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May 15, 2014

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Manuscript title: Dynamic contrast enhanced MRI for differentiation of major salivary glands neoplasms, a 3-Tesla MRI study.

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Manuscript type: original research article

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Running title: DCE MRI salivary gland neoplasms

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Authors:

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Leila Aghaghazvini1,2, MD., Assistant professor of Radiology; Faeze Salahshour3, MD.; Nasrin Yazdani4, MD., Associate Professor of Otolaryngology; Hashem Sharifian2,3,*, MD., Assistant professor of Radiology; Soheil Kooraki1, MD; Manijeh Pakravan3; Madjid Shakiba3, MD

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1. Department of Radiology, Shariati hospital, Tehran university of medical sciences, Tehran, Iran 2. Department of Radiology, Amir Alam hospital, Tehran university of medical sciences, Tehran, Iran 3. Advanced diagnostic and interventional radiology research center, Imam Khomeini hospital, Tehran university of medical sciences, Tehran, Iran 4. Department of Otolaryngology, Amir Alam hospital, Tehran university of medical sciences, Tehran, Iran

Corresponding Author:

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Hashem Sharifian, MD. Assistant Professor of Radiology Tehran University of Medical Sciences, Tehran, Iran Email: [email protected] Address: Advanced diagnostic and interventional radiology research center, Medical imaging center, Imam Khomeini hospital, Keshavarz blvd., Tehran, Iran, P.O. Box: 1419733141 Tel: +98 21 66581577 Fax: +98 21 66581580

clean copy manuscript

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Abstract

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Introduction: Pre-operative differentiation of salivary gland neoplasms is of great importance.

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This study was designed to evaluate the use of dynamic contrast-enhanced MRI (DCE-MRI) for differentiation between malignant, warthin and benign non-warthin(BNW) neoplasms of major

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salivary glands.

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Materials and Methods: 46 major salivary gland tumors (SGT) underwent preoperative DCE-

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MRI. Postsurgical histopathologic evaluation showed 30 BNW, 6 warthin and 10 malignant

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tumors. TIC (Time-signal intensity curves) were categorized as (A) Tpeak>43s and WR180

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(washout ratio at 180 seconds)43s and

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WR180:4.6-22%

Results: Accuracy of Tpeak was 98.9% for differentiation between BNW and warthin, 83.7% between BNW and malignant and 80% between malignant and warthin. All warthins showed

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Tpeak≤43s, while one BNW had Tpeak43s and WR18043s and WR180:4.6-22% with relative moderate increase and relative moderate

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washout

Statistical analysis was performed using SPSS software (version 16.0, SPSS Inc. Chicago, IL,

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U.S.A.). Receiver operating characteristic (ROC) curve was carried out to find out the best cutoff

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values of DCE-MRI parameters. Non-parametric tests (Mann-whitney) were used for analysis of

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qualitative variables. All data are expressed as mean±SD and P value 210 s and WR300
40%, and malignant tumor; 60s < Tmax < 210 s and 10% < WR300 < 30%; using this categorization, they differentiated all pleomorphic

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adenoma and malignant tumors from warthin, 90% of BNW and all warthin tumors from malignant tumors, 91.7% of malignant and all warthin tumors from pleopmorphic adenomas.[16]

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According to another study by Yabuuchi et al on a 0.5 T MRI data, a threshold of 120s for Tpeak

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was powerful in differentiation of malignant tumors from pleomorphic adenomas. Also, A 5-

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minute WR cutoff of 30% enabled differentiation between malignant and Warthin tumors. Using Tpeak and WR, 4 TIC curves were described; type A with Tpeak>120s (including 9 pleomorphic

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adenoma), type B with Tpeak≤120s and WR≥30%(including 8 warthins, one malignant, one

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myoepithelioma), type C with Tpeak≤120s and WR