Diagnostic performance of quantitative parameters derived from twin-beam dual-energy CT for differentiating benign and malignant salivary gland tumors of the palate

To evaluate the diagnostic performance of quantitative parameters derived from twin-beam dual-energy computed tomography (TB-DECT) in distinguishing benign from malignant palatal salivary gland tumors. This retrospective study included 45 patients with pathologically confirmed palatal salivary gland tumors (23 benign, 22 malignant), all of whom underwent contrast-enhanced TB-DECT. Quantitative and qualitative imaging features were analyzed using TB-DECT images. Quantitative parameters included iodine concentration (IC), normalized IC (NIC), effective atomic number (Z), electron density (Rho), dual-energy index (DEI), and the slope of the spectral attenuation curve (λHU). Statistical analyses were performed to identify predictors of malignancy. Tumor size did not differ significantly between groups. However, malignant tumors showed significantly higher Hounsfield units (HU) at 1-minute post-contrast (p = 0.050). Among DECT parameters, IC, NIC, Z, DEI, and λHU were significantly elevated in malignant tumors (p < 0.05). Univariate logistic regression showed significant associations of malignancy with IC (OR, 1.609; p = 0.020), DEI_N (OR, 65.605; p = 0.025), λHU (OR, 3.494; p = 0.033), and HU at 66 keV (OR, 1.028; p = 0.009). Multivariate analysis was limited by multicollinearity and small sample size. TB-DECT-derived parameters, especially IC, DEI, and λHU, may aid in differentiating malignant from benign palatal salivary gland tumors. Virtual monochromatic images at low keV levels can enhance discrimination between malignant and benign lesions. Twin-beam DECT quantitative parameters can be clinically utilized to differentiate between benign and malignant salivary gland tumors of the palate, especially when conventional CT imaging features are inconclusive.