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

Table 1 Etiological spectrum of the sinonasal lesions

Groups	Diagnosis	Number of lesions
Benign (n = 12)	Inflammatory myofibroblastic tumor	1
	Mycetoma	1
	Central giant cell reparative granuloma	1
	Schwannoma	1
	Meningioma	2
	Juvenile nasopharyngeal angiofibroma	1
	Neuroendocrine tumor	1
	Solitary fibrous tumor	1
	Inflammatory nasal polyp	3
Malignant (n = 18)	Squamous cell carcinoma	4
	Undifferentiated Sinonasal carcinoma	3
	Sinonasal teratocarcinoma	1
	Lymphoma	2
	Plasmacytoma	2
	Chondrosarcoma	1
	Chondroma	1
	Nasopharyngeal carcinoma	2
	Nasopharyngeal adenocystic carcinoma	1
	Metastasis	1

Table 2 Diffusion-weighted imaging, intravoxel incoherent motion imaging, and diffusion kurtosis imaging parameters of benign and malignant sinonasal masses, mean ± SD

Parameters	Benign lesion	Malignant lesion	P value
ADC (× 10-3 mm2/second)	1.77 ± 0.45	1.06 ± 0.32	0.000
Dt (× 10-3 mm2/second)	1.07 ± 0.38	0.76 ± 0.33	0.015
Dx (× 10-3 mm2/second)	30.49 ± 56.15	11.86 ± 16.82	0.109
f	0.23 ± 0.09	0.17 ± 0.07	0.070
Dapp (× 10-3 mm2/second)	1.59 ± 0.54	1.15 ± 0.50	0.030
Kapp	0.53 ± 0.32	1.01 ± 0.39	0.001

ADC: Apparent diffusion coefficient; Dapp: Apparent diffusion coefficient derived from diffusion kurtosis imaging; Dt: True diffusion coefficient; Dx: Pseudodiffusion coefficient; f: Perfusion fraction; Kapp: Apparent kurtosis coefficient.

Table 3 Receiver operating characteristic curve analysis of significant parameters for benign and malignant sinonasal lesions

Parameters	AUC	Cutoff value	Sensitivity	Specificity	Accuracy
ADC	0.898	1.75	88.89%	83.33%	86.11%
Dt	0.761	1.006	83.33%	50%	66.67%
Dapp	0.755	1.35	66.67%	66.67%	66.67%
Kapp	0.808	0.63	88.89%	66.67%	77.78%

ADC: Apparent diffusion coefficient; AUC: Area under the curve; Dapp: Apparent diffusion coefficient derived from diffusion kurtosis imaging; Dt: True diffusion coefficient; Dx: Pseudodiffusion coefficient; Kapp: Apparent kurtosis coefficient.

Table 4 Comparison of receiver operating characteristic curve curves of apparent diffusion coefficient, true diffusion coefficient, apparent diffusion coefficient derived from diffusion kurtosis imaging and kurtosis coefficient

Test result pair	AUC difference	P value
ADC-Dapp	0.144	0.07
ADC-Dt	0.137	0.08
ADC-Kapp	0.090	0.09
Kapp-Dapp	0.053	0.08
Kapp-Dt	0.046	0.05
Dt-Dapp	0.007	0.04

ADC: Apparent diffusion coefficient; AUC: Area under the curve; Dapp: Apparent diffusion coefficient derived from diffusion kurtosis imaging; Dt: True diffusion coefficient; Dx: Pseudodiffusion coefficient; Kapp: Apparent kurtosis coefficient.

Table 5 Comparison of diffusion-weighted imaging, intravoxel incoherent motion imaging, and diffusion kurtosis imaging in differentiating benign and malignant sinonasal masses between previous studies and the current study

Ref.	Number of lesions	Magnet strength and b-values	Cutoff value if given	Efficacy
Srinivasan et al[16]	33 sinonasal masses (B-17 and M-16)	3 T, b-values (0 and 800)	ADC-1.3 × 10-3 mm2/second	NA
Razek et al[23]	50 sinonasal masses (B-12 and M-38)	1.5 T, b-values (0, 500 and 1000)	ADC-1.53 × 10-3 mm2/second	Sn: 94.1%; Sp: 92%
Wang et al[17]	197 sinonasal masses (B-81 and M-116)	3 T, b-values (0, 700 and 1000)	ADCws (b value 0 and 1000)-1.37 × 10-3 mm2/second	Sn: 85.3%; Sp: 81.2%
El-Gerby et al[18]	24 sinonasal masses (B-17 and M-7)	1.5 T, b-values (500 and 1000)	ADC-1.2 × 10-3 mm2/second	Sn: 100%; Sp: 86.4%
Das et al[22]	28 sinonasal masses (B-10 and M- 18)	3 T, b-values (0, 500 and 1000)	ADC-1.79 × 10-3 mm2/second	Sn: 80%; Sp: 83.3%
Wang et al[19]	98 sinonasal masses (B-40 and M- 58)	3 T, b-values (0 and 1000)	ADC-0.852 × 10-3 mm2/second	Sn: 77.3%; Sp: 94.7%
Daga et al[20]	40 sinonasal masses (B-17 and M-23)	3 T, b-values (50 and 1000)	ADC-1.005 × 10-3 mm2/second	Accuracy: 92.5%
Xiao et al[30]	131 sinonasal masses (B-56 and M-75)	3 T, b-values (0 and 1000)	ADC-0.919 × 10-3mm2/second	Sn: 80%; Sp: 54.7%
		11 b-values for IVIM	Dt-0.715 × 10-3 mm2/second	Sn: 84.1%; Sp: 81.6%
			f (%) 16.99	Sn: 72.3%; Sp: 47.2%
Jiang et al[31]	73 sinonasal masses (B-42 and M-31)	3 T, 13 b-values	Dt-0.84 × 10-3 mm2/second	Sn: 74.16%; Sp: 73.81%
			f (%) 27.1	Sn: 61.27%; Sp: 90.50%
Jiang et al[26]	81 sinonasal masses (B-35 and M-46)	3 T, b-values (0 and 1000)	ADC-1.27 × 10-3 mm2/second	Sn: 69.6%; Sp: 77.1%
		13 b-values for DKI	Dapp-1.75 × 10-3 mm2/second	Sn: 82.6%; Sp: 77.1%
			Kapp: 0.63	Sn: 95.7%; Sp: 77.1%
Wang et al[21]	72 sinonasal masses (B-38 and M-34)	3 T, b-values (0, 1000)	ADC-1.01 × 10-3 mm2/second
Our study (2023)	30 sinonasal masses (B-12 and M-18)	3 T, b-values (0, 500 and 1000)	ADC-1.57 × 10-3 mm2/second	Sn: 88.89%; Sp: 83.33%
		9 b-values for IVIM/DKI	Dt-0.97 × 10-3 mm2/second	Sn: 77.78%; Sp: 50.0%
			Dapp-1.35 × 10-3 mm2/second	Sn: 66.67%; Sp: 66.67%
			Kapp: 0.63	Sn: 88.89%; Sp: 66.67%

ADC: Apparent diffusion coefficient; B: Benign; Dapp: Apparent diffusion coefficient derived from diffusion kurtosis imaging; DKI: Diffusion kurtosis imaging; Dt: True diffusion coefficient; IVIM: Intravoxel incoherent motion imaging; Kapp: Apparent kurtosis coefficient; M: Malignant; Sn: Sensitivity; Sp: Specificity.