Article Figures & Data
Figures
- Fig 1.
Scatterplots depicting the correlations between the patients' ages and ADC values (A), the patients' ages and D values (B), the patients' ages and D* values (C), and the patients' ages and f values (D) for all sinonasal lesions.
- Fig 2.
Comparisons of the mean ADC (A), D (B), D* (C), and f (D) values between benign and malignant sinonasal lesions using the Student t test. Triple asterisks indicate P < .001; double asterisks, P < .01.
- Fig 3.
Inverted papilloma in a 71-year-old man. A mass was predominantly located in the right ethmoid sinus with involvement of the right nasal cavity (blue arrow), demonstrating heterogeneous hypo- (necrosis) to isointensity (tumor cells) on T1WI (A), iso- (tumor cells) to hyperintensity (necrosis) on T2WI (B), and heterogeneously intense enhancement on contrast-enhanced T1WI (C), compared with normal-appearing gray matter. The mass showed isointensity on the DWI (blue arrow) (D) compared with normal-appearing gray matter. On the ADC map (E), the mass showed a slightly high signal intensity with an ADC value of 1.425 × 10−3 mm2/s (red polygonal ROI). On IVIM images, the mass appeared obviously iso- to hyperintense on the D map (F) with a D value of 0.871 × 10−3 mm2/s and appeared isointense on the D* (G) and f maps (H) with D* and f values of 61.048 × 10−3 mm2/s and 25.651%, respectively (red polygonal ROIs). Hematoxylin-eosin staining (I) confirmed the mass as an inverted papilloma (original magnification, ×100; scale bar, 250 μm).
- Fig 4.
Squamous cell carcinoma in a 53-year-old man. A mass was predominantly located in the left ethmoid sinus with involvement of the ipsilateral orbit, nasal cavity, and sphenoid sinus (blue arrow), demonstrating heterogeneous hypo- (necrosis) to isointensity (tumor cells) on T1WI (A), iso- (tumor cells) to hyperintensity (necrosis) on T2WI (B), and heterogeneously intense enhancement on contrast-enhanced T1WI (C), compared with normal-appearing gray matter. The mass showed heterogeneously hypo- to hyperintensity on the DWI (blue arrow) (D) compared with normal-appearing gray matter. On the ADC map (E), the mass showed hypointensity with an ADC value of 0.872 × 10−3 mm2/s (red polygonal ROI). On IVIM images, the mass appeared dramatically hypointense on the D map (F), with a D value of 0.533 × 10−3 mm2/s, hypo- to isointense on the D* map (G), and iso- to hyperintense on the f map (H), with D* and f values of 77.473 × 10−3 mm2/s and 22.966%, respectively (red polygonal ROIs). Hematoxylin-eosin staining (I) confirmed the mass as a squamous cell carcinoma (original magnification, × 200; scale bar, 50 μm).
- Fig 5.
ROC curves with 10-fold cross-validation of single- parameter models (including ADC, D, and f) and multiparametric models (including ADC+f, ADC+D, D+f, and ADC+D+f) in the contrast-enhancing lesions for differentiating benign from malignant sinonasal lesions.
Tables
Parameters Benign Lesions (n = 56) Malignant Lesions (n = 75) Mean age (yr) 43.86 ± 14.11 52.27 ± 15.21 Sex (female/male) 24:32 24:51 Histologic subtypes Inflammatory polyps (28) Squamous cell carcinoma (23) Inverted papilloma (14) Olfactory neuroblastoma (13) Fibroangioma (5) Malignant melanoma (12) Spindle cell tumor (4) Rhabdomyosarcoma (9) Schwannoma (2) Lymphoma (6) Ossifying fibroma (2) Adenoid cystic carcinoma (5) Enamel cell tumor (1) Undifferentiated carcinoma (2) Osteosarcoma (2) Neuroendocrine carcinoma (2) Malignant fibrohistiocytoma (1) ↵a Data in parentheses indicate the number of corresponding patients. All inverted papillomas did not have the potential for association with/conversion to squamous cell carcinoma, proven by histopathology.
Parameters ICC Interreader Intrareader ADC (×10−3 mm2/s) 0.961 (0.913–0.977) 0.954 (0.871–0.980) D (×10−3 mm2/s) 0.942 (0.860–0.986) 0.936 (0.884–0.975) D* (×10−3 mm2/s) 0.840 (0.762–0.931) 0.848 (0.766–0.909) f (%) 0.908 (0.819–0.965) 0.922 (0.835–0.964) Note:—ICC indicates intraclass correlation coefficient.
↵a Data in parentheses are 95% confidence intervals.
- Table 3:
Comparisons of ADC, D, D*, and f values between benign and malignant sinonasal lesionsa
Parameters Benign Lesions (n = 56) Malignant Lesions (n = 75) P Value ADC (×10−3 mm2/s) 1.163 ± 0.354 0.862 ± 0.258 <.001 D (× 10−3 mm2/s) 1.322 ± 0.347 0.677 ± 0.299 <.001 D* (×10−3 mm2/s) 90.470 ± 40.756 86.445 ± 22.865 .474 f (%) 16.656 ± 4.274 19.211 ± 4.066 .001 ↵a Except for the P values, data are expressed as the mean ± SD.
- Table 4:
Diagnostic performance of single parameters (ADC, D and f) and combined parameters (ADC+f, ADC+D, D+f, and ADC+D+f) for the differentiation of benign and malignant sinonasal lesions using receiver operating characteristic curve analysis with 10-fold cross-validation
TV AUC Cross-Validated AUC Sensitivity Specificity Accuracy Precision F Score ADC 0.919 0.754 0.735 0.800 0.547 0.686 0.684 0.738 D 0.715 0.907 0.899 0.841 0.816 0.831 0.866 0.853 f 16.995 0.676 0.656 0.723 0.472 0.610 0.627 0.723 ADC+f – 0.910 0.907 0.857 0.792 0.831 0.857 0.857 ADC+D – 0.944 0.914 0.813 0.778 0.797 0.813 0.813 D+f – 0.938 0.935 0.914 0.813 0.873 0.877 0.895 ADC+D+f – 0.951 0.944 0.900 0.833 0.873 0.887 0.894 Note:—TV indicates threshold value.
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