Salivary Gland Tumors: Use of Intravoxel Incoherent Motion MR Imaging for Assessment of Diffusion and Perfusion for the Differentiation of Benign from Malignant Tumors

Abstract

To prospectively evaluate the intravoxel incoherent motion (IVIM) parameters (microvascular volume fraction, f; pure diffusion coefficient, D; and perfusion-related incoherent microcirculation, D*) for differentiating between benign and malignant salivary gland tumors. All participants in this prospective institutional review board-approved study provided written informed consent. The perfusion and diffusion of 20 (65%) benign (12 pleomorphic adenomas and eight Warthin tumors) and 11 (35%) malignant salivary gland tumors were assessed on the basis of the IVIM theory. Diffusion-weighted magnetic resonance imaging was performed by using 11 b values (0-800 sec/mm(2)). The IVIM parameters of the salivary gland tumors were determined by a radiologist, and significant differences between the tumor types were assessed by using the Steel-Dwass test. The f values of Warthin tumors (0.156 ± 0.039 [standard deviation]) were significantly larger than those of pleomorphic adenomas (0.066 ± 0.031) (P = .003). The D values of malignant tumors (0.96 × 10(-3) mm(2)/sec ± 0.22) were significantly different from those of benign tumors (pleomorphic adenomas, 1.38 × 10(-3) mm(2)/sec ± 0.30 [P = .002]; Warthin tumors, 0.61 × 10(-3) mm(2)/sec ± 0.11 [P = .005]). The D* values of malignant tumors (21.99 × 10(-3) mm(2)/sec ± 19.01) were significantly smaller than those of Warthin tumors (42.64 × 10(-3) mm(2)/sec ± 20.17) (P = .022). The combination of D and D* criteria provided the best diagnostic accuracy (100%) for differentiation among the three tumor types. IVIM imaging may be helpful for differentiation between benign and malignant salivary gland tumors.