Study of imaging characteristics of Kimura disease in the head and neck

doi:10.3969/j.issn.1674-8115.2024.09.013

Abstract

Abstract:

Objective ·To investigate the imaging features of computed tomography (CT) and magnetic resonance imaging (MRI) in the patients with Kimura disease (KD) in the head and neck. Methods ·Sixty-four cases of KD in the head and neck comfirmed by histopathology were retrospectively collected from 2009 to 2023 in Shanghai Ninth People′s Hospital, Shanghai Jiao Tong University School of Medicine. All patients completed CT and/or MRI enhancement imaging before surgery. Clinical and imaging characteristics were collected, recorded and analyzed, including age, gender, peripheral blood eosinophilic ratio, serum IgE level, the lesion location, shape, size, CT density and degree of enhancement, MRI signal intensity and degree of enhancement, apparent diffusion coefficient (ADC), time-signal intensity curve (TIC) patterns, wash-in rate, and time to peak (TTP). Results ·The average age of the 64 KD patients was (40±19) years, and 92.2% were males. A total of 73.5% of the patients showed an elevated ratio of peripheral blood eosinophil, and all 10 tested patients exhibited increased serum IgE levels. There were 82 extranodal (subcutaneous and glandular) lesions and 144 lymph node lesions detected by CT and MRI. Among the extranodal lesions, 80.5% were subcutaneous or glandular patchy lesions with unclear boundaries, and the rest were nodular lesions with clear boundaries. All lesions exhibited isodensity on CT scans and showed isointensity on T1-weighted imaging (T1WI) and hyperintensity on T2-weighted imaging (T2WI) in MRI. Most extranodal lesions tended to show heterogeneous enhancement, while most lymph node lesions showed homogeneous enhancement. The median ADCs of the extranodal lesions and the lymph node lesions were 1.04×10 ^-3 mm ²/s and 0.67×10 ^-3 mm ²/s, respectively, which were significantly different ( P=0.000). The dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) results showed that the TIC patterns of extranodal lesions were predominantly type Ⅰ and Ⅱ, accounting for 57.5% and 42.5%, respectively; while the TIC patterns of lymph node lesions were predominantly type Ⅱ (96.6%). The difference in the TTP and the wash-in rate between the extranodal lesions and the lymph node lesions were both statistically significant ( P=0.000). Conclusion ·Extranodal lesions and lymph node lesions of KD both show isodensity on CT, and isointensity on T1WI and hyperintensity on T2WI in MRI. Extranodal lesions often show high ADC, TIC type Ⅰ or Ⅱ, and mostly heterogeneous enhancement; lymph node lesions often show low ADC, TIC type Ⅱ, and mostly homogenous enhancement.

Key words: Kimura disease, computed tomography (CT), magnetic resonance imaging (MRI), diffusion-weighted imaging (DWI), dynamic enhanced magnetic resonance imaging (DCE-MRI)

CLC Number:

R445.2

LUO Rui, YANG Gongxin, SHI Huimin, HAN Yongshun, HE Yining, TIAN Zhen, WU Yingwei. Study of imaging characteristics of Kimura disease in the head and neck[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2024, 44(9): 1182-1189.

Figures/Tables 6

TrendMD

References 22

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Sequence	FOV/(mm×mm)	FA/(°)	TR/ms	TE/ms	Slice thickness/mm	Slice gap/mm	Matrix size
1.5 T MRI machine (GE)
T1WI (FSE)	240×240	90	540	9	5	6.0	512×512
Fat suppression-T2WI (FSFSE)	240×240	90	4 440	94	5	6.0	512×512
T2WI-Cor (FSE)	220×220	90	3 700	80	4	5.0	512×512
DWI (SE-EPI)	240×240	90	2 200	70	5	5.5	256×256
Fat suppression-T1WI+C (FSFSE)	240×240	90	700	9	5	6.0	512×512
Fat suppression-T1WI+C-Cor (FSFSE)	220×220	90	500	10	4	5.0	512×512
DCE-MRI (FSPGR)	240×240	30	4	2	5	5.5	256×256
3.0 T MRI machine (Philips)
T1WI (TSE)	210×210	90	641	18	4	4.5	512×512
Fat suppression-T2WI (HR-mDIXON-TSE)	210×210	90	2 810	85	4	4.5	384×384
Fat suppression-T2WI-Cor (SS-mDIXON)	210×210	90	3 000	80	3	3.3	864×864
DWI (SPAIR)	222×222	90	2 254	68	5	5.5	192×192
Fat suppression-T1WI+C (mDIXON-TSE-Fast)	209×209	90	582	15	4	4.5	336×336
Fat suppression-T1WI+C-Cor (mDIXON-TSE)	210×210	90	589	16	3	3.3	432×432
DCE-MRI (THRIVE)	210×210	10	7	4	6	3.0	320×320

