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.