{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T21:35:46Z","timestamp":1791495346153,"version":"4.3.4"},"reference-count":39,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2022,8,1]],"date-time":"2022-08-01T00:00:00Z","timestamp":1659312000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>The aim of this study was to assess the diagnostic value of ADC distribution curves for differentiation between benign and malignant parotid gland tumors and to compare with mean ADC values. 73 patients with parotid gland tumors underwent head-and-neck MRI on a 1.5 Tesla scanner prior to surgery and histograms of ADC values were extracted. Histopathological results served as a reference standard for further analysis. ADC histograms were evaluated by comparing their similarity to a reference distribution using Chi2-test-statistics. The assumed reference distribution for benign and malignant parotid gland lesions was calculated after pooling the entire ADC data. In addition, mean ADC values were determined. For both methods, we calculated and compared the sensitivity and specificity between benign and malignant parotid gland tumors and three subgroups (pleomorphic adenoma, Warthin tumor, and malignant lesions), respectively. Moreover, we performed cross-validation (CV) techniques to estimate the predictive performance between ADC distributions and mean values. Histopathological results revealed 30 pleomorphic adenomas, 22 Warthin tumors, and 21 malignant tumors. ADC histogram distribution yielded a better specificity for detection of benign parotid gland lesions (ADChistogram: 75.0% vs. ADCmean: 71.2%), but mean ADC values provided a higher sensitivity (ADCmean: 71.4% vs. ADChistogram: 61.9%). The discrepancies are most pronounced in the differentiation between malignant and Warthin tumors (sensitivity ADCmean: 76.2% vs. ADChistogram: 61.9%; specificity ADChistogram: 81.8% vs. ADCmean: 68.2%). Using CV techniques, ADC distribution revealed consistently better accuracy to differentiate benign from malignant lesions (\u201cleave-one-out CV\u201d accuracy ADChistogram: 71.2% vs. ADCmean: 67.1%). ADC histogram analysis using full distribution curves is a promising new approach for differentiation between primary benign and malignant parotid gland tumors, especially with respect to the advantage in predictive performance based on CV techniques.<\/jats:p>","DOI":"10.3390\/diagnostics12081860","type":"journal-article","created":{"date-parts":[[2022,8,1]],"date-time":"2022-08-01T21:01:24Z","timestamp":1659387684000},"page":"1860","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Apparent Diffusion Coefficient (ADC) Histogram Analysis in Parotid Gland Tumors: Evaluating a Novel Approach for Differentiation between Benign and Malignant Parotid Lesions Based on Full Histogram Distributions"],"prefix":"10.3390","volume":"12","author":[{"given":"Tobias","family":"Hepp","sequence":"first","affiliation":[{"name":"Institute of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfgang","family":"Wuest","sequence":"additional","affiliation":[{"name":"Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"},{"name":"Imaging Science Institute, University-Hospital-Erlangen, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2897-5411","authenticated-orcid":false,"given":"Rafael","family":"Heiss","sequence":"additional","affiliation":[{"name":"Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"},{"name":"Imaging Science Institute, University-Hospital-Erlangen, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2540-850X","authenticated-orcid":false,"given":"Matthias Stefan","family":"May","sequence":"additional","affiliation":[{"name":"Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"},{"name":"Imaging Science Institute, University-Hospital-Erlangen, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Kopp","sequence":"additional","affiliation":[{"name":"Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"},{"name":"Imaging Science Institute, University-Hospital-Erlangen, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9980-9528","authenticated-orcid":false,"given":"Matthias","family":"Wetzl","sequence":"additional","affiliation":[{"name":"Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"},{"name":"Imaging Science Institute, University-Hospital-Erlangen, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Treutlein","sequence":"additional","affiliation":[{"name":"Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"},{"name":"Imaging Science Institute, University-Hospital-Erlangen, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Uder","sequence":"additional","affiliation":[{"name":"Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"},{"name":"Imaging Science Institute, University-Hospital-Erlangen, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4185-1122","authenticated-orcid":false,"given":"Marco","family":"Wiesmueller","sequence":"additional","affiliation":[{"name":"Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"},{"name":"Imaging Science Institute, University-Hospital-Erlangen, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,8,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Kanetake, H., Inaka, Y., Kinoshita, I., Ayani, Y., Ozaki, A., Omura, S., Higashino, M., Terada, T., Haginomori, S.I., and Kawata, R. (2021). Characteristics and Outcomes of Parotid Gland Tumors in Adolescents. Ear Nose Throat J., 