Sequence	FOV/(mm×mm)	FA/(°)	TR/ms	TE/ms	Slice thickness/mm	Slice gap/mm	Matrix size
1.5 T MRI machine (GE)
T1WI (FSE)	240×240	90	540	9	5	6.0	512×512
Fat suppression-T2WI (FSFSE)	240×240	90	4 440	94	5	6.0	512×512
T2WI-Cor (FSE)	220×220	90	3 700	80	4	5.0	512×512
DWI (SE-EPI)	240×240	90	2 200	70	5	5.5	256×256
Fat suppression-T1WI+C (FSFSE)	240×240	90	700	9	5	6.0	512×512
Fat suppression-T1WI+C-Cor (FSFSE)	220×220	90	500	10	4	5.0	512×512
DCE-MRI (FSPGR)	240×240	30	4	2	5	5.5	256×256
3.0 T MRI machine (Philips)
T1WI (TSE)	210×210	90	641	18	4	4.5	512×512
Fat suppression-T2WI (HR-mDIXON-TSE)	210×210	90	2 810	85	4	4.5	384×384
Fat suppression-T2WI-Cor (SS-mDIXON)	210×210	90	3 000	80	3	3.3	864×864
DWI (SPAIR)	222×222	90	2 254	68	5	5.5	192×192
Fat suppression-T1WI+C (mDIXON-TSE-Fast)	209×209	90	582	15	4	4.5	336×336
Fat suppression-T1WI+C-Cor (mDIXON-TSE)	210×210	90	589	16	3	3.3	432×432
DCE-MRI (THRIVE)	210×210	10	7	4	6	3.0	320×320

Item	Value
Location/ n(%)
Parotid +subcutaneous tissue	29 (35.4)
Lacrimal gland+subcutaneous tissue	1 (1.2)
Parotid	16 (19.5)
Subcutaneous tissue	36 (43.9)
Border/ n(%)
Well-defined	16 (19.5)
Ill-defined	66 (80.5)
Morphology/ n(%)
Patchy	66 (80.5)
Nodular	16 (19.5)
Maximum diameter/cm	4.3 (3.2, 5.8)
CT
Non-enhanced/ n(%) ^①
Isodensity	53 (100.0)
Others	0 (0)
Enhancement ^②
Homogenous/ n(%)
Marked	2 (3.9)
Others	0 (0)
Heterogeneous/ n(%)
Mild	7 (13.7)
Middle	24 (47.1)
Marked	18 (35.3)
MRI ^③
T1WI/ n(%)
Isointensity	40 (100.0)
Others	0 (0)
T2WI/ n(%)
Hyperintensity	40 (100.0)
Others	0 (0)
Enhancement (fat suppression T1WI)
Homogenous/ n(%)
Marked	2 (5.0)
Others	0 (0)
Heterogeneous/ n(%)
Mild	1 (2.5)
Marked	37 (92.5)

Item	Value
Location/ n(%)
Parotid +subcutaneous tissue	29 (35.4)
Lacrimal gland+subcutaneous tissue	1 (1.2)
Parotid	16 (19.5)
Subcutaneous tissue	36 (43.9)
Border/ n(%)
Well-defined	16 (19.5)
Ill-defined	66 (80.5)
Morphology/ n(%)
Patchy	66 (80.5)
Nodular	16 (19.5)
Maximum diameter/cm	4.3 (3.2, 5.8)
CT
Non-enhanced/ n(%) ^①
Isodensity	53 (100.0)
Others	0 (0)
Enhancement ^②
Homogenous/ n(%)
Marked	2 (3.9)
Others	0 (0)
Heterogeneous/ n(%)
Mild	7 (13.7)
Middle	24 (47.1)
Marked	18 (35.3)
MRI ^③
T1WI/ n(%)
Isointensity	40 (100.0)
Others	0 (0)
T2WI/ n(%)
Hyperintensity	40 (100.0)
Others	0 (0)
Enhancement (fat suppression T1WI)
Homogenous/ n(%)
Marked	2 (5.0)
Others	0 (0)
Heterogeneous/ n(%)
Mild	1 (2.5)
Marked	37 (92.5)

Item	Value
Location/ n(%)
Neck	53 (36.8)
Parotid	91 (63.2)
Maximum diameter/cm	1.7 (1.3, 2.1)
CT
Non-enhanced/ n(%) ^①
Isodensity	78 (100.0)
Others	0 (0)
Enhancement ^②
Homogenous/ n(%)
Mild	7 (9.1)
Middle	35 (45.4)
Marked	35 (45.5)
Heterogeneous/ n(%)	0 (0)
MRI ^③
T1WI/ n(%)
Isointensity	87 (100.0)
Others	0 (0)
T2WI/ n(%)
Hyperintensity	87 (100.0)
Others	0 (0)
Enhancement (fat suppression T1WI)
Homogenous/ n(%)
Mild	3 (3.4)
Marked	84 (96.6)
Heterogeneous/ n(%)	0 (0)