Differential Diagnosis of Sinonasal Lymphoma and Squamous Cell Carcinoma on CT, MRI, and PET/CT

Abstract

Objective The purpose of this study was to analyze computed tomography (CT) and magnetic resonance (MR) images and to evaluate the maximum standardized uptake value (SUV max) of positron emission tomography (PET)/CT parameters between sinonasal non-Hodgkin's lymphoma (NHL) and squamous cell carcinoma (SCC), knowing the imaging features that distinguish sinonasal NHL from SCC. Study Design Case series with chart review. Setting University tertiary care facility. Subjects and Methods We analyzed the features on CT, MR imaging, and PET/CT of 78 patients diagnosed with sinonasal NHL or SCC histopathologically. The CT (n = 34), MRI (n = 25), and PET/CT (n = 33) images of 39 patients with sinonasal NHL and the CT (n = 38), MR (n = 28), and PET/CT (n = 31) images of 39 patients with SCC were evaluated. The sinonasal NHL was diagnosed as natural killer/T-cell lymphoma (n = 28) and diffuse large B-cell lymphoma (n = 11). Results Patients with sinonasal NHL had a larger tumor volume and higher tumor homogeneity than patients with SCC on T2-weighted and postcontrast MR images. Most of the sinonasal NHL and SCC showed a high degree of enhancement. The apparent diffusion coefficient (ADC) values and adjacent bone destruction were significantly lower in sinonasal NHL than in SCC. However, cervical lymphadenopathy, Waldeyer's ring involvement, and PET/CT SUV max showed no significant differences between sinonasal NHL and SCC. Conclusion CT and MR images of sinonasal masses showing a bulky lesion, marked homogeneity, and low ADC values without adjacent bone destruction are more suggestive of sinonasal NHL than SCC.

Differential diagnosis of sinonasal extranodal NK/T cell lymphoma and diffuse large B cell lymphoma on MRI

“…Magnetic resonance imaging (MRI) has been proven to play crucial roles in the differential diagnosis of sinonasal tumors [ 10 , 11 ], especially for classification of the lymphoma and squamous cell carcinoma [ 12 – 14 ]. Previous studies reported that the homogenous signal intensity, facial soft tissue involvement, and low ADC values on MR findings suggested the diagnosis of the lymphomas [ 12 – 14 ]. However, whether these features can help in differential diagnosis of lymphoma subtypes is still unclear.…”

Squamous Cell Carcinoma and Lymphoma of the Oropharynx: Differentiation Using a Radiomics Approach

“…4 In the sinonasal cavity, lymphomas are thought to yield larger tumor volume with more homogeneous signal intensity and less intratumoral necrosis than SCC. 14,15 These findings may be associated with a prolonged hypoxic microenvironment in SCC and consequent tumor necrosis. 16 In addition, several studies have discriminated between SCC and lymphoma with advanced MR imaging techniques, such as diffusion and perfusion MR imaging.…”

“…Radiologists obtain the information from intrinsic tumor characteristics and from other associated imaging features, such as tumor growth patterns, adjacent structural changes, and metastatic lymph node appearance. For example, adjacent bone destruction is more prominent in SCC than in lymphoma, 14 and central necrosis is one of the characteristic findings of metastatic lymph nodes from SCC. 15 Therefore, additional radiomics information obtained from the intrinsic tumor appearance would be useful to improve the diagnostic performance of radiologists.…”

“… 9 The increased heterogeneity of the tumor signal intensity with more frequent intratumoral necrosis and hemorrhage in SCC may be the main contributor to the texture features. 14 15 However, although radiomic features have been shown to capture variable microscopic characteristics of the tumor, there are limitations in the understanding of their underlying biologic mechanism and in the identification of the value of individual features. 9 18 …”

Positron emission computed tomography and magnetic resonance imaging features of sinonasal small round blue cell tumors

“…Malignancies of the sinonasal cavity are associated with substantially greater heterogeneity compared to malignancies of the upper aerodigestive tract, where squamous-cell carcinoma (SCC) predominates. 1 Even though SCC is the most frequent sinonasal neoplasm, 2 there exists a growing variety of some other histologies, such as tumors of epithelial, neuroectodermal, mesenchymal, and lymphoproliferative lineage. Probably the most challenging diagnostic category of sinonasal malignancies is the small round blue cell tumor (SRBCT), which constitutes a heterogeneous group of malignant neoplasms characterized by undifferentiated tumor cells with small-sized nuclei and scant cytoplasm.…”