Department of Radiology, Beijing Tongren Hospital, Capital Medical University, No. 1, DongJiaoMinXiang Street, DongCheng District, Beijing, 100730, China.
Neuroradiology. 2023 Aug;65(8):1263-1270. doi: 10.1007/s00234-023-03164-3. Epub 2023 May 20.
This study aimed to investigate the feasibility of diffusion-weighted imaging (DWI) in combination with conventional MRI features to differentiate sinonasal malignant melanoma (SNMM) from sinonasal squamous cell carcinoma (SNSCC).
A total of 37 patients with SNMM and 44 patients with SNSCC were retrospectively reviewed. Conventional MRI features and apparent diffusion coefficients (ADCs) were evaluated independently by two experienced head and neck radiologists. ADCs were obtained from two different regions of interest (ROIs) including maximum slice (MS) and small solid sample (SSS). Multivariate logistic regression analysis was performed to identify significant MR imaging features in discriminating between SNMM and SNSCC. Receiver operating characteristic (ROC) curves were used to assess the diagnostic performance.
SNMMs were more frequently located in the nasal cavity, with well-defined border, T1 Septate Pattern (T1-SP) and heterogeneous T1 hyperintensity, whereas SNSCCs were more frequently located in the paranasal sinus, with homogenous T1 isointensity, ill-defined border, reticular or linear T2 hyperintensity, and pterygopalatine fossa or orbital involvement (all p < 0.05). The mean ADCs of SNMM (MS ADC, 0.85 × 10mm/s; SSS ADC, 0.69 × 10mm/s) were significantly lower than those of SNSCC (MS ADC, 1.05 × 10mm/s; SSS ADC, 0.82 × 10mm/s) (p < 0.05). With a combination of location, T1 signal intensity, reticular or linear T2 hyperintensity, and a cut-off MS ADC of 0.87 × 10mm/s, the sensitivity, specificity, and AUC were 97.3%, 68.2%, and 0.89, respectively.
DWI combined with conventional MRI can effectively improve the diagnostic performance in differentiating SNMM from SNSCC.
本研究旨在探讨扩散加权成像（DWI）联合常规 MRI 特征鉴别鼻腔鼻窦恶性黑色素瘤（SNMM）与鼻腔鼻窦鳞状细胞癌（SNSCC）的可行性。
回顾性分析 37 例 SNMM 和 44 例 SNSCC 患者的资料。由 2 名经验丰富的头颈放射科医生分别评估常规 MRI 特征和表观扩散系数（ADC）。ADC 值分别在最大层面（MS）和小实性样本（SSS）两个感兴趣区（ROI）中获得。采用多变量逻辑回归分析确定鉴别 SNMM 和 SNSCC 的有意义的 MRI 特征。采用受试者工作特征（ROC）曲线评估诊断效能。
SNMM 更常位于鼻腔，边界清楚，T1 分隔样（T1-SP）和不均匀 T1 高信号，而 SNSCC 更常位于副鼻窦，T1 等信号，边界不清，呈网状或线状 T2 高信号，且累及翼腭窝或眼眶（均 P<0.05）。SNMM 的平均 ADC 值（MS ADC：0.85×10mm/s；SSS ADC：0.69×10mm/s）明显低于 SNSCC（MS ADC：1.05×10mm/s；SSS ADC：0.82×10mm/s）（P<0.05）。当结合位置、T1 信号强度、网状或线状 T2 高信号以及 MS ADC 截断值为 0.87×10mm/s 时，其灵敏度、特异度和 AUC 分别为 97.3%、68.2%和 0.89。
DWI 联合常规 MRI 可有效提高鉴别 SNMM 与 SNSCC 的诊断效能。
