ECHNR 2021 1st Cycle Module 2 [email protected]
Parotid gland:anatomy and spectrum of pathologies
Maartje M.L. de WinHead, neck & neuroradiology
Amsterdam UMC, AMC
ECHNR 20211st Cycle Module 2
ECHNR 2021 1st Cycle Module 2 [email protected]
DISCLOSURES
No disclosures
INTR
OD
UCTIO
N
ECHNR 2021 1st Cycle Module 2 [email protected]
RADIOLOGICAL APPROACH
Congenital
ANATOMY
LEARNING OBJECTIVES
Tumors
Inflammation
- Imaging techniques- Epidemiology- Imaging characteristics
ECHNR 2021 1st Cycle Module 2 [email protected]
Netter
PAROTID GLANDS
Paired, major salivary gland
AN
ATO
MY
ECHNR 2021 1st Cycle Module 2 [email protected]
PAROTID GLANDS
Facial nerve!!
AN
ATO
MY
ECHNR 2021 1st Cycle Module 2 [email protected]
PAROTID GLANDS
parotid glandsuperficial layer deep cervicalfasciamasticator spaceparotid duct (Stensen)parapharyngeal spacecarotid space
AN
ATO
MY
ECHNR 2021 1st Cycle Module 2 [email protected]
PAROTID GLANDS
parotid glandsuperficial layer deep cervicalfasciaparapharyngeal space
AN
ATO
MY
ECHNR 2021 1st Cycle Module 2 [email protected]
-Incidental finding-Incidence 20-30%-Lateral from masseter-Superior to Stensons duct-Separate blood supply and secondary duct
ACCESSORY PAROTID GLANDS
AN
ATO
MY
ECHNR 2021 1st Cycle Module 2 [email protected]
PAROTID SPACE
Within the parotid space- parotid gland- parotid ducts- branches of the facial nerve- lymph nodes 20- retromandibular vein- external carotid arteryA
NA
TOM
Y
ECHNR 2021 1st Cycle Module 2 [email protected]
PAROTID GLAND and the FACIAL NERVE
Branches of the facial nerve divide the parotid gland in superficial (2/3) and deep lobe (1/3)
AN
ATO
MY
ECHNR 2021 1st Cycle Module 2 [email protected]
PAROTID GLAND and the FACIAL NERVE
AN
ATO
MY
ECHNR 2021 1st Cycle Module 2 [email protected]
SURGERY ON A PAROTID LESIONWhat the surgeon needs to know
Relationship with facial nerve
Not seen on imaging
Predict by facial nerve line
Chung-O Lee at al, 2012
AN
ATO
MY
ECHNR 2021 1st Cycle Module 2 [email protected]
FACIAL NERVE – PAROTID
AN
ATO
MY
2 cases of pleiomorphic adenoma
ECHNR 2021 1st Cycle Module 2 [email protected]
J. Chu et al. AJNR Am J Neuroradiol 2013;34:1643-1648
MRI of the PAROTID SEGMENT nVII
3D-PSIF-DWI with a surface coil.