1455613211064013.","DOI":"10.1177\/01455613211064013"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1016\/j.ijom.2009.10.016","article-title":"Salivary gland neoplasms in oral and maxillofacial regions: A 23-year retrospective study of 6982 cases in an eastern Chinese population","volume":"39","author":"Tian","year":"2010","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1177\/014556130608500201","article-title":"World Health Organization classification of tumours: Pathology and genetics of head and neck tumours","volume":"85","author":"Thompson","year":"2006","journal-title":"Ear Nose Throat J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1007\/s00405-016-4253-5","article-title":"Pleomorphic adenomas of the salivary glands: Retrospective multicentric study of 130 cases with emphasis on histopathological features","volume":"274","author":"Lopes","year":"2017","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_5","unstructured":"Limaiem, F., and Jain, P. (2021). Warthin Tumor. StatPearls, StatPearls Publishing LLC."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"S1806-83242016000100208","DOI":"10.1590\/1807-3107BOR-2016.vol30.0002","article-title":"Clinicopathological analysis of salivary gland tumors over a 15-year period","volume":"30","author":"Vasconcelos","year":"2016","journal-title":"Braz. Oral Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1016\/j.oooo.2012.04.008","article-title":"Clinicopathologic analysis of 493 cases of salivary gland tumors in a Southern Brazilian population","volume":"114","author":"Fonseca","year":"2012","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"24106","DOI":"10.1038\/s41598-021-03483-6","article-title":"Systematic review and meta-analysis of modified facelift incision versus modified Blair incision in parotidectomy","volume":"11","author":"Lee","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_9","first-page":"890","article-title":"Surgical management of parotid lesions. Review of seven hundred sixty cases","volume":"80","author":"Beahrs","year":"1960","journal-title":"Arch. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"375","DOI":"10.14639\/0392-100X-1089","article-title":"Parotid tumours: Clinical and oncologic outcomes after microscope-assisted parotidectomy with intraoperative nerve monitoring","volume":"37","author":"Carta","year":"2017","journal-title":"Acta Otorhinolaryngol. Ital."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1007\/s00405-020-06188-0","article-title":"Facial nerve monitoring during parotid gland surgery: A systematic review and meta-analysis","volume":"278","author":"Lechien","year":"2021","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1002\/1097-0142(195407)7:4<637::AID-CNCR2820070403>3.0.CO;2-#","article-title":"Clinical aspects of tumors of the major salivary glands","volume":"7","author":"Frazell","year":"1954","journal-title":"Cancer"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1308\/rcsann.2020.0194","article-title":"Benign parotid mass and facial palsy: Systematic review","volume":"103","author":"Stewart","year":"2021","journal-title":"Ann. R. Coll. Surg. Engl."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/j.nic.2018.02.002","article-title":"State-of-the-Art Imaging of Salivary Gland Tumors","volume":"28","author":"Mukherji","year":"2018","journal-title":"Neuroimaging Clin. N. Am."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1002\/jmri.27061","article-title":"Multiparametric Magnetic Resonance Imaging for the Diagnosis and Differential Diagnosis of Parotid Gland Tumors","volume":"52","year":"2020","journal-title":"J. Magn. Reson. Imaging"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1016\/j.amjoto.2018.04.011","article-title":"Surgeon-performed ultrasound for the assessment of parotid masses","volume":"39","author":"Zheng","year":"2018","journal-title":"Am. J. Otolaryngol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1111\/j.1440-1673.1993.tb00049.x","article-title":"The role of ultrasound and computed tomography in the evaluation of parotid masses","volume":"37","author":"Corr","year":"1993","journal-title":"Australas. Radiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2295","DOI":"10.21037\/gs-20-530","article-title":"Narrative review of multiparametric ultrasound in parotid gland evaluation","volume":"9","author":"Martino","year":"2020","journal-title":"Gland Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1111\/coa.13289","article-title":"The diagnostic performance of ultrasonography and computerized tomography in differentiating superficial from deep lobe parotid tumours","volume":"44","author":"Cheng","year":"2019","journal-title":"Clin. Otolaryngol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"20200391","DOI":"10.1259\/dmfr.20200391","article-title":"Parotid gland tumors: Comparison of conventional and diffusion-weighted MRI findings with histopathological results","volume":"50","author":"Karaman","year":"2021","journal-title":"Dentomaxillofac. Radiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"786.e9","DOI":"10.1016\/j.crad.2021.06.011","article-title":"Analysis of misses in imaging of head and neck pathology by attending neuroradiologists at a single tertiary academic medical centre","volume":"76","author":"Ferguson","year":"2021","journal-title":"Clin. Radiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"20150912","DOI":"10.1259\/bjr.20150912","article-title":"Parotid