Adjunctive Value of Diffusion and Perfusion Permeability Metrics in Differentiating Benign and Malignant Sinonasal Tumours: A Pilot Study
Lamyaa Abdel Galil Eissa *
Radiology Department, Alexandria Faculty of Medicine, Alexandria University, Alexandria, 21131, Egypt.
Aya Mohammed Abdel Aziz
Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Mansoura University, Mansoura City, Egypt.
*Author to whom correspondence should be addressed.
Abstract
The sinonasal area is affected by a variety of benign and malignant lesions that manifest by nonspecific symptoms which can be similar for both conditions. So, differentiating between benign and malignant sinonasal tumours remains a persistent diagnostic challenge. However, CT and MRI are the primary imaging modalities for evaluating sinonasal masses. Conventional magnetic resonance imaging (MRI) possesses no distinctive role in distinguishing between benign and malignant sinonasal masses. So, advanced functional MRI imaging techniques, including diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) perfusion MRI, have provided quantitative metrics related to tissue cellularity and vascular permeability, helping in better tissue characterisation and differentiating benign from malignant masses.
This chapter aims to assess the role of combined diffusion and perfusion by T1-weighed dynamic contrast enhancement (DCE) in characterising sinonasal tumours and solving such a pivotal question, estimating the accuracy of quantitative numeric data on limited low-standard machines.
A prospective pilot study including 30 patients with sinonasal masses is presented, in which combined diffusion-derived apparent diffusion coefficients (ADCs) and perfusion-derived quantitative numeric biomarkers demonstrated statistically significant differences between benign and malignant lesions. Notably, the quantitative results were comparable to those reported from higher-end MRI systems.
The findings highlight that a combined magnetic resonance image (MRI) weighted ADC and DCE perfusion imaging package improves diagnostic confidence and accuracy in sinonasal masses characterisation and differentiation. Importantly, these techniques can be applied in the lowest cost tertiary centres. This chapter discusses the underlying imaging protocols and interpretation strategies of incorporating these advanced MRI metrics into routine sinonasal tumour evaluation.
Keywords: Conventional MRI, sinonasal, perfusion, apparent diffusion coefficient, diffusion