Differential diagnostic value of arterial spin labeling combined with diffusion tensor imaging in parotid gland tumors
Objective:To evaluate the clinical value of multi-parameter MRI in distinguishing parotid tumors by arterial spin labeling(ASL)and diffusion tensor imaging(DTI).Materials and Methods:A total of 66 patients with surgically and pathologically proven parotid gland tumors from Binzhou Medical University Hospital from June 2019 to November 2023 were retrospectively analyzed.3D ASL imaging and DTI were perfomed before surgery,and the maximum tumor blood flow(TBFmax),minimum apparent diffusion coefficient(ADCmin)and fraction anisotropy(FA)were measured.The Mann-Whitney U test or Kruskal-Wallis test were used to compare the parameters of benign tumors(BT)and malignant tumors(MT).Receiver operating characteristic(ROC)curve analysis was used to evaluate the diagnostic efficacy of each parameter and the combination of different parameters for parotid tumors.Results:There were 66 patients with parotid gland tumors,including 55 BT[15 Warthin tumors(WT),23 pleomorphic adenomas(PA),17 others]and 11 MT.The FA value of BT was lower than that of MT(0.13±0.06 vs.0.18±0.04,P=0.003).The TBFmax value of PA[(43.72±37.64)mL/(100 g·min-1)]was lower than that of MT[(92.56±58.26)mL/(100 g·min-1)](P<0.001)and WT[(145.26±64.54)mL/(100 g·min-1)](P=0.016).The ADCmin value of PA[(1.55±0.51)×10-3 mm2/s]was higher than that of MT[(1.11±0.28)×10-3 mm2/s](P=0.016)and WT[(1.03±0.53)×10-3 mm2/s](P<0.001).The FA value of MT(0.18±0.05)was higher than that of PA(0.11±0.04)(P<0.001)and WT(0.12±0.02)(P=0.015).The area under the curve(AUC)for distinguishing BT from MT by FA was 0.78,and the sensitivity and specificity were 81.82%and 70.18%,respectively.The AUC for distinguishing WT,PA from MT by FA were 0.85 and 0.87,the sensitivity were 72.73%and 100.00%,and the specificity were 94.12%and 65.22%,respectively.The AUC for distinguishing WT from PA by TBFmax and ADCmin were 0.90 and 0.85,the sensitivity were 94.12%and 95.65%,and the specificity were 91.30%and 82.35%,respectively.The AUC for distinguishing PA from MT by combining them could be increased to 0.98,the sensitivity was 100.00%,and the specificity was 86.96%.Conclusions:The combination of ASL and DTI is helpful for the differential diagnosis of benign and malignant parotid tumors,and the comprehensive application of multiple parameters is helpful for the differentiation of WT,PA and MT.Combining the different parameters can significantly improve the diagnostic efficiency of distinguishing PA from MT.
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