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Use of Cross-Sectional Imaging in Predicting Surgical Location of Parotid Neoplasms

Divi, Vasu BA*; Fatt, Michael A BS*; Teknos, Theodoros N MD*; Mukherji, Suresh K MD

Journal of Computer Assisted Tomography: May-June 2005 - Volume 29 - Issue 3 - p 315-319
doi: 10.1097/01.rct.0000161758.25130.34
Neuroradiology: Original Article

Objective: The purpose of this study was to determine the diagnostic accuracy of using the retromandibular vein as seen on cross-sectional imaging to help differentiate superficial lobe from deep lobe tumors.

Methods: Of the patients who had parotid neoplasms between January 1997 and July 2002, we were able to identify 44 patients with preoperative imaging studies that were available for evaluation. The films were reviewed by a single head and neck radiologist to determine whether the neoplasms involved the superficial, deep, or both lobes of the parotid gland (total). The lateral margin of the retromandibular vein was used as a marker for the facial nerve, since the nerve is not always visible on CT and MRI scans. The radiologist's findings were then compared with the findings during surgery. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of predicting the location of neoplasms were then calculated.

Results: For lesions in the superficial lobe, cross-sectional imaging was able to predict the location of the neoplasm with a sensitivity of 0.91 (95% CI, 0.70-0.98), specificity of 0.86 (95% CI, 0.63-0.96), PPV of 0.88 (95% CI, 0.67-0.97), and NPV of 0.90 (95% CI, 0.67-0.98). For lesions in both lobes (total), cross-sectional imaging was able to predict the location of the neoplasm with a sensitivity of 0.94 (95% CI, 0.68-0.99), specificity of 0.89 (95% CI, 0.71-0.97), PPV of 0.83 (95% CI, 0.58-0.96), and NPV of 0.96 (95% CI, 0.78-0.99).

Conclusion: Use of the retromandibular vein as a marker for the facial nerve is a sensitive method for identifying the location of parotid gland neoplasms on cross-sectional imaging. This supports the accuracy of using preoperative imaging to detect the position of parotid neoplasms with respect to the facial nerve.

From the *Department of Otolaryngology-Head & Neck Surgery, University of Michigan Medical Center, Ann Arbor, Michigan and †Department of Radiology, Division of Neuroradiology, University of Michigan Medical Center, Ann Arbor, Michigan.

Received for publication August 31, 2004; accepted February 28, 2005.

Presented at The American Society of Head & Neck Radiology 37th Annual Meeting, Rancho Mirage, CA; October 2, 2003.

Reprints: Vasu Divi, 1904 Taubman Center, 1500 E. Medical Center Drive, Ann Arbor, MI 48105-0312 (e-mail:

© 2005 Lippincott Williams & Wilkins, Inc.