gland lesions: Separate and combined diagnostic value of conventional MRI, diffusion-weighted imaging and dynamic contrast-enhanced MRI","volume":"89","author":"Yuan","year":"2016","journal-title":"Br. J. Radiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/j.diii.2020.08.002","article-title":"Multiparametric magnetic resonance imaging of parotid tumors: A systematic review","volume":"102","author":"Coudert","year":"2021","journal-title":"Diagn. Interv. Imaging"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1016\/j.carj.2018.10.010","article-title":"Diagnostic Accuracy of Multiparametric Magnetic Resonance Imaging for Differentiation Between Parotid Neoplasms","volume":"70","author":"Elmokadem","year":"2019","journal-title":"Can. Assoc. Radiol. J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"109444","DOI":"10.1016\/j.ejrad.2020.109444","article-title":"Performance of diffusion-weighted imaging for the diagnosis of parotid gland malignancies: A meta-analysis","volume":"134","author":"Chen","year":"2021","journal-title":"Eur. J. Radiol."},{"key":"ref_26","first-page":"138","article-title":"Differentiation of Benign and Malignant Parotid Gland Tumors with MRI and Diffusion Weighted Imaging","volume":"36","author":"Atalay","year":"2021","journal-title":"Medeni. Med. J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1053\/j.sult.2021.07.006","article-title":"Diffusion-Weighted Imaging: Recent Advances and Applications","volume":"42","author":"Grussu","year":"2021","journal-title":"Semin. Ultrasound CT MR"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"591","DOI":"10.3174\/ajnr.A1412","article-title":"Diffusion-weighted echo-planar MR imaging of primary parotid gland tumors: Is a prediction of different histologic subtypes possible?","volume":"30","author":"Habermann","year":"2009","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"20190420","DOI":"10.1259\/dmfr.20190420","article-title":"The histogram analysis of apparent diffusion coefficient in differential diagnosis of parotid tumor","volume":"49","author":"Chen","year":"2020","journal-title":"Dentomaxillofac. Radiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2151","DOI":"10.1007\/s00405-018-5052-y","article-title":"Histogram analysis of apparent diffusion coefficient maps for differentiating malignant from benign parotid gland tumors","volume":"275","author":"Ma","year":"2018","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"20190100","DOI":"10.1259\/dmfr.20190100","article-title":"Apparent diffusion coefficient (ADC) histogram analysis: Differentiation of benign from malignant parotid gland tumors using readout-segmented diffusion-weighted imaging","volume":"48","author":"Zhang","year":"2019","journal-title":"Dentomaxillofac. Radiol."},{"key":"ref_32","first-page":"799","article-title":"Current trends in surgery for benign parotid lesions","volume":"97","author":"Grosheva","year":"2018","journal-title":"Laryngorhinootologie"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1002\/lary.24837","article-title":"Evolution and changing trends in surgery for benign parotid tumors","volume":"125","author":"Mantsopoulos","year":"2015","journal-title":"Laryngoscope"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1016\/j.bjoms.2020.08.026","article-title":"Malignant tumours of the parotid gland: Management of the neck (including the clinically negative neck) and a literature review","volume":"59","author":"Salzano","year":"2021","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1259\/dmfr\/15047967","article-title":"Diagnosing common parotid tumours with magnetic resonance imaging including diffusion-weighted imaging vs fine-needle aspiration cytology: A comparative study","volume":"39","author":"Yerli","year":"2010","journal-title":"Dentomaxillofac. Radiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"3812","DOI":"10.21037\/qims-20-1178","article-title":"Apparent diffusion coefficient measurement of the parotid gland parenchyma","volume":"11","author":"Bruvo","year":"2021","journal-title":"Quant. Imaging Med. Surg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1186\/s13014-020-01721-1","article-title":"Strategies to improve deep learning-based salivary gland segmentation","volume":"15","author":"Dahele","year":"2020","journal-title":"Radiat. Oncol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1007\/s00330-003-2121-3","article-title":"Reproducibility of brain ADC histograms","volume":"14","author":"Steens","year":"2004","journal-title":"Eur. Radiol."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Markiet, K., Glinska, A., Nowicki, T., Szurowska, E., and Mikaszewski, B. (2022). Feasibility of Intravoxel Incoherent Motion (IVIM) and Dynamic Contrast-Enhanced Magnetic Resonance Imaging (DCE-MRI) in Differentiation of Benign Parotid Gland Tumors. Biology, 11.","DOI":"10.3390\/biology11030399"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/12\/8\/1860\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:00:41Z","timestamp":1760140841000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/12\/8\/1860"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,1]]},"references-count":39,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2022,8]]}},"alternative-id":["diagnostics12081860"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics12081860","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,1]]}}}