Improving the diagnosis of common parotid tumors via the combination of CT image biomarkers and clinical parameters

Abstract

Background: Our study aims to develop and validate diagnostic models of the common parotid tumors based on whole-volume CT textural image biomarkers (IBMs) in combination with clinical parameters at a single institution. Methods: The study cohort was composed of 51 pleomorphic adenoma (PA) patients and 42 Warthin tumor (WT) patients. Clinical parameters and conventional image features were scored retrospectively and textural IBMs were extracted from CT images of arterial phase. Independent-samples t test or Chi-square test was used for evaluating the significance of the difference among clinical parameters, conventional CT image features, and textural IBMs. The diagnostic performance of univariate model and multivariate model was evaluated via receiver operating characteristic (ROC) curve and area under ROC curve (AUC). Results: Significant differences were found in clinical parameters (age, gender, disease duration, smoking), conventional image features (site, maximum diameter, time-density curve, peripheral vessels sign) and textural IBMs (mean, uniformity, energy, entropy) between PA group and WT group (P<0.05). ROC analysis showed that clinical parameter (age) and quantitative textural IBMs (mean, energy, entropy) were able to categorize the patients into PA group and WT group, with the AUC of 0.784, 0.902, 0.910, 0.805, respectively. When IBMs were added in clinical model, the multivariate models including age-mean and age-energy performed significantly better than the univariate models with the improved AUC of 0.940, 0.944, respectively (P<0.001). Conclusions:Both clinical parameter and CT textural IBMs can be used for the preoperative, noninvasive diagnosis of parotid PA and WT. The diagnostic performance of textural IBM model was obviously better than that of clinical model and conventional image model in this study. While the multivariate model consisted of clinical parameter and textural IBM had the optimal diagnostic performance, which would contribute to the better selection of individualized surgery program.

The Role of Preoperative Computed Tomography Radiomics in Distinguishing Benign and Malignant Tumors of the Parotid Gland

“…Therefore, the heterogeneity of malignant lesions is higher than that of benign lesions. Our study employed both plain CT and CECT to extract features to construct the radiomics signature as PG tumors have different CT densities for different tumor histologies and are mainly supplied by arterial blood, yielding more texture information than only the arterial phase, as used in a previous study (22). More features were selected from CECT images than from NCCT images; thus, CECT may reflect more important information, and it may be speculated that unlike plain CT, CECT might also reflect some heterogeneous features associated with the tumor blood supply (3).…”

“…Pallamar et al ( 21 ) utilized standard MRI sequence-based textures to discriminate PG masses; however, only a rather small 38 patients with various pathological entities were enrolled, and regions of interest derived from only three slices rather than from the whole tumor were used for extracting a limited number of features. Another study ( 22 ) used only the arterial phase to distinguish pleomorphic adenoma from Warthin tumor, both of which are benign tumors and have similar clinical management. In addition, several studies have investigated the changes in the parotid morphology and secretory function induced by radiotherapy for head and neck cancers ( 23 , 24 ).…”

Unilateral Deforming Warthin’s Tumor: Case Report and Literature Review

“…Regarding best imaging methods for WT diagnosis, magnetic resonance imaging (MRI) is certainly the most accurate, providing a more detailed description on the extension of the mass, finer intimate reports with important structures of the neck [14], especially with the more advanced techniques of diffusion-weighted MRI [5]. Nevertheless, this investigation is time consuming and expensive, hence computed tomography (CT) is a more accessible method.…”

“…Nevertheless, this investigation is time consuming and expensive, hence computed tomography (CT) is a more accessible method. Zhang et al [14] described the use of CT textural image biomarkers (IBM), as possible means of preoperative differential diagnostics between pleomorphic adenoma and Warthin's tumor. In our case, contrast enhanced CT scan was used due to its increased availability in our department and the experience of our radiologists with this type of investigation.…”