Diagnostic accuracy of computed tomography and magnetic resonance imaging compared to surgical exploration for anterior skull base and medial orbital wall infiltration in advanced sinonasal tumors

Abstract

BackgroundKnowledge of medial orbital wall (MOW) and anterior skull base (ASB) infiltration is of uttermost importance for staging and therapy planning of advanced sinonasal tumors.MethodsWe assessed the diagnostic performance of preoperative computed tomography (CT) and magnetic resonance imaging (MRI) for MOW and ASB infiltration compared to intraoperative exploration.ResultsBoth CT and MRI yielded higher diagnostic accuracy for MOW infiltration (Reader 1: 83.6% CT; 89.0% MRI, Reader 2: 91.8% CT, 93.2% MRI) than for ASB infiltration (Reader 1: 82.2% CT, 82.2% MRI, Reader 2: 67.7% CT, 67.7% MRI). Both modalities were equal to the gold standard, except for ASB assessment by Reader 2 with MRI. A postoperative change of T classification is common (Reader 1: 28.8%, Reader 2: 31.5%).ConclusionsCT and MRI are accurate methods for the assessment of MOW infiltration. ASB assessment is challenging and false‐positive and false‐negative findings are common with both methods, emphasizing the need for intraoperative exploration.

Hybrid positron emission tomography imaging for initial staging of sinonasal tumors: Total lesion glycolysis as prognosticator of treatment response

“…As represented in the AJCC cancer staging system, this information determines the T category and serves as a strong predictor of the 5‐year disease‐specific survival 30‐33 . However, despite state‐of‐the‐art high‐resolution cross‐sectional imaging, radiological assessment needs to be complemented by exploration of the tumor under general anesthesia, in order to ultimately assess local respectability‐defining factors 1,15,28 . While superiority of FDG‐PET/CT over single‐modality PET, CT and MRI imaging was previously shown for the initial staging of head and neck cancer in general, 34,35 only a few studies have investigated the diagnostic accuracy of hybrid PET imaging specifically for the initial staging of sinonasal tumors 9,10 .…”

“…[30][31][32][33] However, despite state-of-the-art high-resolution cross-sectional imaging, radiological assessment needs to be complemented by exploration of the tumor under general anesthesia, in order to ultimately assess local respectability-defining factors. 1,15,28 While superiority of FDG-PET/CT over single-modality PET, CT and MRI imaging was previously shown for the initial staging of head and neck cancer in general, 34,35 only a few studies have investigated the diagnostic accuracy of hybrid PET imaging specifically for the initial staging of sinonasal tumors. 9,10 To the best of our knowledge, the study by Ramakrishnan et al covering 51 subjects is to date the largest series addressing this question.…”

“…Adequate assessment of sinonasal tumors requires a thorough exploration of the tumor under general anesthesia and state-of-the-art cross-sectional imaging in order to devise a patient-tailored therapy regimen. 1 Traditionally, both CT and MRI are considered first-line imaging modalities. CT addresses the bony sinonasal system, identifies calcifying or ossifying elements (eg, osteoma) and provides a bony roadmap for surgery.…”

Imaging of Skull Base and Orbital Invasion in Sinonasal Cancer: Correlation with Histopathology

“…We wanted to evaluate the risk of invasion in these particular cases. In the literature, erosion of the skull base or the orbital wall on the CT scan is a common sign of invasion [ 10 , 11 , 12 , 13 , 14 , 15 , 20 , 21 ]. Likewise, on MRI, modification of the bony skull base/orbital bony wall (“black line”) [ 28 ] is associated with invasion [ 17 ].…”

“…Other studies correlated radiological assessment of tumor extension with histopathologic findings: they predominantly used small retrospective cohorts. Most of them evaluated skull base and dural invasion [ 9 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ], whereas a few of them evaluated orbital invasion [ 21 , 22 , 23 , 24 ]. Double reviewing was not performed in all studies.…”