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Inverted papilloma: evaluation with MR imaging
D M Yousem1, D W Fellows, D W Kennedy
1Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia 19104.
Abstract:
The authors examined the magnetic resonance (MR) appearance of inverted papillomas to determine if this histologically benign lesion could be distinguished from malignancies of the sinonasal cavity. MR images in 10 patients with histologically proved inverted papilloma were retrospectively reviewed. The signal intensity of inverted papillomas on short repetition time (TR) images was iso- to slightly hypertintense to muscle in all 10 patients. Inverted papillomas had intermediate signal intensity on the long TR/echo time (TE) images. The tumors were iso- or slightly hypointense to fat on long TR/short TE images. In the seven patients who received gadopentetate dimeglumine, all inverted papillomas showed solid inhomogeneous enhancement. A review of eight sinonasal malignancies showed no distinctive signal intensity or enhancement characteristics to help differentiate inverted papillomas from various malignant tumors. The authors conclude that there is no signature MR appearance for the benign inverted papilloma. The main utility of MR imaging is in defining the extent of the lesion.
Insights
Magnetic resonance (MR) imaging cannot reliably distinguish benign inverted papillomas from malignant sinonasal tumors. While MR helps define lesion extent, it lacks a signature appearance for differentiating these conditions.
Area of Science:
- Radiology
- Oncology
- Otolaryngology
Background:
- Inverted papillomas are benign sinonasal tumors that can mimic malignancies.
- Accurate differentiation is crucial for appropriate patient management.
Purpose of the Study:
- To evaluate the magnetic resonance (MR) imaging characteristics of inverted papillomas.
- To determine if MR can differentiate inverted papillomas from sinonasal malignancies.
Main Methods:
- Retrospective review of MR images from 10 patients with inverted papilloma.
- Analysis of signal intensity on various sequences (short TR, long TR/TE, long TR/short TE).
- Assessment of enhancement patterns after gadolinium administration.
Main Results:
- Inverted papillomas showed consistent signal intensities: iso- to hyperintense to muscle on short TR, intermediate on long TR/TE, and iso- to hypointense to fat on long TR/short TE.
- All enhancing papillomas demonstrated solid, inhomogeneous enhancement.
- No distinctive MR signal or enhancement patterns differentiated papillomas from eight reviewed malignancies.
Conclusions:
- There is no specific MR imaging signature for inverted papilloma.
- MR imaging is primarily useful for defining the extent of sinonasal lesions, not for differentiating benign from malignant types.