Parotid gland tumors: can addition of diffusion-weighted MR imaging to dynamic contrast-enhanced MR imaging improve diagnostic accuracy in characterization?

To determine the value of adding diffusion-weighted (DW) magnetic resonance (MR) imaging to dynamic contrast material-enhanced MR imaging when distinguishing between benign and malignant parotid tumors. This retrospective study was approved by the institutional review board, and the informed consent requirement was waived. The authors analyzed MR images of 50 lesions (36 benign, 14 malignant) in 47 patients. DW MR imaging and dynamic contrast-enhanced MR imaging were performed in all patients. Time-intensity curve (TIC) patterns were categorized as follows: type A, time to peak was more than 120 seconds; type B, time to peak was 120 seconds or less with high washout ratio (> or = 30%); type C, time to peak was 120 seconds or less with low washout ratio (< 30%); and type D, flat. The apparent diffusion coefficient (ADC) values were measured on DW MR images. Sensitivity, specificity, accuracy, and positive and negative predictive values were calculated for type A, B, and D tumors regarded as benign and for type C tumors regarded as malignant. On the basis of DW MR imaging results, ADC threshold values between pleomorphic adenomas and carcinomas and between Warthin tumors and carcinomas were selected. Diagnostic accuracy was compared before and after modification diagnosis referring to the ADC value obtained with the McNemar test. P < .05 was considered to indicate a significant difference. ADC threshold values were 1.4 x 10(-3) mm(2)/sec between pleomorphic adenomas and carcinomas and 1.0 x 10(-3) mm(2)/sec between Warthin tumors and carcinomas. Accuracy (82% vs 94%) and positive predictive value (67% vs 92%) significantly improved with the addition of ADC values in the evaluation of patients with type B or C tumors. A persistent or flat TIC pattern on dynamic contrast-enhanced MR images indicates benign disease, but there is added value from including the ADC value in the evaluation of tumors that show a plateau or washout TIC pattern. RSNA, 2008