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01-05-2012 | Head and Neck

Sonoelastography of parotid gland tumours: initial experience and identification of characteristic patterns

Published in: European Radiology | Issue 5/2012

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Abstract

Objectives

The aim of this study was to investigate B-mode and elastographical ultrasound criteria capable of differentiating between benign and malignant parotid tumours and to define characteristic elastographical patterns for pleomorphic adenomas and Warthin’s tumours.

Methods

Fifty-seven patients with parotid gland tumours were examined using a combination of B-mode and elastographic ultrasounds. The data acquired were analysed retrospectively by two experienced ultrasound operators to identify specific sonographical features of benign and malignant lesions. Additionally, elastographical patterns were defined and analysed for their specificity.

Results

A blurred margin proved to be the only significant criterion in B-mode ultrasound capable of differentiating between malignant and benign tumours. The garland sign was defined as an elastographical pattern found significantly more frequently in malignant tumours, improving sonographical prediction of the benign or malignant nature of a parotid lesion. A logistic regression model was developed that achieved a correct prediction in 87.7% of cases. A “dense core” sign was also specifically defined for pleomorphic adenomas and a “half-half” sign for Warthin’s tumours.

Conclusions

Elastography is an innovative and powerful diagnostic tool that can improve the sonographical examination of parotid gland tumours by revealing easily recognised and characteristic patterns of tissue distribution.

