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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 20:1445-1451 (9 1999)
© 1999 American Society of Neuroradiology

ARTICLE

Recurrent Inverted Papilloma: Diagnosis with Pharmacokinetic Dynamic Gadolinium-EnhancedMR Imaging

Ping H. Lai^,a, Chien F. Yang^a, Huay B. Pan^a, Ming T. Wu^a, Sau T. Chu^a, Luo P. Ger^a, Wen C. Huang^a, Cheng C. Hsu^a and Chung N. Lee^a

^a From the Departments of Radiology (P.H.L., C.F.Y., H.B.P., M.T.W.), Otolaryngology (S.T.C.), and Medical Education and Research and Biostatistics (L.P.G.), Veterans General Hospital-Kaohsiung, National Yang-Ming College, Taiwan, ROC; the Department of Hospital Management (W.C.H.), Chia-Nan College of Pharmacy and Science, Tainan, Taiwan, ROC; and the Institute of Computer and Information Engineering (C.C.H., C.N.L.), National Sun Yat-Sen University, Kaohsiung, Taiwan, ROC.

BACKGROUND AND PURPOSE: Dynamic gadolinium-enhanced MR imaging has been used successfully to identify post-treatment recurrence or postoperative changes in rectal and cervical carcinoma. Our purpose was to evaluate the usefulness of dynamic gadolinium-enhanced MR imaging for distinguishing recurrent inverted papilloma (IP) from postoperative changes.

METHODS: Fifteen patients with 20 pathologically proved lesions (recurrent IP, 12; fibrosis or granulation tissue, eight) were enrolled in the study. Three observers, blinded to pathologic results, independently evaluated conventional MR images, including T1-weighted (unenhanced and postcontrast), proton-density–weighted, and T2-weighted spin-echo images. Results then were determined by consensus. Dynamic images were obtained using fast spin-echo sequences at 5, 30, 60, 90, 120, 150, 180, and 300 seconds after the injection of gadolinium-diethylenetriamine penta-acetic acid. Time-signal intensity curves of suspected lesions were analyzed by a pharmacokinetic model. The calculated amplitude and tissue distribution time were used to characterize tissue, and their values were displayed as a color-coded overlay.

RESULTS: T2-weighted images yielded a sensitivity of 67%, a specificity of 75%, and an accuracy of 70% in the diagnosis of recurrent IP. Contrast-enhanced T1-weighted images yielded a sensitivity of 75%, a specificity of 50%, and an accuracy of 65%. Pharmacokinetic analysis showed that recurrent IP had faster (distribution time, 41 versus 88 seconds) and higher (amplitude, 2.4 versus 1.2 arbitrary units) enhancement than did fibrosis or granulation tissue. A cut-off of 65 seconds for distribution time and 1.6 units for amplitude yielded a sensitivity of 100% and a specificity of 100% for diagnosing recurrent IP.

CONCLUSION: Dynamic MR imaging can differentiate accurately recurrent IP from postoperative changes and seems to be a valuable diagnostic tool.

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