Sinonasal Inverted Papilloma: Value of Convoluted Cerebriform Pattern on MR Imaging

Abstract

BACKGROUND AND PURPOSE:A convoluted cerebriform pattern (CCP) has been reported as a valuable MR imaging feature of inverted papilloma (IP). The purpose of this study was to validate the usefulness of CCP for distinguishing IP from various malignant sinonasal tumors in a relatively large number of patients.

Apparent Diffusion Coefficient Mapping for Sinonasal Diseases: Differentiation of Benign and Malignant Lesions

“…A convoluted cerebriform pattern is a reliable MR imaging feature of sinonasal inverted papillomas, but it is lacking in many cases (such an imaging feature was seen in 2 of the 7 present cases). 17 Signal-intensity voids are characteristic MR imaging features of angiofibromas with high vascularity, 18 but they also may be absent (seen in 2 of the 3 present cases). Finally, in the present study, there were no significant differences in overall ADCs or ADC mapping between inverted papillomas, angiofibromas, and hemangiomas (On-line Tables 1 and 2).…”

Cavernous hemangioma of the nasal cavity: mimicking as the inverted papilloma

“…12 However, a cavernous haemangioma presenting in a convulated cerebriform pattern has not been reported in literature as yet.…”

MRI Sequences in Head & Neck Radiology – State of the Art

“…cysts, sinus tracts, fistulae or cartilaginous remnants based on location and clinical symptoms [4] sinonasal inverted papilloma convoluted cerebriform pattern on T2w and T1wC+ [6] paraganglioma "salt and pepper" appearance (30 -40 %) [7] cancer intermediate to high signal in T2w, high signal in T1wC+, mass, infiltration, inhomogeneity, necrosis perineural invasion T2w and T1w thickening and T1wC+ contrast enhancement along the cranial nerve [8] dural invasion nodular dural enhancement on T1wC+ and width of enhancement of more than 5 mm [9] mandibular bone invasion replacement of peripheral hypointense signal (cortical bone) through either tumor signal intensity on both T1w and T2w, or central hyperintense signal (medullary bone) is replaced by intermediate tumor signal [11] neoplastic invasion of laryngeal cartilages low T1w signal, similar to that of tumor T2w signal and similar to tumor T1wC+ signal [12] residual cancer after chemoradiation therapy intermediate T2 signal intensity similar to that of the untreated tumor with areas formed a focal expansible mass > = 1 cm [14] dissection high T1w signal in the vessel wall [15] TIRM/STIR, Dixon, spectral fat sat edema, swelling, tumor high signal in TIRM/STIR necrosis, cystic lesions high signal in TIRM/STIR adipose tissue (lipoma, cholesterol granuloma) suppressed signal lymph node metastasis nodal size (minimum axial diameter of 8 -9 mm in level II and 7 -8 mm for the rest of the neck), loss of hilar structure and necrosis (varying level of low-to-high signal intensity on T2w fat sat depending on keratinization, and coagulation and liquefaction necrosis) [18]; lower signal than regular or reactive lymph nodes on inverted TIRM/ STIR [16] extranodal tumor spread nodal size, shaggy margin and flare sign on T2w fat sat [19] SSFP (CISS, FIESTA), SPACE, VISTA, 3D-FLAIR cerebellopontine angles and inner ear (facial and vestibulocochlear nerves, schwannomas)…”

“…The ability to discriminate fluid and mucus from soft tissue is extremely helpful in the imaging of sinonasal tumors. The convoluted cerebriform pattern on T2w and T1wC+images is a reliable feature of sinonasal inverted papilloma, with focal loss of the cerebriform pattern to be a clue to the diagnosis of focal malignancy [6]. Paraganglioma may show the typical "salt and pepper" appearance in about 30 -40 % of cases [7].…”