Retromolar trigone tumors: evaluation by magnetic resonance imaging and correlation with pathological data

Abstract

The aim of this study was to evaluate the diagnostic accuracy of magnetic resonance (MR) images to establish both the T stage and the relationships between the tumors and the surrounding structures in retromolar trigone tumors. Twenty-two patients with squamous cell carcinoma of the retromolar trigone were examined by MR with a superconductive scanner operating at 1.5T. The study was performed with spin-echo (SE) T1 and T2 and short SE T1 sequences (TR 180 ms, TE 15 ms) after the administration of 0.2 mmol/kg of gadolinium-DTPA (Gd-DTPA). The mandible was studied with SE T1weighted sequences and GE sequences. The results were compared with the pathological data on the T stage (TNM classification) and the involvement of the surrounding structures. A positive correlation was found in 19 of the 22 patients with an accuracy of 86%. In one patient, the lesion was classified as T1 by MR which, at surgery, resulted being T4, given the infiltration of the cortical mandible (this infiltration was too limited). In another, the MR showed a T4 lesion because of the presence of low signal intensity in the mandibular marrow with enhancement after the Gd-DTPA injection without cortical erosion, while pathological data revealed a T2 lesion (this signal intensity was secondary to inflammation). In another case, the lesion was classified as T1 by MR which, at surgery, proved to be a T2 lesion. In assessing the involvement of the surrounding structures, MR showed a high accuracy, specificity and sensitivity (>90%). Five false positive cases were observed: in two because of infiltration of the masseter muscle and in the other three, because of infiltration to the pterigoid muscle, mandible and tonsillar bed, respectively, due to the close contact between the tumors and the surrounding structures. Only one false negative case was observed with infiltration of the mandibular marrow. In evaluating the low signal intensity of the mandibular marrow, the accuracy of MR was 87%, the specificity 77% and the sensitivity 100%. In one case, perineural spread along the mandibular nerve was found. In conclusion, MR proved to be highly accurate to study the T stage and examine the relationships between the surrounding structures in cases of retromolar trigone tumors.