Multiparametric magnetic resonance imaging in differentiating benign and malignant sinonasal masses: A prospective study and literature review

BACKGROUND The sinonasal area poses diagnostic challenges due to a range of benign and malignant tumors presenting with vague symptoms. Conventional magnetic resonance imaging (MRI) has limited specificity in differentiation. AIM To study the role of dynamic contrast-enhanced MRI (DCE-MRI), intravoxel incoherent motion imaging (IVIM), diffusion kurtosis imaging (DKI), and conventional diffusion-weighted imaging (DWI) for distinguishing between benign and malignant sinonasal masses. METHODS This prospective study was conducted at a tertiary center in which 30 patients with sinonasal masses (18 malignant lesions and 12 benign lesions) underwent routine MRI, conventional DWI and IVIM, and DCE-MRI. Various imaging parameters were measured and compared between two groups. RESULTS Malignant lesions exhibited significantly lower apparent diffusion coefficient (ADC), true diffusion coefficient (Dt), and apparent diffusion coefficient (Dapp) values (P = 0.000, P = 0.015, and P = 0.030, respectively) and higher apparent kurtosis coefficient (Kapp) values (P = 0.001) than benign lesions. There were no significant differences in the pseudodiffusion coefficient, perfusion fraction, or perfusion parameters. Among all of the significant parameters, the ADC had the highest area under the curve (0.898). An ADC cutoff value of 1.57 × 10-3 mm2/second had a sensitivity of 88.89% and specificity of 83.33% to predict a malignant lesion. Our conventional DWI findings are in accordance with the published literature. CONCLUSION This study highlights the utility of conventional DWI, DKI, and IVIM as noninvasive methods for distinguishing between benign and malignant sinonasal lesions; however, there is no added advantage of DKI and IVIM over conventional DWI. Similarly, the perfusion parameters also did not show an additive role in distinguishing between benign and malignant sinonasal lesions.