Key Points

Elastography can help differentiate benign from malignant parotid tumours during parotid ultrasound.
The elastographical “garland sign” is more frequent in malignant than benign parotid tumours.
Pleomorphic adenomas show an elastographical “dense core sign”.
Warthin’s tumours show an elastographical “half-half sign”.
Parotid cysts show an elastographical “bull’s-eye sign”.
Literature
1.
go back to reference Stennert E, Wittekindt C, Klussmann JP, Guntinas-Lichius O (2004) New aspects in parotid gland surgery. Otolaryngol Pol 58:109–114PubMed Stennert E, Wittekindt C, Klussmann JP, Guntinas-Lichius O (2004) New aspects in parotid gland surgery. Otolaryngol Pol 58:109–114PubMed
2.
go back to reference Klintworth N, Zenk J, Koch M, Iro H (2010) Postoperative complications after extracapsular dissection of benign parotid lesions with particular reference to facial nerve function. Laryngoscope 120:484–490. doi:10.1002/lary.20801 PubMedCrossRef Klintworth N, Zenk J, Koch M, Iro H (2010) Postoperative complications after extracapsular dissection of benign parotid lesions with particular reference to facial nerve function. Laryngoscope 120:484–490. doi:10.​1002/​lary.​20801 PubMedCrossRef
5.
go back to reference Howlett DC, Mercer J, Williams MD (2008) Same day diagnosis of neck lumps using ultrasound-guided fine-needle core biopsy. Br J Oral Maxillofac Surg 46:64–65PubMedCrossRef Howlett DC, Mercer J, Williams MD (2008) Same day diagnosis of neck lumps using ultrasound-guided fine-needle core biopsy. Br J Oral Maxillofac Surg 46:64–65PubMedCrossRef
6.
go back to reference Hausegger KW, Krasa H, Pelzmann W, Grasser RK, Frisch C, Simon H (1993) Sonography of the salivary glands. Ultraschall Med 14:68–74PubMedCrossRef Hausegger KW, Krasa H, Pelzmann W, Grasser RK, Frisch C, Simon H (1993) Sonography of the salivary glands. Ultraschall Med 14:68–74PubMedCrossRef
7.
go back to reference Yasumoto M, Yoshimura R, Sunaba K, Shibuya H (2001) Sonographic appearances of malignant lymphoma of the salivary glands. J Clin Ultrasound 29:491–498PubMedCrossRef Yasumoto M, Yoshimura R, Sunaba K, Shibuya H (2001) Sonographic appearances of malignant lymphoma of the salivary glands. J Clin Ultrasound 29:491–498PubMedCrossRef
8.
go back to reference Zhang L, Zhang ZY (2010) Evaluation of the ultrasonographic features of salivary gland tumours. Chin J Dent Res 13:133–137PubMedCrossRef Zhang L, Zhang ZY (2010) Evaluation of the ultrasonographic features of salivary gland tumours. Chin J Dent Res 13:133–137PubMedCrossRef
9.
go back to reference Burke CJ, Thomas RH, Howlett D (2010) Imaging the major salivary glands. Br J Oral Maxillofac Surg 49:261–269PubMedCrossRef Burke CJ, Thomas RH, Howlett D (2010) Imaging the major salivary glands. Br J Oral Maxillofac Surg 49:261–269PubMedCrossRef
11.
go back to reference Wojcinski S, Farrokh A, Weber S et al (2010) Multicenter study of ultrasound real-time tissue elastography in 779 cases for the assessment of breast lesions: improved diagnostic performance by combining the BI-RADS(R)-US classification system with sonoelastography. Ultraschall Med 31:484–491PubMedCrossRef Wojcinski S, Farrokh A, Weber S et al (2010) Multicenter study of ultrasound real-time tissue elastography in 779 cases for the assessment of breast lesions: improved diagnostic performance by combining the BI-RADS(R)-US classification system with sonoelastography. Ultraschall Med 31:484–491PubMedCrossRef
12.
go back to reference Yonetsu K, Ohki M, Kumazawa S, Eida S, Sumi M, Nakamura T (2004) Parotid tumors: differentiation of benign and malignant tumors with quantitative sonographic analyses. Ultrasound Med Biol 30:567–574PubMedCrossRef Yonetsu K, Ohki M, Kumazawa S, Eida S, Sumi M, Nakamura T (2004) Parotid tumors: differentiation of benign and malignant tumors with quantitative sonographic analyses. Ultrasound Med Biol 30:567–574PubMedCrossRef
13.
