Diagnostic Role of Diffusion-Weighted and Dynamic Contrast-Enhanced Perfusion MR Imaging in Paragangliomas and Schwannomas in the Head and Neck

Abstract

BACKGROUND AND PURPOSE: Distinguishing schwannomas from paragangliomas in the head and neck and determining succinate dehydrogenase (SDH) mutation status in paragangliomas are clinically important. We aimed to assess the clinical usefulness of DWI and dynamic contrast-enhanced MR imaging in differentiating these 2 types of tumors, as well as the SDH mutation status of paragangliomas. MATERIALS AND METHODS:This retrospective study from June 2016 to June 2020 included 42 patients with 15 schwannomas and 27 paragangliomas (10 SDH mutation-positive and 17 SDH mutation-negative). ADC values, dynamic contrast-enhanced MRI parameters, and tumor imaging characteristics were compared between the 2 tumors and between the mutation statuses of paragangliomas as appropriate. Multivariate stepwise logistic regression analysis was performed to identify significant differences in these parameters.RESULTS: Fractional plasma volume (P # .001), rate transfer constant (P ¼ .038), time-to-maximum enhancement (P , .001), maximum signal-enhancement ratio (P , .001) and maximum concentration of contrast agent (P , .001), velocity of enhancement (P ¼ .002), and tumor characteristics including the presence of flow voids (P ¼ .001) and enhancement patterns (P ¼ .027) showed significant differences between schwannomas and paragangliomas, though there was no significant difference in ADC values. In the multivariate logistic regression analysis, fractional plasma volume was identified as the most significant value for differentiation of the 2 tumor types (P ¼ .014). ADC values were significantly higher in nonhereditary than in hereditary paragangliomas, while there was no difference in dynamic contrast-enhanced MR imaging parameters.CONCLUSIONS: Dynamic contrast-enhanced MR imaging parameters show promise in differentiating head and neck schwannomas and paragangliomas, while DWI can be useful in detecting SDH mutation status in paragangliomas. ABBREVIATIONS: AUC ¼ area under the curve; DCE ¼ dynamic contrast-enhanced; EES ¼ extravascular extracellular space; Kep ¼ rate transfer constant between EES and blood plasma per minute; K trans ¼ volume transfer constant between EES and blood plasma per minute; SDH ¼ succinate dehydrogenase; SER ¼ signal-enhancement ratio; TIC ¼ time-intensity curve; TME ¼ time-to-maximum enhancement; Ve ¼ EES volume per unit tissue volume; Vp ¼ blood plasma volume per unit tissue volume

Neurofibromatosis type 2 versus sporadic vestibular schwannoma: The utility of MR diffusion and dynamic contrast‐enhanced imaging

“…Regarding DWI analysis, the ADC value can represent cellularity and internal structure and can be used for assessing tumor differentiation and gene mutation status 13 . In this study, normalized mean ADC was significantly higher in the sporadic VSs than in the NF2‐related VSs.…”

“…10 Diffusion-weighted imaging (DWI) and DCE-MRI have been recently used for differentiation of head and neck tumors and treatment effect assessment. [11][12][13][14] Therefore, in this study we aimed to assess the utility of DWI and DCE-MRI as well as conventional MRI findings for differentiation between sporadic and NF2 VSs and to compare the diagnostic performances between DWI and DCE-MRI.…”

MR diffusion and dynamic‐contrast enhanced imaging to distinguish meningioma, paraganglioma, and schwannoma in the cerebellopontine angle and jugular foramen

“…18 Consistent with the present findings, a separate previous study failed to show any significant difference in ADC values between paragangliomas and schwannomas in the head and neck regions. 14 Abbreviations: AUC, area under the curve; K trans , forward volume transfer constant; NPV, negative predictive value; PPV, positive predictive value; V e , extravascular extracellular space; V p , fractional plasma volume.…”

“…Previous studies have explored the differentiation of head and neck schwannomas and paragangliomas using DWI and DCE-MRI scans; one study has shown that V p may be the most significant parameter in differentiating these lesions. 14 However, the utility of DWI and DCE-MRI scans for differentiating intracranial meningiomas from schwannomas and paragangliomas has not been fully investigated.…”

“…Meningiomas, schwannomas, and paragangliomas have different internal histoarchitecture, blood flow, and vascular permeability, which suggests that DWI and DCE‐MRI can help to differentiate among them. Previous studies have explored the differentiation of head and neck schwannomas and paragangliomas using DWI and DCE‐MRI scans; one study has shown that V p may be the most significant parameter in differentiating these lesions 14 . However, the utility of DWI and DCE‐MRI scans for differentiating intracranial meningiomas from schwannomas and paragangliomas has not been fully investigated.…”