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Two-Phase Computed Tomography Study of Warthin Tumor of Parotid Gland: Differentiation From Other Parotid Gland Tumors and Its Pathologic Explanation

Woo, Seung Hoon MD*†; Choi, Dae-Seob MD, PhD; Kim, Jin-pyeong MD, PhD*; Park, Jung Je MD, PhD*; Joo, Yeon Hee MD*; Chung, Phil-Sang MD, PhD§; Kim, Bo-Young MD; Ko, Young-Hyeh MD, PhD; Jeong, Han-Sin MD, PhD; Kim, Hyung-Jin MD, PhD#

Journal of Computer Assisted Tomography: July/August 2013 - Volume 37 - Issue 4 - p 518–524
doi: 10.1097/RCT.0b013e31828aede8

Objective: The objective of this study was to define the radiological characteristics of 2-phase computed tomography (CT) of parotid gland Warthin tumors (WTs) with a pathologic basis for these findings.

Methods: We prospectively enrolled 116 patients with parotid gland tumor who underwent preoperative 2-phase CT scans(scanning delays of 30 and 120 seconds). The attenuation changes and enhancement patterns were analyzed according to pathology. We also evaluated size-matched samples of WTs and pleomorphic adenoma by staining CD31, vascular endothelial growth factor-receptor 2, collagen IV, and smooth muscle actin.

Results: Computed tomography numbers in WTs were significantly higher than those in other tumors in early-phase scans and lower in delayed scans. Pathologically, CD31(+) blood vessel area was significantly higher in WTs than in pleomorphic adenomas. In addition, WTs had an extensive capillary network and many leaky blood vessels.

Conclusions: The enhancement pattern of early fill-in and early washout is the typical finding of WTs on 2-phase CT scans, which may be attributed pathologically to abundant blood vessel and extensive capillary network.

From the *Department of Otolaryngology, †Institute of Health Sciences, ‡Department of Radiology, Gyeongsang National University, Jinju; §Department of Otorhinolaryngology–Head and Neck Surgery, College of Medicine, Dankook University, Cheonan; and Departments of ∥Otorhinolaryngology–Head and Neck Surgery, ¶Pathology, and #Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Received for publication November 12, 2012; accepted January 31, 2013.

Reprints: Han-Sin Jeong, MD, PhD, Department of Otorhinolaryngology–Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Korea (e-mail:

This work was supported by a National Research Foundation of Korea grant funded by the government of Korea (MEST) (no. 2009-0064073 to H.-S.J.).

The authors have no conflicts of interest to report.

© 2013 by Lippincott Williams & Wilkins