Assessing parotid gland tumor perfusion with a new imaging biomarker DDVD (diffusion-derived vessel density): promising initial results

Abstract

Purpose

DDVD (diffusion-derived vessel density) is an MRI surrogate of the area of micro-vessels per unit tissue area. DDVD is calculated according to: DDVD(b0b20) = Sb0/ROIarea0 – Sb20/ROIarea20, where Sb0 and Sb20 refer to the tissue signal when b is 0 or 20 s/mm². This study applied DDVD to assess the perfusion of parotid gland tumors.

Materials and Methods

MRI was performed at 3.0T. Diffusion-weighted images with b-values of 0, 20, 1000 s/mm² were acquired for 24 pleomorphic adenomas (PA), 16 Warthin’s tumors (WT), and 14 malignant tumors (MT). DDVDr was DDVD of the tumor divided by DDVD of tumor-free parotid gland tissue. A systematic literature search was conducted for parotid gland tumor perfusion imaging studies. Perfusion parameters of PA, MT, and WT were normalized by PA value, and thus the ratio for PA value was assumed to be 1. The ratio results of MT DDVDr and WT DDVDr further normalized by PA DDVDr were compared with the literature results. In addition, the ADC (apparent diffusion coefficient) was calculated with b=0, 1000 s/mm² images.

Results

Most of the tumors were hyper-vascular relative to native parotid gland tissue with DDVDr >1, with PA, MT, and WT having mean DDVDr values of 1.753±0.462, 2.731±2.254, and 4.324 ±3.203, respectively. DDVDr ratios of MT/PA and WT/PA agreed with the literature perfusion results derived with non-DWI methods, particularly consistent with CT perfusion blood volume results. PA, MT, and WT had ADC values of 1.485 ±0.36, 0.969± 0.194, and 0.772± 0.070 (×10^-3 mm²/s), respectively. WT had very high DDVDr and low ADC, while PA had moderately high DDVDr and very high ADC. Most of the MTs had moderately high DDVDr and low ADC. A combination of ADC and DDVDr can largely differentiate between PA and WT.

Conclusion

DDVD results approximately agree with parotid gland perfusion imaging literature data. A combination of DDVD and ADC may support parotid gland tumor tissue characterization.

Key Points

• As a straightforward diffusion MRI biomarker, DDVD can be used to assess parotid gland tumor perfusion.

• Warthin’s tumors have very high DDVD and low ADC.

• Pleomorphic adenomas have moderately high DDVDr and very high ADC.

• A combination of ADC and DDVDr can largely differentiate between pleomorphic adenoma and Warthin’s tumor.

Citation Format

• Yao D, King AD, Zhang R etal. Assessing parotid gland tumor perfusion with a new imaging biomarker DDVD (diffusion-derived vessel density): promising initial results. Rofo 2024; DOI 10.1055/a-2543-3305

Zusammenfassung

Zweck

DDVD (diffusion-derived “vessel density” ) ist ein MRT-Ersatzwert für die Fläche der Mikrogefäße pro Gewebeflächeneinheit. DDVD wird wie folgt berechnet: DDVD(b0b20) = Sb0/ROIarea0 – Sb20/ROIarea20, wobei sich Sb0 und Sb20 auf das Gewebesignal beziehen, wenn b 0 oder 20 s/mm² beträgt. In dieser Studie wurde DDVD zur Beurteilung der Durchblutung von Ohrspeicheldrüsentumoren eingesetzt.

Materialien und Methoden

Die MRT wurde bei 3,0 T durchgeführt. Diffusionsgewichtete Bilder mit b-Werten von 0, 20, 1000 s/mm² wurden von 24 pleomorphen Adenomen (PA), 16 Warthin-Tumoren (WT) und 14 malignen Tumoren (MT) aufgenommen. DDVDr war DDVD des Tumors geteilt durch DDVD des tumorfreien Ohrspeicheldrüsengewebes. Es wurde eine systematische Literaturrecherche nach Studien zur Perfusionsbildgebung von Ohrspeicheldrüsentumoren durchgeführt. Die Perfusionsparameter von PA, MT und WT wurden durch die PA-Messung normalisiert, und daher wurde das Verhältnis für die PA-Messung als 1 angenommen. Die Verhältnisergebnisse von MT DDVDr und WT DDVDr, weiter normalisiert durch PA DDVDr, wurden mit Literaturergebnissen verglichen. Zusätzlich wurde der ADC (scheinbarer Diffusionskoeffizient) mit Bildern mit b=0, 1000 s/mm² berechnet.

Ergebnisse

Die meisten Tumoren waren im Vergleich zum nativen Ohrspeicheldrüsengewebe hypervaskulär mit DDVDr >1, wobei PA, MT und WT mittlere DDVDr-Werte von 1,753 ± 0,462, 2,731 ± 2,254 bzw. 4,324 ± 3,203 aufwiesen. Die DDVDr-Verhältnisse von MT/PA und WT/PA stimmten mit in der Literatur angegebenen Perfusionsergebnissen überein, die mit Nicht-DWI-Methoden ermittelt wurden, und waren insbesondere mit den CT-Perfusionsblutvolumenergebnissen konsistent. PA, MT und WT hatten ADC-Werte von 1,485 ± 0,36, 0,969 ± 0,194 bzw. 0,772 ± 0,070 (× 10^-3 mm²/s). WT hatte sehr hohe DDVDr und niedrige ADC, während PA mäßig hohe DDVDr und sehr hohe ADC hatte. Die meisten MT hatten mäßig hohe DDVDr und niedrige ADC. Eine Kombination aus ADC und DDVDr kann PA und WT weitgehend trennen.

Schlussfolgerung

Die DDVD-Ergebnisse stimmen in etwa mit den Literaturdaten zur Ohrspeicheldrüsen-Perfusionsbildgebung überein. Eine Kombination aus DDVD und ADC kann die Charakterisierung des Ohrspeicheldrüsentumorgewebes unterstützen.

Kernaussagen

• Als unkomplizierter Diffusions-MRT-Biomarker kann DDVD zur Beurteilung der Durchblutung von Ohrspeicheldrüsentumoren verwendet werden.

• Warthin-Tumoren haben einen sehr hohen DDVD und einen niedrigen ADC.

• Pleomorphe Adenome haben einen mäßig hohen DDVDr und einen sehr hohen ADC.

• Eine Kombination aus ADC und DDVDr kann pleomorphe Adenome und Warthin-Tumoren weitgehend voneinander unterscheiden.

Keywords

parotid gland tumors - Warthin’s tumor - perfusion - pleomorphic adenoma - diffusion-weighted imaging

Publikationsverlauf

Eingereicht: 14. Oktober 2024

Angenommen nach Revision: 17. Februar 2025

Artikel online veröffentlicht:
13. März 2025

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