USEFULNESS OF MRI IN THE
DIAGNOSIS OF SALIVARY
GLAND PATHOLOGIES
ABSTRACT ID : IRIA -1099
INTRODUCTION
 MAJOR SALIVARY GLAND
o
-PAROTID,SUBMANDIBULAR,SUBLINGUAL
• MINOR SALIVARY GLANDS
o
NUMEROUS SCATTERED THROUGHOUT UPPER
AERODIGESTIVE TRACT.
 SALIVARY GLAND PATHOLOGIES
o
o
o
BENIGN NON NEOPLASTIC
BENIGN NEOPLASTIC
MALIGNANT.
INTRODUCTION
 ULTRASOUND
o
Cheaper, widely available
o
fine-needle aspiration (FNA) and biopsy.
 CT
o
Radio- dense calculi
 MRI
o
o
o
o
o
Superficial /deep parts and the facial nerve .
To evaluate minor salivary gland disease
Perineural spread or skull base involvement of tumor
Deep spaces involvement for surgical assessment .
Thin slices (3D FIESTA) – ducts can be studied .
AIM
 To assess the usefulness of MRI in the diagnosis of salivary gland
pathologies.
REVIEW OF LITERATURE
MR Imaging of Parotid Tumors: Typical Lesion Characteristics
in MR Imaging Improve Discrimination between Benign and
Malignant Disease
 84 pts with parotid gland tumors were studied.
 Histology was available for all tumors.
 MR imaging parameters analyzed were:
o signal intensity,
o contrast enhancement,
o lesion margins (well-defined versus ill-defined),
o lesion location (deep/superficial lobe),
o growth pattern (focal, multifocal, or diffuse), and
o extension into neighbouring structures,
o perineural spread,
o Lymphadenopathy.
Christe C. Waldherr R. Hallett P. Zbaeren H. Thoeny
AJNR Am J Neuroradiol 32:1202–07 􏰅 Aug 2011
 Low signal intensity on T2-weighted images and
postcontrast ill-defined margins of a parotid tumor
are highly suggestive of malignancy.
MATERIALS AND METHODS
o Prospective study, May 2013- Oct 2014
o 24 Patients with suspected salivary gland disease
o 5 Excluded as follow up was not available
o MRI findings correlated with clinical follow up (10) and
surgical/ histopathological diagnosis(9) in 19 pts
TECHNIQUE
o Procedure – Head first, Head neck coil,
Scan covers salivary gland and neck region
o AXIAL– T1, T2, T2 FS,DIFFUSION,CISS,GRADIENT .
o CORONAL STIR
o SAGITTAL T2 weighted images
RESULTS
sex
PATHOLOGY
1
8
18
11
female
male
Parotid (18)
Submandibular gland (1)
PAROTID PATHOLOGY
Bilateral parotid microabscesses
1
Recurrent sialadenitis
1
Haemangioendothelioma
1
AVM of parotid
1
Parotid cyst
1
Pleomorphic adenoma
3
Parotitis
10
0
2
4
6
8
10
12
SUBMANDIBULAR GLAND PATHOLOGY
1
0.8
0.6
0.4
0.2
0
submandibular lipoma
BENIGN NON NEOPLASTIC
PAROTITIS
PAROTID CYST
AVM OF PAROTID
BILATERAL PAROTID MICROABSCESSES
RECURRENT SIALADENITIS
BENIGN NEOPLASTIC
PLEOMORPHIC ADENOMA
SUBMANDIBULAR LIPOMA
HAEMANGIOENDOTHELIOMA
DIAGNOSIS
Parotitis
Pleomorphic adenoma
MRI
10
3
FINAL
10
2
Parotid cyst
AVM of parotid
1
1
1
1
Lymphoma
0
1
Haemangioendothelioma
Recurrent sialadenitis
Bilateral parotid
microabscesses
Submandibular lipoma
1
1
1
1
1
1
1
1
16
14
12
10
MRI
DIAGNOSIS
FINAL
DIAGNOSIS
8
6
4
2
0
Malignant Benign non Benign
neoplastic neoplastic
DISCUSSION
24 YEAR MALE WITH
PAROTITIS
• Diffusely enlarged
superficial and deep
lobes of parotid
•
T 1 hypointense
• T2 hyperintense
45 YEAR OLD MALE WITH
PAROTID CYST
• Well Circumscribed
• T1 hypointense
• T2 hyperintense lesion
23 YEAR OLD FEMALE WITH
HAEMANGIOENDOTHELIOMA
• well defined lesion
•
solid and cystic components.
• T1 isointense to muscles
• T2 hyperintense
38 YEAR OLD MALE WITH
PLEOMORPHIC ADENOMA
• Well circumscribed
•
T1 hypointense
•
T2 hyperintense mass
•
smooth margins
52 YEAR OLD FEMALE WITH
SUBMANDIBULAR LIPOMA
• Well circumscribed
• T1 Hyperintense
• T2 Hyperintense
• Saturates on fat saturated
sequences
CORRELATION
Christie et al found 70% accuracy in diagnosing benign parotid lesions
and 36% in malignant lesions.
Our study showed an accuracy of 95% in diagnosing salivary gland
pathologies.
CONCLUSION
 There are certain MRI characteristics for each of the common
salivary gland pathologies which helps in the exact diagnosis.
 MRI showed an accuracy of 95% in diagnosis of salivary gland
pathologies.
 Hence MRI is an extremely useful in the diagnosis of salivary
gland pathologies.