AN
ATO
MY
ECHNR 2021 1st Cycle Module 2 [email protected]
PAROTID IMAGING
• Ultrasound / US guided FNA• MRI• CT• PET-CT
IMA
GIN
G
Pre-auricular swelling- unilateral vs bilateral- age- painfull vs painless
ECHNR 2021 1st Cycle Module 2 [email protected]
PAROTID IMAGING
• Ultrasound / US guided FNA• MRI• CT• PET-CT
Radiation, poor soft tissue discrimination
Pre-auricular swelling- unilateral vs bilateral- age- painfull vs painless
IMA
GIN
G
ECHNR 2021 1st Cycle Module 2 [email protected]
MRI PROTOCOL (1.5 & 3T)
TSE T1
TSE T2
DWI
Post gadolinium: fatsat TSE T1 or 3D T1 (VIBE, eTHRIVE)
(DCE-MRI)
Axial & Coronal
Including skull base / cavernous sinus / mastoids
High resolution, slice thickness 3 mm
MRI SALIVARY GLANDS
IMA
GIN
G
ECHNR 2021 1st Cycle Module 2 [email protected]
PATHOLOGY OF THE PAROTID GLAND
Congenital- 1st branchial cleft cyst- venolymphatic malformation
Tumors- benign- malignant
Parotitis- infection- inflammation
PATH
OLO
GY
ECHNR 2021 1st Cycle Module 2 [email protected]
PATHOLOGY OF THE PAROTID GLAND
Congenital- 1st branchial cleft cyst- venolymphatic malformation
PATH
OLO
GY
ECHNR 2021 1st Cycle Module 2 [email protected]
1st BRANCHIAL CLEFT CYST• Persisting branchial cleft remnants• Rare (8% of branchial remnants)• Recurrent peri-auricular swelling, enlarging after infection• In parotid gland, near pinna & EAC
• Recurrent parotid space abscess or otorrhea without otitis• Majority presents < 10 y but also in adults
CO
NG
ENITA
L
ECHNR 2021 1st Cycle Module 2 [email protected]
1st BRANCHIAL CLEFT CYST
CO
NG
ENITA
L
ImagingUltrasound 1st step• Anechoic cystic lesion• Posterior acoustic enhancement
ECHNR 2021 1st Cycle Module 2 [email protected]
1st BRANCHIAL CLEFT CYSTC
ON
GEN
ITAL
ImagingUltrasound 1st step• Anechoic cystic lesion• Posterior acoustic enhancement
MRI for extension• Unilocular cyst• Sometimes sinus tract • Thickened and enhancing wall when infected
ECHNR 2021 1st Cycle Module 2 [email protected]
VENOLYMPHATIC MALFORMATION
• Spectrum of venous and lymphatic developmental abnormalities• Spongy soft tissue mass that grows proportionately with patient• in si e with Valsalva, bending over, crying• rapidly after trauma or infection or under hormonal influences• Present at birth• Percutaneous sclerotherapy
CO
NG
ENITA
L
ECHNR 2021 1st Cycle Module 2 [email protected]
VENOLYMPHATIC MALFORMATION
ImagingUltrasound 1st step• Compressible• No arterial flow on Doppler
CO
NG
ENITA
L
ECHNR 2021 1st Cycle Module 2 [email protected]
VENOLYMPHATIC MALFORMATION
ImagingMRI for extension & exclude high flow • Trans-spatial• Venous
- Flow-voids, phleboliths, enhancement• Lymphatic
- Unilocular or multilocular- Fluid-fluid levels, peripheral & septal enhancement
CO
NG
ENITA
L
ECHNR 2021 1st Cycle Module 2 [email protected]
VENOLYMPHATIC MALFORMATION
CO
NG
ENITA
L
• Percutaneous sclerotherapy
ECHNR 2021 1st Cycle Module 2 [email protected]
PATHOLOGY OF THE PAROTID GLAND
Tumors- benign- malignant
PATH
OLO
GY
ECHNR 2021 1st Cycle Module 2 [email protected]
SET1 SET2 DWI-B1000
SET1 & Gd SET1 & Gd & FS ADC
M62 y, PREAURICULAR SWELLINGTU
MO
RS
ECHNR 2021 1st Cycle Module 2 [email protected]
M62 y, PREAURICULAR SWELLING
Solid neoplasmSuperficial lobe of the parotid glandBenign characteristics
Most likely diagnosis?
TUM
ORS
ECHNR 2021 1st Cycle Module 2 [email protected]
M62 y, PREAURICULAR SWELLING
Solid neoplasmSuperficial lobe of the parotid glandBenign characteristics
Most likely diagnosis?
