Fujima N, Nakamaru Y, Sakashita T, Homma A, Tsukahara A, Kudo K, Shirato H
1 Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan.
2 Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Dentomaxillofac Radiol. 2015;44(9):20150074. doi: 10.1259/dmfr.20150074. Epub 2015 Jun 9.
To investigate the diagnostic value of tumour blood flow (TBF) obtained with pseudocontinuous arterial spin labelling for the differentiation of squamous cell carcinoma (SCC) and inverted papilloma (IP) in the nasal or sinonasal cavity.
We retrospectively analysed the cases of 33 patients with SCC and 8 patients with IP in the nasal or sinonasal cavity. Pseudocontinuous arterial spin labelling scanning was performed for all patients using a 3.0-T MR unit. Quantitative TBF values were measured by two neuroradiologists by respectively delineating the whole-tumour regions of interest, and the mean of them was determined as TBF value in each patient. Additionally, the presence of imaging findings of convoluted cerebriform pattern (CCP) on MR T2 weighted images was determined in all patients. As a subgroup analysis, patients with IP were divided into aggressive and non-aggressive IPs depending on their progression range. First, an intraclass correlation coefficient (ICC) of TBF values between two neuroradiologists was determined. Next, a statistical comparison of the TBF value by a Mann-Whitney U test between the patients with SCC and IP was performed. Additionally, the comparison by an ANOVA with a post hoc test of Tukey's method among the SCC, non-aggressive IP and aggressive IP groups was also performed. If significance was observed, the diagnostic accuracy to differentiate SCCs from IPs was calculated. Diagnostic accuracy by CCP findings alone and by the combination of CCP findings and TBF were also assessed.
The ICC of TBF values between two neuroradiologists was 0.82. The mean TBF values in the patients with SCC, all patients with IP, those with aggressive IP and those with non-aggressive IP were 141.2 ± 33.1, 77.8 ± 31.5, 109.4 ± 16.7 and 58.8 ± 19.9 ml 100 g⁻¹ min⁻¹, respectively. A significant difference was observed between SCC and IP (p < 0.001), SCC and non-aggressive IP (p < 0.01) and non-aggressive IP and aggressive IP (p < 0.01). The diagnostic accuracy values obtained with receiver operating characteristic curve analysis for the differentiation of SCC from IP and for SCC from non-aggressive IP were 0.90 and 0.92, respectively. The diagnostic accuracy was elevated (0.95 from 0.88) by adding the TBF value to CCP findings.
The pseudocontinuous arterial spin labelling technique can be a useful non-invasive diagnostic tool to differentiate SCC from IP in nasal or sinonasal cavity.
探讨伪连续动脉自旋标记获得的肿瘤血流（TBF）对鼻腔或鼻窦鳞状细胞癌（SCC）和内翻性乳头状瘤（IP）的鉴别诊断价值。
我们回顾性分析了33例鼻腔或鼻窦SCC患者和8例IP患者的病例。使用3.0-T磁共振成像设备对所有患者进行伪连续动脉自旋标记扫描。由两名神经放射科医生分别勾勒出整个肿瘤感兴趣区域，测量定量TBF值，并将其平均值确定为每位患者的TBF值。此外，确定所有患者在磁共振T2加权图像上是否存在脑回状模式（CCP）的影像学表现。作为亚组分析，根据IP患者的进展范围将其分为侵袭性和非侵袭性IP。首先，确定两名神经放射科医生之间TBF值的组内相关系数（ICC）。接下来，采用Mann-Whitney U检验对SCC和IP患者的TBF值进行统计学比较。此外，还在SCC、非侵袭性IP和侵袭性IP组之间进行了方差分析及Tukey法的事后检验比较。如果观察到显著性差异，则计算鉴别SCC和IP的诊断准确性。还评估了单独根据CCP表现以及CCP表现与TBF相结合的诊断准确性。
两名神经放射科医生之间TBF值的ICC为0.82。SCC患者、所有IP患者、侵袭性IP患者和非侵袭性IP患者的平均TBF值分别为141.2±33.1、77.8±31.5、109.4±16.7和58.8±19.9 ml 100 g⁻¹ min⁻¹。SCC与IP之间（p<0.001）、SCC与非侵袭性IP之间（p<0.01）以及非侵袭性IP与侵袭性IP之间（p<0.01）均观察到显著差异。通过受试者操作特征曲线分析获得的鉴别SCC与IP以及SCC与非侵袭性IP的诊断准确性值分别为0.90和0.92。将TBF值添加到CCP表现中可提高诊断准确性（从0.88提高到0.95）。
伪连续动脉自旋标记技术可成为鉴别鼻腔或鼻窦SCC与IP的一种有用的非侵入性诊断工具。
