Intravoxel Incoherent Motion MR Imaging in the Differentiation of Benign and Malignant Sinonasal Lesions: Comparison with Conventional Diffusion-Weighted MR Imaging

Jeffrey Ross Fellows' Journal Club, Head and Neck

Fellows’ Journal Club

One hundred thirty-one patients with histologically proved solid sinonasal lesions (56 benign and 75 malignant) who underwent conventional DWI and intravoxel incoherent motion were evaluated. The diffusion coefficient (D), pseudodiffusion coefficient (D*), and perfusion fraction (f) values derived from intravoxel incoherent motion and ADC values derived from conventional DWI were measured and compared. The mean ADC and D values were significantly lower in malignant sinonasal lesions than in benign sinonasal lesions and the mean f value was higher in malignant than in benign lesions. Multiparametric models can significantly improve the cross-validated areas under the curve for the differentiation of sinonasal lesions compared with single-parametric models. The authors conclude that intravoxel incoherent motion appears to be a more effective MR imaging technique than conventional DWI in the differentiation of benign and malignant sinonasal lesions.

Abstract

Figure 3 from paper
Inverted papilloma in a 71-year-old man. A mass was predominantly located in the right ethmoid sinus with involvement of the right nasal cavity (blue arrow), demonstrating heterogeneous hypo- (necrosis) to isointensity (tumor cells) on T1WI (A), iso- (tumor cells) to hyperintensity (necrosis) on T2WI (B), and heterogeneously intense enhancement on contrast-enhanced T1WI (C), compared with normal-appearing gray matter. The mass showed isointensity on the DWI (blue arrow) (D) compared with normal-appearing gray matter. On the ADC map (E), the mass showed a slightly high signal intensity with an ADC value of 1.425 × 10−3 mm2/s (red polygonal ROI). On IVIM images, the mass appeared obviously iso- to hyperintense on the D map (F) with a D value of 0.871 × 10−3 mm2/s and appeared isointense on the D* (G) and f maps (H) with D* and f values of 61.048 × 10−3 mm2/s and 25.651%, respectively (red polygonal ROIs). Hematoxylin-eosin staining (I) confirmed the mass as an inverted papilloma (original magnification, ×100; scale bar, 250 μm).

BACKGROUND AND PURPOSE

Intravoxel incoherent motion is a promising method for the differentiation of sinonasal lesions. This study aimed to evaluate the value of intravoxel incoherent motion in the differentiation of benign and malignant sinonasal lesions and to compare the diagnostic performance of intravoxel incoherent motion with that of conventional DWI.

MATERIALS AND METHODS

One hundred thirty-one patients with histologically proved solid sinonasal lesions (56 benign and 75 malignant) who underwent conventional DWI and intravoxel incoherent motion were recruited in this study. The diffusion coefficient (D), pseudodiffusion coefficient (D*), and perfusion fraction (f) values derived from intravoxel incoherent motion and ADC values derived from conventional DWI were measured and compared between the 2 groups using the Student t test. Receiver operating characteristic curve analysis, logistic regression analysis, and 10-fold cross-validation were performed to evaluate the diagnostic performance of single-parametric and multiparametric models.

RESULTS

The mean ADC and D values were significantly lower in malignant sinonasal lesions than in benign sinonasal lesions (both P < .001). The mean f value was higher in malignant lesions than in benign lesions (P = .003). Multiparametric models can significantly improve the cross-validated areas under the curve for the differentiation of sinonasal lesions compared with single-parametric models (all corrected P < .05 except the D value). The model of D+f provided a better diagnostic performance than the ADC value (corrected P < .001).

CONCLUSIONS

Intravoxel incoherent motion appears to be a more effective MR imaging technique than conventional DWI in the differentiation of benign and malignant sinonasal lesions.

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Intravoxel Incoherent Motion MR Imaging in the Differentiation of Benign and Malignant Sinonasal Lesions: Comparison with Conventional Diffusion-Weighted MR Imaging
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Jeffrey Ross
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