Pleomorphic adenoma
TUM
ORS
ECHNR 2021 1st Cycle Module 2 [email protected]
EPIDEMIOLOGY SG TUMORS
• Rare lesions• 2-6% of all head and neck tumors• 0,5% of all head and neck malignancies
TUM
ORS
ECHNR 2021 1st Cycle Module 2 [email protected]
EPIDEMIOLOGY SG TUMORS
WHO revised classification 2017
TUM
ORS
ECHNR 2021 1st Cycle Module 2 [email protected]
EPIDEMIOLOGY SG TUMORS
Location Incidence % Malignancy
Parotid 70-80% 20%Submandibular 10-15% 50%
Sublingual 5% 80-90%
Minor salivary 5% 50%
TUM
ORS
ECHNR 2021 1st Cycle Module 2 [email protected]
EPIDEMIOLOGY PAROTID TUMORS
Benign most common
Pleomorphic adenoma
Warthin (only parotid)
Malignant most common
Mucoepidermoid carcinoma
Adenoid cystic carcinoma
Carcinoma ex-pleomorphic adenoma
TUM
ORS
ECHNR 2021 1st Cycle Module 2 [email protected]
PLEOMORPHIC ADENOMA = benign mixed tumor
Epidemiology
70% of all benign tumors
80% in parotid gland
40-50 yrs
F>MHistology:
Cartilage
Myxoid stroma
Myoepithelial cells
Ducts
TUM
ORS
ECHNR 2021 1st Cycle Module 2 [email protected]
PLEOMORPHIC ADENOMA
MRISolitary, unilateralOvoid, lobulatedT2 very hyperintens to intermediateT1 hyperintens if hemorrhagic
Very high ADC valuesDCE contrast retention
TUM
ORS
ECHNR 2021 1st Cycle Module 2 [email protected]
chondroid/myxoid matrix vs higher cellularity (myoepithelial cells)
TSE T2
PLEOMORPHIC ADENOMA ON T2
TUM
ORS
ECHNR 2021 1st Cycle Module 2 [email protected]
PLEOMORPHIC ADENOMA
What the surgeon needs to know
Extension
Relationship with facial nerve
Total resection very important
TUM
ORS
ECHNR 2021 1st Cycle Module 2 [email protected]
M, 66y• resection of deep lobe pleomorphic
adenoma 18 y before. • Multifocal recurrent disease parotid
and parapharyngeal space
RECURRENT PLEOMORPH ADENOMA
TUM
ORS
ECHNR 2021 1st Cycle Module 2 [email protected]
PLEOMORPHIC ADENOMAWhy surgery?• 5-10% risk of malignant degeneration • Carcinoma ex pleomorphic adenoma• Risk increases with time
TUM
ORS
carcinoma ex pleomorphic adenoma 16 years after biopsy-proven pleomorphic adenoma
ECHNR 2021 1st Cycle Module 2 [email protected]
CASE 2
Incidental finding on brain MRI in 27 year old male
Incidental finding
Deep lobe/PPS
TUM
ORS
ECHNR 2021 1st Cycle Module 2 [email protected]
Looks like pleomorphic adenoma
What’s next?
CASE 2
TUM
ORS
ECHNR 2021 1st Cycle Module 2 [email protected]
Possible strategies
surgical resection facial nerve!
wait – and – scan • elderly people
• difficult to reach
INCIDENTAL LESION
TUM
ORS
ECHNR 2021 1st Cycle Module 2 [email protected]
Possible strategies
surgical resection facial nerve!
wait – and – scan
be sure it’s benign
INCIDENTAL LESION
TUM
ORS
ECHNR 2021 1st Cycle Module 2 [email protected]
Possible strategies
surgical resection facial nerve!
wait – and – scan
be sure it’s benign
HOW?
