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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.

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.