title: Multimodal ultrasonographic characterisation of parotid gland lesions--a pilot study.
abstract: OBJECTIVE
  Lesions of the major salivary glands represent a heterogeneous group comprising infectious, autoimmune, and neoplastic disorders. The reliable pre-operative assessment of the lesional dignity might reduce patient's morbidity preventing re-surgery. To date, there exists no imaging technique which reliably distinguishes tumour entities.
  
  
  METHODS
  35 parotid lesions were analysed in this study. B-mode ultrasound, colour duplex imaging and contrast enhanced ultrasound were applied for all patients. After fractionated boli of 4.8 ml SonoVue® perfusion kinetics, time to peak (TP) and mean transit time (MTT), were analysed for intraparotideal lesion and were normalised by circumjacent parotid tissue. Ultrasonographic data was structured in a multimodal diagnostic pathway.
  
  
  RESULTS
  B-mode ultrasound identifies six lymphoepithelial lesions due to Sjoegren's syndrome (p: 0.0001). CDS further differentiates hypovascularised pleomorphic adenoma from hypervascularised Warthin's tumours, monomorphic adenomas, and carcinomas (p<0.0001). Application of CEUS detected Warthin's tumours being significantly hypervascularised compared to monomorphic adenomas (MTT, p<0.05) and carcinomas (MTT, p<0.02).
  
  
  CONCLUSIONS
  A multimodal diagnostic pathway unifies different ultrasonographic techniques and identifies pleomorphic adenomas, Warthin's tumours and carcinomas with sensitivities of 100%. Further studies have to be performed to validate this diagnostic approach and to specify monomorphic adenomas.
authors.affiliation: Technische Universität München, Hals-Nasen-Ohrenklinik und Poliklinik, Ismaningerstrasse 22, 81675 München, Germany. a.knopf@lrz.tum.de
authors.forename: Andreas
authors.initials: A
authors.lastname: Knopf
authors.forename: Naglaa
authors.initials: N
authors.lastname: Mansour
authors.forename: Adam
authors.initials: A
authors.lastname: Chaker
authors.forename: Murat
authors.initials: M
authors.lastname: Bas
authors.forename: Konrad
authors.initials: K
authors.lastname: Stock
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010305:Parotid Diseases / Q000175:diagnosis*; D010865:Pilot Projects; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013382:Subtraction Technique; D018615:Ultrasonography, Doppler, Color / Q000379:methods*