INCIDENTAL LESION
TUM
ORS
ECHNR 2021 1st Cycle Module 2 [email protected]
Possible strategies FNA
Difficult location, sample error (15% non diagnostic)
‘Standard’ imaging (borders, heterogeneity, infiltration)Not discriminative between benign and malignant disease
Multiparametric imagingT1, T2, ce T1 FSDiffusion weighted imagingDynamic Contrast Enhanced Imaging
TUMOR CHARACTERIZATION
Yabuuchi et al 2008, Freling et al 1992
TUM
ORS
ECHNR 2021 1st Cycle Module 2 [email protected]
Possible strategies FNA
Difficult location, sample error (15% non diagnostic)
‘Standard’ imaging (borders, heterogeneity, infiltration)Not discriminative between benign and malignant disease
Multiparametric imagingT1, T2, ce T1 FSDiffusion weighted imagingDynamic Contrast Enhanced Imaging
TUMOUR CHARACTERIZATION
Yabuuchi et al 2008, Freling et al 1992
TUM
ORS
ECHNR 2021 1st Cycle Module 2 [email protected]
T1 & fat sat
T1 & fat sat & Gado
T1
T2
MRI TUMOUR CHARACTERISATION
TUM
ORS
ECHNR 2021 1st Cycle Module 2 [email protected]
T1 & fat sat
T1 & fat sat & Gado
T1
T2
MRI TUMOUR CHARACTERISATION
TTT1TTTTTTTTTTTTTTTTTTTTTTT &&& f& f& f& f& f& ffff& ff& ffffffffffffffffatatatttatatatatattattaaaaatttaaaaaaaaaaatattataaaaaatataaaattaaaatttattatttaT1TTTTTTTTTTTTTTT
TUM
ORS
ECHNR 2021 1st Cycle Module 2 [email protected]
T1
T1 Gd
MRI TUMOUR CHARACTERISATION
TUM
ORS
ECHNR 2021 1st Cycle Module 2 [email protected]
Possible strategies FNA
Difficult location, sample error (15% non diagnostic)
‘Standard’ imaging (borders, heterogeneity, infiltration)
Not discriminative between benign and malignant disease
Multiparametric imagingT1, T2, ce T1 FSFunctional imaging techniquesDiffusion weighted imagingDynamic Contrast Enhanced Imaging
TUMOR CHARACTERIZATION
Yabuuchi et al 2008, Freling et al 1992
TUM
ORS
ECHNR 2021 1st Cycle Module 2 [email protected]
Possible strategies FNA
Difficult location, sample error (15% non diagnostic)
‘Standard’ imaging (borders, heterogeneity, infiltration)
Multiparametric imagingT1, T2, ce T1 FSFunctional imaging techniques• DIFFUSION WEIGHTED IMAGING• DYNAMIC CONTRAST ENHANCED IMAGING
TUMOR CHARACTERIZATION
Yabuuchi et al 2008, Lam et al 2014, Couldert et al 2021
TUM
ORS
ECHNR 2021 1st Cycle Module 2 [email protected]
DIFFUSION WEIGHTED IMAGING
• High cellularity low ADC– Warthin, lymphoma, carcinoma
• Low cellularity high ADC– Pleiomorphic adenoma,
inflammation, edema
ADC =2,2x10-3 cm2/secpleiomorphic adenoma
ADC = 0,8x10-3 cm2/secWarthin
IMA
GIN
G
ECHNR 2021 1st Cycle Module 2 [email protected]
DIFFUSION WEIGHTED IMAGING
• High cellularity low ADC– Warthin, lymphoma, carcinoma
• Low cellularity high ADC– Pleiomorphic adenoma,
inflammation, edema
ADC =2,2 cm2/secpleiomorphic adenoma
ADC = 0,8x10-3 cm2/secWarthin
IMA
GIN
G
ECHNR 2021 1st Cycle Module 2 [email protected]
DIFFUSION WEIGHTED IMAGING
• TSE- DWI preferable to EPI-DWI
• TSE- DWI less distortions
