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AJNR - American Journal of Neuroradiology

Publication Preview: Published May 22, 2008

American Journal of Neuroradiology 2008;29:1556.

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American Journal of Neuroradiology
DOI 10.3174/ajnr.A1128

HEAD & NECK

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

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

From the Departments of Radiology (T.Y.J., H.-J.K., Y.J.Y., S.T.K., P.J., K.H.K.) and Otorhinolaryngology-Head and Neck Surgery (S.-K.C., H.-J.D., H.Y.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Please address correspondence to Hyung-Jin Kim, Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea; E-mail: hyungkim{at}skku.edu

BACKGROUND AND PURPOSE: A convoluted cerebriform pattern (CCP) has been reported as a valuable MR imaging feature of inverted papilloma (IP). The purpose of this study was to validate the usefulness of CCP for distinguishing IP from various malignant sinonasal tumors in a relatively large number of patients.

MATERIALS AND METHODS: We retrospectively reviewed MR images of 30 patients with IP and 128 patients with various malignant sinonasal tumors proved on histologic examination and compared the prevalence of a CCP between the 2 groups. In 8 patients with IP concomitant with squamous cell carcinoma, we also tried to find the MR features to help suggest coexistent malignancy.

RESULTS: A CCP was demonstrated in all 30 (100%) of the IPs and 17 (13%) of the 128 malignant sinonasal tumors on MR imaging. There was a significant statistical difference in the prevalence of a CCP between IP and malignant sinonasal tumors with the overall sensitivity, specificity, positive predictive value, negative predictive value, and accuracy 100%, 87%, 64%, 100%, and 89%, respectively. Of 8 IPs concomitant with squamous cell carcinoma, a focal loss of a CCP was demonstrated in 4 tumors, 3 of which also showed aggressive bone destruction with extrasinonasal extension on MR images.

CONCLUSION: Although a CCP is a reliable MR imaging feature of sinonasal IPs, it can also be seen in various malignant sinonasal tumors. A focal loss of a CCP might be a clue to the diagnosis of IPs concomitant with malignancy.