal T2-weighted (2500/120) and (d) contrast-enhanced transverse T1-weighted (425/18) MR images show the tumor (arrows).

View larger version (25K): [in a new window]   Figure 3a. (a) Spectrum acquired at echo time of 136 msec in a 24-year-old man with an adenoid cystic carcinoma of the right parotid gland. Cho (3.2 ppm), Cr (3.02 ppm), and intense lipid (1.50–2.02 ppm) signals were detected. The nominal voxel volume was 2.5 cm3. Residual water resonance (4.65 ppm) and lipids were removed from the spectrum with time-domain Hankel-Lanczos singular value decomposition filtering. The bottom trace shows the result of a fitted spectrum with prior knowledge. (b) Transverse T1-weighted MR image (425/18) shows the positioning of the volume of interest (box) that was selected for 1H MR spectroscopy. (c) Coronal T2-weighted (2500/120) and (d) contrast-enhanced transverse T1-weighted (425/18) MR images show the tumor (arrows).

View larger version (184K): [in a new window]   Figure 3b. (a) Spectrum acquired at echo time of 136 msec in a 24-year-old man with an adenoid cystic carcinoma of the right parotid gland. Cho (3.2 ppm), Cr (3.02 ppm), and intense lipid (1.50–2.02 ppm) signals were detected. The nominal voxel volume was 2.5 cm3. Residual water resonance (4.65 ppm) and lipids were removed from the spectrum with time-domain Hankel-Lanczos singular value decomposition filtering. The bottom trace shows the result of a fitted spectrum with prior knowledge. (b) Transverse T1-weighted MR image (425/18) shows the positioning of the volume of interest (box) that was selected for 1H MR spectroscopy. (c) Coronal T2-weighted (2500/120) and (d) contrast-enhanced transverse T1-weighted (425/18) MR images show the tumor (arrows).

View larger version (117K): [in a new window]   Figure 3c. (a) Spectrum acquired at echo time of 136 msec in a 24-year-old man with an adenoid cystic carcinoma of the right parotid gland. Cho (3.2 ppm), Cr (3.02 ppm), and intense lipid (1.50–2.02 ppm) signals were detected. The nominal voxel volume was 2.5 cm3. Residual water resonance (4.65 ppm) and lipids were removed from the spectrum with time-domain Hankel-Lanczos singular value decomposition filtering. The bottom trace shows the result of a fitted spectrum with prior knowledge. (b) Transverse T1-weighted MR image (425/18) shows the positioning of the volume of interest (box) that was selected for 1H MR spectroscopy. (c) Coronal T2-weighted (2500/120) and (d) contrast-enhanced transverse T1-weighted (425/18) MR images show the tumor (arrows).

View larger version (85K): [in a new window]   Figure 3d. (a) Spectrum acquired at echo time of 136 msec in a 24-year-old man with an adenoid cystic carcinoma of the right parotid gland. Cho (3.2 ppm), Cr (3.02 ppm), and intense lipid (1.50–2.02 ppm) signals were detected. The nominal voxel volume was 2.5 cm3. Residual water resonance (4.65 ppm) and lipids were removed from the spectrum with time-domain Hankel-Lanczos singular value decomposition filtering. The bottom trace shows the result of a fitted spectrum with prior knowledge. (b) Transverse T1-weighted MR image (425/18) shows the positioning of the volume of interest (box) that was selected for 1H MR spectroscopy. (c) Coronal T2-weighted (2500/120) and (d) contrast-enhanced transverse T1-weighted (425/18) MR images show the tumor (arrows).

View larger version (15K): [in a new window]   Figure 4a. (a) Scatterplot of Cho/Cr values obtained at an echo time of 136 msec for Warthin tumors, pleomorphic adenomas, an oncocytoma, and malignant tumors. A Cho/Cr ratio greater than 2.4 (dotted line) completely separates benign SGTs from cancers. In discriminating between Warthin tumors and pleomorphic adenomas, a Cho/Cr ratio of 4.5 or greater (dashed line) would give a sensitivity of 71.4% and a specificity of 84.6%. (b) Receiver operating characteristic curve (dashed line) of Cho/Cr values obtained at an echo time of 136 msec for use in differentiating Warthin tumor from pleomorphic adenoma. The area under the curve is 0.86 ± 0.09.

View larger version (13K): [in a new window]   Figure 4b. (a) Scatterplot of Cho/Cr values obtained at an echo time of 136 msec for Warthin tumors, pleomorphic adenomas, an oncocytoma, and malignant tumors. A Cho/Cr ratio greater than 2.4 (dotted line) completely separates benign SGTs from cancers. In discriminating between Warthin tumors and pleomorphic adenomas, a Cho/Cr ratio of 4.5 or greater (dashed line) would give a sensitivity of 71.4% and a specificity of 84.6%. (b) Receiver operating characteristic curve (dashed line) of Cho/Cr values obtained at an echo time of 136 msec for use in differentiating Warthin tumor from pleomorphic adenoma. The area under the curve is 0.86 ± 0.09.