• At least 3 B values (0, 500, 1000 sec/m2)
• ROI to measure ADC
Hirata et al, Medicine 2018
IMA
GIN
G
ECHNR 2021 1st Cycle Module 2 [email protected]
DWI SALIVARY GLANDS
• DWI may differentiate between malignant and benign tissue– Cut-off 1.4x10-3 mm2/sec pleomorphic adenoma vs carcinoma (sens&spec > 90%)
• ADC Warthin resembles malignant tumors
• IVIM for the future
Yabuuchi et al 2008ADC values
IMA
GIN
G
ECHNR 2021 1st Cycle Module 2 [email protected]
DYNAMIC CONTRAST-ENHANCED MRI
• Microvascular characteristics / biomarkers– Blood volume– Blood flow– Permeability– Wash-in & wash-out
Paldino et al, Magn Reson Imaging Clin Am, 2009
IMA
GIN
G
ECHNR 2021 1st Cycle Module 2 [email protected]
DCE ACQUISITION
• Baseline T1 mapping before Gd• Short T1 GE images after iv Gd (0,2mmol/kg; 4mL/s)• Temporal resolution 3-4s• Duration 3-5 min
Lavini & Pieters, Imago 2016
IMA
GIN
G
ECHNR 2021 1st Cycle Module 2 [email protected]
DCE ACQUISITION
• Postprocessing software• ROI selection
– Exclude cystic and hemorrhagic areas
• Visual /non-parametric analysis– Time Intensity Curves (TICs)
• Time to peak• Washout
• Parametric analysis– Pharmacokinetic modeling
Lavini, Imago 2016; Khalifa et al Med Phys 2014
IMA
GIN
G
ECHNR 2021 1st Cycle Module 2 [email protected]
Yabuuchi H. et al. 2003, Hisatomi M. et al. 2007; Espinoza et al 2013, Lavini et al Imago 2016
TIME-INTENSITY CURVES (TIC’s)
Type A: Ascending plateau, no washoutBenign: pleomorphic adenoma
TUM
ORS
TUM
ORS
IMA
GIN
G
ECHNR 2021 1st Cycle Module 2 [email protected]
TIME-INTENSITY CURVES (TIC’s)
Type B: rapid uptake, high washoutWarthin
IMA
GIN
G
Yabuuchi H. et al. 2003, Hisatomi M. et al. 2007; Espinoza et al 2013, Lavini et al Imago 2016
ECHNR 2021 1st Cycle Module 2 [email protected]
TIME-INTENSITY CURVES (TIC’s)
Type C: rapid uptake, low washoutMalignant tumor
IMA
GIN
G
Yabuuchi H. et al. 2003, Hisatomi M. et al. 2007; Espinoza et al 2013, Lavini et al Imago 2016
ECHNR 2021 1st Cycle Module 2 [email protected]
TIME-INTENSITY CURVES (TIC’s)
Not 100% sensitive/specificOverlap in low grade malignancies, Warthin
IMA
GIN
G
Yabuuchi H. et al. 2003, Hisatomi M. et al. 2007; Espinoza et al 2013, Lavini et al Imago 2016
ECHNR 2021 1st Cycle Module 2 [email protected]
S. Espinoza et al, Diagnostic and Interventional Imaging 2013
INTERPRETATION ALGORITHMTU
MO
RS
ECHNR 2021 1st Cycle Module 2 [email protected]
M, 74ypreauricular swelling
TUM
ORS
ECHNR 2021 1st Cycle Module 2 [email protected]
PAROTID LESION – DWI & DCEM, 74y, preauricular swelling
ADC = 2,2 cm2/sec DWI DCE
Curve: TTP> 120s, no washout
No diffusion restrictionAscending uptake
Histology: pleiomorphic adenoma
TUM
ORS
ECHNR 2021 1st Cycle Module 2 [email protected]
MULTIMODALITY IMAGING
HIST: Mucoepidermoid carcinoma
TUM
ORS
ECHNR 2021 1st Cycle Module 2 [email protected]
MULTIMODALITY IMAGING
Do we always need multimodality imaging?
No!
