Clinical Significance of Incidentally Detected Parotid Masses on Brain MRI and PET-CT

<b>Background/Objectives</b>: Parotid incidentalomas are increasingly detected during brain MRI and PET-CT, particularly in patients with serious diseases such as cancer. This study aimed to evaluate the clinical significance of incidentally identified parotid lesions. <b>Methods</b>: We retrospectively reviewed the records of 44,952 patients (≥19 years) who underwent brain MRI and 10,957 who underwent PET-CT between January 2014 and December 2023. The incidence, imaging findings, and pathological results of parotid incidentalomas were analyzed. <b>Results</b>: Among 44,952 brain MRIs, 100 incidental parotid lesions (0.22%) were detected, compared with 92 lesions (0.84%) among 10,957 PET-CT scans. The mean patient age was slightly higher in the PET-CT group. Of the MRI-detected lesions, 35 patients underwent further evaluation and 14 underwent surgery, with final pathology confirming only benign tumors, including pleomorphic adenomas, Warthin tumors, and basal cell adenomas. In contrast, among 23 PET-CT patients who underwent additional evaluation, 7 had surgery, and final pathology revealed both benign and malignant tumors. Malignant cases included mucoepidermoid carcinoma, metastatic Merkel cell carcinoma, metastatic sebaceous carcinoma, and adenoid cystic carcinoma. Notably, two patients with initially benign cytology and negative PET-CT findings were later confirmed to have malignancies after surgery, Primary sites of metastatic disease included the thyroid, cervix, head and neck, and skin. <b>Conclusions</b>: Most parotid incidentalomas detected on brain MRI are benign and may be managed conservatively. However, incidentalomas identified on PET-CT require thorough evaluation, as they may indicate metastatic disease or a second primary malignancy, particularly in patients with head and neck or skin cancers.