Can Diffusion Weighted Imaging Aid in Differentiating Benign from Malignant Sinonasal Masses?: A Useful Adjunct

Abstract

SummaryBackgroundTo evaluate the role of diffusion weighted imaging (DWI) and apparent diffusion coefficient (ADC) values at 3 Tesla in characterizing sinonasal masses.Material/MethodsAfter ethical clearance, 79 treatment naive patients with head and neck masses underwent magnetic resonance imaging (MRI), including DWI at 3 Tesla using the following b values – 0, 500 and 1000 s/mm2. Thirty-one patients were found to have sinonasal tumours and were subsequently analysed. Image analysis consisted of a morphological evaluation of conventional MR images, qualitative evaluation of DW trace images and quantitative assessment of mean ADC values. Receiver operating characteristic (ROC) curve was drawn to determine a cut-off ADC value for the differentiation between benign and malignant masses.ResultsSinonasal masses showed an overlapping growth pattern on conventional imaging, irrespective of their biological nature. The mean ADC value of benign lesions was 1.948±0.459×10−3 mm2/s, while that of malignant lesions was 1.046±0.711×10−3 mm2/s, and the difference was statistically significant (p=0.004). When a cut-off ADC value of 1.791×10−3 mm2/s was used, sensitivity of 80% and specificity of 83.3% were obtained for characterization of malignant lesions, which was statistically significant. Juvenile nasopharyngeal angiofibroma (JNA) showed distinctly high ADC values, while meningioma was the only benign lesion with restricted diffusion. Atypical entities with unexpected diffusion characteristics included: adenocarcinoma, adenoid cystic carcinoma, meningioma, chondrosarcoma and fibromyxoid sarcoma.ConclusionsDWI in conjunction with conventional imaging can potentially enhance the diagnostic accuracy in characterizing sinonasal masses as benign or malignant. Some specific entities such as JNA and meningioma showed distinctive diffusion characteristics.

Diffusion-Weighted Imaging (DWI) derived from PET/MRI for lymph node assessment in patients with Head and Neck Squamous Cell Carcinoma (HNSCC)

“…DWI/ADC offers this non-invasive medical intervention. For example, a study by Das et al was reported that 1.791 × 10 − 3 mm 2 /s ADC cut off value in Sinonasal lesions was able to differentiate between benign and malignant lesions with 80% sensitivity and 83.3% specificity [ 24 ]. Barchetti et al in a study of cervical lymph nodes in patients with HNSCC reported a cut off value of 0.965 × 10 − 3 mm 2 /sec to differentiate between benign and malignant nodes with a sensitivity of 97%, a specificity of 93, 92% accuracy, 95% PPV, and 96% NPV of [ 25 ].…”

Accuracy of combined quantitative diffusion-weighted MRI and routine contrast-enhanced MRI in discrimination of benign and malignant salivary gland tumors

“…Previous studies showed that AdCCs have ADC values higher than other malignancies. 17–19 In our cohort, AdCCs had lower ADC values (0.94 × 10 −3 mm 2 /s); this might be explained as most of our cases were high-grade tumors with significant heterogeneously enhancing solid components. 18…”

“…9 Previous studies showed that AdCCs have ADC values higher than other malignancies. [17][18][19] In our cohort, AdCCs had lower ADC values Figure 3. Sixty-three year-old female presenting with nasal discharge, with a history of nasopharyngeal carcinoma.…”

Could intravoxel incoherent motion diffusion-weighted magnetic resonance imaging be feasible and beneficial to the evaluation of gastrointestinal tumors histopathology and the therapeutic response?

“…The apparent diffusion coefficient (ADC) is sensitive to water molecules in the tissues and reflects the microenvironmental changes of tumors[ 5 ]. It is used to differentiate malignant from benign tumors and to evaluate tumor responses after chemotherapy[ 6 , 7 ]. However, ADC values of the tumor are not consistent after treatment because treatment may cause cell swelling or fibrosis that decreases ADC values[ 8 ].…”