TUM
ORS
ECHNR 2021 1st Cycle Module 2 [email protected]
SET1
M, 75y
TUM
ORS
• Smoker• Swelling preauricular
ECHNR 2021 1st Cycle Module 2 [email protected]
M, 75y
What to do?– MRI with Diffusion &Perfusion– US guided FNA: Warthin tumor
TUM
ORS
ECHNR 2021 1st Cycle Module 2 [email protected]
Epidemiology
15% of all benign SG tumors
Parotid only
M:F = 1:1; smoking ++
50-70 yrs.
Bilateral 10-15%
No malignant transformation
No surgery needed!
WARTHIN’s TUMOR = ADENOLYMPHOMA
TUM
ORS
ECHNR 2021 1st Cycle Module 2 [email protected]
WARTHIN’s TUMOR = ADENOLYMPHOMA
ImagingT1 & T2 Heterogeneity
Cysts + blood
DWI: low ADC
DCE: wash-out > 30%
FDG-PET: uptake!
FDG-PET
ADCB1000
T2
TUM
ORS
ECHNR 2021 1st Cycle Module 2 [email protected]
DIFFERENTIAL WARTHIN’s TUMOR
Single lesion
Pleomorphic adenoma
Low grade ACC
Mucoepithelial carcinoma
Lymphoma
MetastasisTUM
ORS
ECHNR 2021 1st Cycle Module 2 [email protected]
DIFFERENTIAL WARTHIN’s TUMOR
Single lesion Multiple/ bilateral lesionsPleomorphic adenoma Lymphoma
Low grade ACC Lymphadenopathy
Mucoepithelial carcinoma Benign lymphoepithelial cysts (HIV)
Lymphoma
Metastasis
Chronic auto-immune sialoadenitis
TUM
ORS
ECHNR 2021 1st Cycle Module 2 [email protected]
ADENOID CYSTIC CARCINOMA
Epidemiology40-70yrs, F>M
Most common high grade salivary gland tumor
TUM
ORS
MRILow grade: well described
High grade: infiltrative
T2 hyperintens to intermediate
Contrast: homogeneous enhancement
Perineural spread
ECHNR 2021 1st Cycle Module 2 [email protected]
T1
T1 & fat sat
T2
F, 28yTU
MO
RS
• Preauricular swelling right side since months
• Facial nerve paralysis since 1 week
ECHNR 2021 1st Cycle Module 2 [email protected]
T1 T1 ctrStylomastoid foramen!
F, 28y
T1 & FS ctr
TUM
ORS
ECHNR 2021 1st Cycle Module 2 [email protected]
WHAT THE SURGEON WANTS TO KNOW
• Extension of the lesion• Perineural spread• Surgical options vs chemo & radiation therapy
• Diagnosis
TUM
ORS
ECHNR 2021 1st Cycle Module 2 [email protected]
Facial nerve (VII) Trigeminal nerve (V-3)
PERINEURAL SPREAD
TUM
ORS
ECHNR 2021 1st Cycle Module 2 [email protected]
IF THE PATIENT IS A CHILD
M, 2yr
IS IT BENIGN?
TUM
ORS
ECHNR 2021 1st Cycle Module 2 [email protected]
Bradley et al. 2007 ORL; 69:137-145
Children AdultsIncidence: 3-4 /million/yr 80/million/yr
Parotid
benign 48% 90%
malignant 52% 10%
EPIDEMIOLOGY: AGE MATTERS!
TUM
ORS
ECHNR 2021 1st Cycle Module 2 [email protected]
IF THE PATIENT IS A CHILD
M, 3yr
BIOPSY!