go back to reference Scheipers U, Siebers S, Gottwald F et al (2005) Sonohistology for the computerized differentiation of parotid gland tumors. Ultrasound Med Biol 31:1287–1296PubMedCrossRef Scheipers U, Siebers S, Gottwald F et al (2005) Sonohistology for the computerized differentiation of parotid gland tumors. Ultrasound Med Biol 31:1287–1296PubMedCrossRef
14.
go back to reference Yabuuchi H, Matsuo Y, Kamitani T et al (2008) Parotid gland tumors: can addition of diffusion-weighted MR imaging to dynamic contrast-enhanced MR imaging improve diagnostic accuracy in characterization? Radiology 249:909–916PubMedCrossRef Yabuuchi H, Matsuo Y, Kamitani T et al (2008) Parotid gland tumors: can addition of diffusion-weighted MR imaging to dynamic contrast-enhanced MR imaging improve diagnostic accuracy in characterization? Radiology 249:909–916PubMedCrossRef
15.
go back to reference Habermann CR, Arndt C, Graessner J et al (2009) Diffusion-weighted echo-planar MR imaging of primary parotid gland tumors: is a prediction of different histologic subtypes possible? AJNR Am J Neuroradiol 30:591–596PubMedCrossRef Habermann CR, Arndt C, Graessner J et al (2009) Diffusion-weighted echo-planar MR imaging of primary parotid gland tumors: is a prediction of different histologic subtypes possible? AJNR Am J Neuroradiol 30:591–596PubMedCrossRef
16.
go back to reference Christe A, Waldherr C, Hallett R, Zbaeren P, Thoeny H (2011) MR imaging of parotid tumors: typical lesion characteristics in MR imaging improve discrimination between benign and malignant disease. AJNR Am J Neuroradiol 32:1202–1207PubMedCrossRef Christe A, Waldherr C, Hallett R, Zbaeren P, Thoeny H (2011) MR imaging of parotid tumors: typical lesion characteristics in MR imaging improve discrimination between benign and malignant disease. AJNR Am J Neuroradiol 32:1202–1207PubMedCrossRef
17.
go back to reference Fodor D, Pop S, Maniu A, Cosgaria M (2010) Gray scale and Doppler ultrasonography of the benign tumors of parotid gland (pleomorphic adenoma and Warthin’s tumor). Pictorial essay. Med Ultrason 12:238–244PubMed Fodor D, Pop S, Maniu A, Cosgaria M (2010) Gray scale and Doppler ultrasonography of the benign tumors of parotid gland (pleomorphic adenoma and Warthin’s tumor). Pictorial essay. Med Ultrason 12:238–244PubMed
18.
go back to reference Ajayi BA, Pugh ND, Carolan G, Woodcock JP (1992) Salivary gland tumours: is colour Doppler imaging of added value in their preoperative assessment? Eur J Surg Oncol 18:463–468PubMed Ajayi BA, Pugh ND, Carolan G, Woodcock JP (1992) Salivary gland tumours: is colour Doppler imaging of added value in their preoperative assessment? Eur J Surg Oncol 18:463–468PubMed
19.
go back to reference Chikui T, Tokumori K, Yoshiura K, Oobu K, Nakamura S, Nakamura K (2005) Sonographic texture characterization of salivary gland tumors by fractal analyses. Ultrasound Med Biol 31:1297–1304PubMedCrossRef Chikui T, Tokumori K, Yoshiura K, Oobu K, Nakamura S, Nakamura K (2005) Sonographic texture characterization of salivary gland tumors by fractal analyses. Ultrasound Med Biol 31:1297–1304PubMedCrossRef
20.
go back to reference Steinhart H, Zenk J, Sprang K, Bozzato A, Iro H (2003) Contrast-enhanced color Doppler sonography of parotid gland tumors. Eur Arch Otorhinolaryngol 260:344–348PubMedCrossRef Steinhart H, Zenk J, Sprang K, Bozzato A, Iro H (2003) Contrast-enhanced color Doppler sonography of parotid gland tumors. Eur Arch Otorhinolaryngol 260:344–348PubMedCrossRef
21.
go back to reference Siebers S, Zenk J, Bozzato A, Klintworth N, Iro H, Ermert H (2010) Computer aided diagnosis of parotid gland lesions using ultrasonic multi-feature tissue characterization. Ultrasound Med Biol 36:1525–1534PubMedCrossRef Siebers S, Zenk J, Bozzato A, Klintworth N, Iro H, Ermert H (2010) Computer aided diagnosis of parotid gland lesions using ultrasonic multi-feature tissue characterization. Ultrasound Med Biol 36:1525–1534PubMedCrossRef
22.
