Sinonasal Inflammation or Neoplasm: Raise the Red Flagsǃ-A Pictorial Review.

Inflammatory pathology remains the most common indication for sinonasal imaging. However, sinonasal region is also the epicenter of a variety of neoplasms. These are often missed both clinically and radiologically owing to nonspecific signs and symptoms and subtle imaging pointers. An early diagnosis of sinonasal neoplasms is critical for timely management and hence better prognosis and survival rate. This pictorial review aims to acquaint the reader with the "red flag" signs on computed tomography that should raise suspicion for an underlying neoplastic pathology and also highlights the imaging features of common sinonasal neoplasms.

Differentiation of Benign From Malignant Sinonasal Masses Using Diffusion Weighted Imaging and Dynamic Contrast Enhanced Magnetic Resonance Imaging.

BACKGROUND: The sinonasal region is affected by a variety of neoplasms. A differentiation between benign and malignant masses is essential both for management and prognostication. Morphological analysis often does not allow this differentiation. OBJECTIVES: This article aims to assess the value of advanced MRI (diffusion [DWI] and dynamic contrast enhanced MRI [DCE-MRI]) in differentiation of benign and malignant sinonasal masses. METHODS: This prospective study included 40 patients with sinonasal masses who underwent advanced MR on 3T MR scanner. The lesions were analyzed based on morphological characteristics, qualitative, quantitative diffusion parameters, and time signal intensity curves. Apparent diffusion coefficient (ADC) values were acquired using b values of 50 and 1000 s/mm2. The accuracy of DWI, DCE-MRI, and combined DWI/DCE-MRI in differentiating benign from malignant sinonasal masses were analyzed. RESULTS: Perineural extension and growth pattern of the tumor were the best morphological discriminators. Mean ADC values for benign and malignant lesions were 1.675 ± 0.561 and 0.903 ± 0.405 × 10-3 mm2/sec, ,respectively. ROC revealed that ADC cutoff value of 1.005 × 10-3 mm2/sec provided an accuracy of 92.5% in differentiating benign from malignant masses (P value <.01). On excluding the benign vascular masses (Juvenile Nasopharyngeal Angiofibroma and hemangioma), the time signal intensity curve showed 78% accuracy (P value <.001). The highest diagnostic performance was achieved by combining DWI and DCE-MRI (95% accuracy). CONCLUSION: DWI has higher accuracy than DCE-MRI. Quantitative DWI is preferable over qualitative DWI. Accuracy of DCE-MRI can be increased by excluding vascular masses with characteristic imaging features. DWI and DCE-MRI have the highest accuracy when used in combination than either of them alone in differentiating benign from malignant sinonasal masses.