The Value Of Multiparametric MRI Imaging In Distinguishing Sinonasal Lymphoma From Sinonasal Carcinoma

Objective:The purpose of this study was to evaluate the diagnostic value of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)and diffusion-weighted imaging(DWI)in differentiating sinonasal lymphoma(SL)and sinonasal carcinoma(SC).Methods:The clinical and imaging data of 94 patients with SL and SC confirmed by surgery and pathology in Baoding First Central Hospital from January2017 to December 2021 were retrospectively analyzed(42 patients with SL and 52 patients with SC).All patients underwent DCE-MRI and DWI examinations using 3.0 T MR scanners.All imaging data were obtained on a Philips workstation(Achieva TX;Philips Healthcare,Best,Netherlands),and DCE-MRI analysis and DWI analysis were performed using internally settled software.Time-signal intensity curve(TIC),time to peak(TTP),enhancement peak(EP),maximum contrast enhancement ratio(MCER),wash-out ratio(WR),apparent diffusion coefficient(ADC),and relative ADC(r ADC)values were automatically generated or calculated.The values of TTP,EP and MCER were calculated from the patients with TIC type II or III,and the values of WR were calculated from the patients with TIC Type III.r ADC referred to the ratio of the lesion’s ADC value to the inviolate lateral pterygoid muscle’s ADC value.The statistical significance of each parameter was determined by the statistical analysis between two groups.Multivariate logistic regression analysis and receiver operating characteristic(ROC)curve analysis were used to assess the diagnostic ability of single parameter and combined parameters for distinguishing SL from SC.Results:TIC type was statistically significant between the two groups(X~2=9.767,P=0.008),The most common TIC curve was type II in patients with SL(n=20),while the majority of the curves were III(n=23)in patients with SC.TTP,EP,MCER,ADC,and r ADC were statistically significantly different between SL and SC(P<0.05).WR was not statistically significant(P>0.05).Compared with the SC group,the TTP of the SL group was longer,while the EP,MCER,ADC and r ADC values were lower.Among these parameters,ADC revealed the most reliable diagnostic performance(AUC=0.863),followed by r ADC(AUC=0.813),TTP(AUC=0.753),MCER(AUC=0.749),and EP(AUC=0.745).Meanwhile,the results demonstrated that ADC had relatively high positive predictive value,the highest negative predictive value and the highest accuracy,and to some extent,the diagnostic efficiency of DWI was better than that of DCE-MRI.For cases of TIC type II or III,the AUC values of DCE-MRI combined parameters(TTP,EP,MCER),DWI combined parameters(ADC,r ADC),DCE-MRI and DWI combined parameters(TTP,EP,MCER,ADC,r ADC)were 0.882,0.863,0.945,respectively.Moreover,the diagnostic efficiency of the combined DCE-MRI parameters was higher than that of TTP,EP,and MCER each alone.The combination of all DCE-MRI and DWI parameters together demonstrated the highest diagnostic efficiency,and the accuracy rate was 87.7%higher than that of the single technique.There was no significant difference in TIC type,TTP,EP,MCER,WR,ADC and r ADC between NK/T-cell lymphoma and diffuse large B-cell lymphoma,keratinizing squamous cell carcinoma and non-keratinizing squamous cell carcinoma(P>0.05).Conclusions:DCE-MRI and DWI have high efficiency in the differential diagnosis of SL and SC.TIC type,TTP,EP,MCER,ADC and r ADC are helpful for the differential diagnosis of SL and SC.To some extent,the diagnostic efficiency of DWI is relatively high,which is better than DCE-MRI.In addition,DWI combined with DCE-MRI is superior to single technique application,and multiparametric MRI imaging can significantly improve the accuracy of differential diagnosis of SL and SC.