go back to reference Dumitriu D, Dudea SM, Botar-Jid C, Baciut G (2010) Ultrasonographic and sonoelastographic features of pleomorphic adenomas of the salivary glands. Med Ultrason 12:175–183PubMed Dumitriu D, Dudea SM, Botar-Jid C, Baciut G (2010) Ultrasonographic and sonoelastographic features of pleomorphic adenomas of the salivary glands. Med Ultrason 12:175–183PubMed
23.
go back to reference Hall TJ (2003) AAPM/RSNA physics tutorial for residents: topics in US: beyond the basics: elasticity imaging with US. Radiographics 23:1657–1671PubMedCrossRef Hall TJ (2003) AAPM/RSNA physics tutorial for residents: topics in US: beyond the basics: elasticity imaging with US. Radiographics 23:1657–1671PubMedCrossRef
24.
go back to reference Leong LC, Sim LS, Lee YS et al (2010) A prospective study to compare the diagnostic performance of breast elastography versus conventional breast ultrasound. Clin Radiol 65:887–894PubMedCrossRef Leong LC, Sim LS, Lee YS et al (2010) A prospective study to compare the diagnostic performance of breast elastography versus conventional breast ultrasound. Clin Radiol 65:887–894PubMedCrossRef
25.
go back to reference Schaefer FK, Heer I, Schaefer PJ et al (2011) Breast ultrasound elastography—results of 193 breast lesions in a prospective study with histopathologic correlation. Eur J Radiol 77:450–456PubMedCrossRef Schaefer FK, Heer I, Schaefer PJ et al (2011) Breast ultrasound elastography—results of 193 breast lesions in a prospective study with histopathologic correlation. Eur J Radiol 77:450–456PubMedCrossRef
26.
go back to reference Adamietz BR, Meier-Meitinger M, Fasching P et al (2011) New diagnostic criteria in real-time elastography for the assessment of breast lesions. Ultraschall Med 32:67–73PubMedCrossRef Adamietz BR, Meier-Meitinger M, Fasching P et al (2011) New diagnostic criteria in real-time elastography for the assessment of breast lesions. Ultraschall Med 32:67–73PubMedCrossRef
27.
go back to reference Bojunga J, Herrmann E, Meyer G, Weber S, Zeuzem S, Friedrich-Rust M (2010) Real-time elastography for the differentiation of benign and malignant thyroid nodules: a meta-analysis. Thyroid 20:1145–1150PubMedCrossRef Bojunga J, Herrmann E, Meyer G, Weber S, Zeuzem S, Friedrich-Rust M (2010) Real-time elastography for the differentiation of benign and malignant thyroid nodules: a meta-analysis. Thyroid 20:1145–1150PubMedCrossRef
28.
go back to reference Holtel MR (2010) Emerging technology in head and neck ultrasonography. Otolaryngol Clin North Am 43:1267–1274, viiPubMedCrossRef Holtel MR (2010) Emerging technology in head and neck ultrasonography. Otolaryngol Clin North Am 43:1267–1274, viiPubMedCrossRef
29.
go back to reference Luo S, Kim EH, Dighe M, Kim Y (2011) Thyroid nodule classification using ultrasound elastography via linear discriminant analysis. Ultrasonics 51:425–431PubMedCrossRef Luo S, Kim EH, Dighe M, Kim Y (2011) Thyroid nodule classification using ultrasound elastography via linear discriminant analysis. Ultrasonics 51:425–431PubMedCrossRef
30.
go back to reference Oliver C, Vaillant-Lombard J, Albarel F et al (2011) What is the contribution of elastography to thyroid nodules evaluation? Ann Endocrinol (Paris) 72:120–124CrossRef Oliver C, Vaillant-Lombard J, Albarel F et al (2011) What is the contribution of elastography to thyroid nodules evaluation? Ann Endocrinol (Paris) 72:120–124CrossRef
31.
go back to reference Sporea I, Vlad M, Bota S et al (2011) Thyroid stiffness assessment by acoustic radiation force impulse elastography (ARFI). Ultraschall Med 32:281–285PubMedCrossRef Sporea I, Vlad M, Bota S et al (2011) Thyroid stiffness assessment by acoustic radiation force impulse elastography (ARFI). Ultraschall Med 32:281–285PubMedCrossRef
32.
go back to reference Pinto F, Totaro A, Calarco A et al (2011) Imaging in prostate cancer diagnosis: present role and future perspectives. Urol Int 86:373–382PubMedCrossRef Pinto F, Totaro A, Calarco A et al (2011) Imaging in prostate cancer diagnosis: present role and future perspectives. Urol Int 86:373–382PubMedCrossRef
33.