Histology:SialoblastomaTU
MO
RS
ECHNR 2021 1st Cycle Module 2 [email protected]
PATHOLOGY OF THE PAROTID GLAND
Parotitis- infection- inflammation
PATH
OLO
GY
ECHNR 2021 1st Cycle Module 2 [email protected]
INFLAMMATION
– Acute (unilateral)– Chronic
• obstructive• non-obstructive: autoimmune (bilateral)
PARO
TITIS
ECHNR 2021 1st Cycle Module 2 [email protected]
INFLAMMATION
– Acute (unilateral)– Chronic
• obstructive• non-obstructive: autoimmune (bilateral)
Start with ultrasoundInfiltration & hyperemiaDilatation of the ductCystic changesCalculi
PARO
TITIS
ECHNR 2021 1st Cycle Module 2 [email protected]
MRI IN PAROTITIS
MRI salivary glandsChronic autoimmune (selected cases)
MR sialography with ductal involvementChronic obstructive sialadenitis - Sialithiasis- Strictures- Post radiation xerostomie
PARO
TITIS
ECHNR 2021 1st Cycle Module 2 [email protected]
AUTOIMMUNE PAROTITIS
• Diffuse enhancement of enlarged or atrophied glands• Cystic changes
Top differential• Sjögren = myoepithelial sialadenitis• IgG4 related sialadenitis• Sarcoidosis PA
ROTIT
IS
ECHNR 2021 1st Cycle Module 2 [email protected]
M. Sjögren
AUTOIMMUNE SIALADENITISPA
ROTIT
IS
ECHNR 2021 1st Cycle Module 2 [email protected]
M SJÖGREN = MYOEPITHELIAL SIALADENITIS
Autoimmune disease of thesalivary & lacrimal glands
F>>M, 40-60 yrs
Parotid 85%, submandibular 15%
Sicca symptoms
Swelling 60%
risk of lymphoma
MRI: non-obstructive sialectasia, multiple cystic lesions
PARO
TITIS
ECHNR 2021 1st Cycle Module 2 [email protected]
MR SIALOGRAPHY
Saliva as natural contrastNo cannulationInformation about the salivary gland distal to obstruction
PARO
TITIS
ECHNR 2021 1st Cycle Module 2 [email protected]
MR SIALOGRAPHYMRI PROTOCOL
TSE T1 ax
TSE T2 ax & cor
DWI
T2 3D-CISS/DRIVE
or 2D-single shot FSE axial 0,6mm & MIP
Head coils / Surface coils
Sialogogue (5cc lemon juice)
Patiënt should be hydrated
PARO
TITIS
ECHNR 2021 1st Cycle Module 2 [email protected]
Calculus
Erdogan et al. Biomed Res Int. 2013
MR SIALOGRAPHY
PARO
TITIS
ECHNR 2021 1st Cycle Module 2 [email protected]
MR-SIALOGRAPHY
Erdogan et al. Biomed Res Int. 2013PARO
TITIS
ECHNR 2021 1st Cycle Module 2 [email protected]
TAKE HOME 1: EPIDEMIOLOGY
• Parotid tumors are rare• Many different histological types• 80% in parotid 80% benign
• Different DDx for children: – Congenital, venous malformation & infantile hemangioma– 50% of parotid tumors malignant
TAKE
HO
ME
ECHNR 2021 1st Cycle Module 2 [email protected]
TAKE HOME 2: CHOICE OF IMAGING
• CT not first choice• US + FNA (without MRI)
– Warthin no resection– Superficial, benign on FNA
superficial parotidectomy without MRI– (Acute) Sialadenitis
• MRI – in all other salivary gland neoplasms– selected cases of (chronic) sialadenitis
TAKE
HO
ME
ECHNR 2021 1st Cycle Module 2 [email protected]
TAKE HOME 3: MRI
• Standard MRI sequences do not discriminate between malignant and benign neoplasms
• Include DWI with ADC in your standard protocol– Easy, short, no postprocessing– MRI + DWI: high sens & spec– Warthin mimics malignant tumor on DWI (also on FDG-PET)
• DCE Perfusion has additional benefit– Postprocessing needed (also software)
TAKE
HO
ME
THANK YOU FOR YOUR ATTENTION