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AJNR - American Journal of Neuroradiology

Published ahead of print on May 22, 2008
doi: 10.3174/ajnr.A1128

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Sinonasal Inverted Papilloma: Value of Convoluted Cerebriform Pattern on MR Imaging

T.Y. Jeon^a, H.-J. Kim^a, S.-K. Chung^b, H.-J. Dhong^b, H.Y. Kim^b, Y.J. Yim^a, S.T. Kim^a, P. Jeon^a and K.H. Kim^a

^a Departments of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
^b Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

View larger version (83K): [in this window] [in a new window]   Fig 1. Characteristic MR imaging appearance of a CCP in IP. Coronal T2-weighted (A) and contrast-enhanced fat-suppressed T1-weighted (B) MR images show alternating hypointense and hyperintense striations throughout the tumor involving the left maxillary sinus and nasal cavity.

View larger version (100K): [in this window] [in a new window]   Fig 2. MR images of the IPs concomitant with SCC in 2 different patients. A, Coronal contrast-enhanced, fat-suppressed, T1-weighted image shows a large irregular mass in the right nasal cavity and maxillary sinus. Although the nasal mass displays the characteristic CCP, it is lost in most of the mass of the maxillary sinus. Note the bone destruction at the superior and lateral walls of the maxillary sinus with associated orbital invasion (arrows). B, Axial contrast-enhanced, fat-suppressed, T1-weighted image shows an expansile mass in the left nasal cavity, which displays a diffuse CCP throughout the lesion, indistinguishable from the IP without associated carcinoma. The histology revealed multiple foci of microscopic carcinoma scattered within the tumor.

View larger version (160K): [in this window] [in a new window]   Fig 3. Contrast-enhanced fat-suppressed MR images of 4 different malignant sinonasal tumors displaying a CCP either diffusely (A–C) or partially (D). A, SCC. B, Primitive neuroectodermal tumor. C, Mucoepidermoid carcinoma. D, Esthesioneuroblastoma. In the case of esthesioneuroblastoma, the MR image shows a large mass in the left nasal cavity, extending to the orbit and cranial cavity. Note that, whereas the nasal component of the mass displays a typical appearance of CCP, it is not seen in the rather homogeneously enhancing orbital and intracranial components (asterisks in D).