go back to reference Seitz M, Strittmatter F, Roosen A, Tilki D, Gratzke C (2010) Current status of ultrasound imaging in prostate cancer. Panminerva Med 52:189–194PubMed Seitz M, Strittmatter F, Roosen A, Tilki D, Gratzke C (2010) Current status of ultrasound imaging in prostate cancer. Panminerva Med 52:189–194PubMed
34.
go back to reference Mahdavi SS, Moradi M, Wen X, Morris WJ, Salcudean SE (2011) Evaluation of visualization of the prostate gland in vibro-elastography images. Med Image Anal 15:589–600PubMedCrossRef Mahdavi SS, Moradi M, Wen X, Morris WJ, Salcudean SE (2011) Evaluation of visualization of the prostate gland in vibro-elastography images. Med Image Anal 15:589–600PubMedCrossRef
35.
go back to reference Andersen ES, Christensen PB, Weis N (2009) Transient elastography for liver fibrosis diagnosis. Eur J Intern Med 20:339–342PubMedCrossRef Andersen ES, Christensen PB, Weis N (2009) Transient elastography for liver fibrosis diagnosis. Eur J Intern Med 20:339–342PubMedCrossRef
36.
go back to reference Goertz RS, Amann K, Heide R, Bernatik T, Neurath MF, Strobel D (2011) An abdominal and thyroid status with Acoustic Radiation Force Impulse Elastometry - a feasibility srudy: Acoustic Radiation Force Impulse Elastometry of human organs. Eur J Radiol 80(3):e226–e230. doi:10.1016/j.ejrad.2010.09.025 Goertz RS, Amann K, Heide R, Bernatik T, Neurath MF, Strobel D (2011) An abdominal and thyroid status with Acoustic Radiation Force Impulse Elastometry - a feasibility srudy: Acoustic Radiation Force Impulse Elastometry of human organs. Eur J Radiol 80(3):e226–e230. doi:10.​1016/​j.​ejrad.​2010.​09.​025
37.
go back to reference Heide R, Strobel D, Bernatik T, Goertz RS (2010) Characterization of focal liver lesions (FLL) with acoustic radiation force impulse (ARFI) elastometry. Ultraschall Med 31:405–409PubMedCrossRef Heide R, Strobel D, Bernatik T, Goertz RS (2010) Characterization of focal liver lesions (FLL) with acoustic radiation force impulse (ARFI) elastometry. Ultraschall Med 31:405–409PubMedCrossRef
38.
go back to reference Bhatia KS, Rasalkar DD, Lee YP et al (2010) Evaluation of real-time qualitative sonoelastography of focal lesions in the parotid and submandibular glands: applications and limitations. Eur Radiol 20:1958–1964PubMedCrossRef Bhatia KS, Rasalkar DD, Lee YP et al (2010) Evaluation of real-time qualitative sonoelastography of focal lesions in the parotid and submandibular glands: applications and limitations. Eur Radiol 20:1958–1964PubMedCrossRef
39.
go back to reference Lyshchik A, Higashi T, Asato R et al (2007) Cervical lymph node metastases: diagnosis at sonoelastography—initial experience. Radiology 243:258–267PubMedCrossRef Lyshchik A, Higashi T, Asato R et al (2007) Cervical lymph node metastases: diagnosis at sonoelastography—initial experience. Radiology 243:258–267PubMedCrossRef
40.
go back to reference Bozzato A, Zenk J, Greess H et al (2007) Potential of ultrasound diagnosis for parotid tumors: analysis of qualitative and quantitative parameters. Otolaryngol Head Neck Surg 137:642–646PubMedCrossRef Bozzato A, Zenk J, Greess H et al (2007) Potential of ultrasound diagnosis for parotid tumors: analysis of qualitative and quantitative parameters. Otolaryngol Head Neck Surg 137:642–646PubMedCrossRef
41.
go back to reference Poorten VV, Hart A, Vauterin T et al (2009) Prognostic index for patients with parotid carcinoma: international external validation in a Belgian–German database. Cancer 115:540–550. doi:10.1002/cncr.24015 PubMedCrossRef Poorten VV, Hart A, Vauterin T et al (2009) Prognostic index for patients with parotid carcinoma: international external validation in a Belgian–German database. Cancer 115:540–550. doi:10.​1002/​cncr.​24015 PubMedCrossRef
Metadata
Title
Sonoelastography of parotid gland tumours: initial experience and identification of characteristic patterns
Publication date
01-05-2012
Published in
European Radiology / Issue 5/2012
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-011-2344-7