Application of diffusion-weighted MR imaging with ADC measurement for distinguishing between the histopathological types of sinonasal neoplasms

Published:February 07, 2019DOI:


      • Mean ADCmean and ADCratio were significantly higher in ACC than in SCC, lymphoma, SNUC, and neuroendocrine carcinoma.
      • The ADCmean threshold of 0.80 (10−3 mm2/s) could be used to differentiate ACC from non-ACC sinonasal neoplasms.
      • ADC values were not different between MM, poorly differentiated carcinoma, metastasis, sarcoma, ONB, and adenocarcinoma.



      To evaluate the potential contribution of quantitative DWI parameters including ADCmean and ADCratio values to help in distinguishing the histopathological types of sinonasal neoplasms.


      This retrospective study included 83 patients (50 males, 33 females; mean age 61 years) with pathologically proven untreated sinonasal neoplasms who have undergone diffusion-weighted MRI imaging from February 2010 to August 2017. Diffusion-weighted MRI was performed on a 3 T unit with b factors of 0 and 1000 s/mm2, and ADC maps were generated. Mean ADC values of sinonasal tumors and ADC ratios (ADCmean of the tumor to ADCmean of pterygoid muscles) were compared with the histopathological diagnosis by utilizing the Kruskal-Wallis non-parametric test.


      Mean ADCmean and ADCratio were 0.8 (SD, ±0.4) × (10−3 mm2/s) and 1.2 (SD, ±0.5), respectively, and each parameter was significantly different between histopathological types (p < 0.05). Mean ADCmean and ADCratio were higher in adenoid cystic carcinoma (ACC) than in SCC, lymphoma, neuroendocrine carcinoma and sinonasal undifferentiated carcinoma (SNUC) (p < 0.05). Optimized ADCmean thresholds of 0.79, 0.81, 0.74 and 0.78 (10−3 mm2/s) achieved maximal discriminatory accuracies of 100%, 79%, 100% and 89% for ACC/SNUC, ACC/SCC, ACC/neuroendocrine carcinoma, and ACC/lymphoma, respectively.


      The optimized ADCmean threshold of 0.80 (10−3 mm2/s) could be used to differentiate ACC from non-ACC sinonasal neoplasms with maximal discriminatory accuracy (82%) and sensitivity of 100%. However, there is considerable overlapping of the ADCmean and ADCratio values among non-ACC sinonasal neoplasms hence surgical biopsy is still needed.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Clinical Imaging
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Eggesbø H.B.
        Imaging of sinonasal tumours.
        Cancer Imaging. 2012; 12: 136-152
        • Franchi A.
        • Miligi L.
        • Palomba A.
        • Giovannetti L.
        • Santucci M.
        Sinonasal carcinomas: recent advances in molecular and phenotypic characterization and their clinical implications.
        Crit Rev Oncol Hematol. 2011; 79: 265-277
        • Lango M.N.
        • Topham N.S.
        • Perlis C.S.
        • Flieder D.B.
        • Weaver M.W.
        • Turaka A.
        • et al.
        Surgery in the multimodality treatment of sinonasal malignancies.
        Curr Probl Cancer. 2010; 34: 304-321
        • Haerle S.K.
        • Gullane P.J.
        • Witterick I.J.
        • Zweifel C.
        • Gentili F.
        Sinonasal carcinomas: epidemiology, pathology, and management.
        Neurosurg Clin N Am. 2013; 24: 39-49
        • Wang X.
        • Zhang Z.
        • Chen Q.
        • Li J.
        Effectiveness of 3 T PROPELLER DUO diffusion-weighted MRI in differentiating sinonasal lymphomas and carcinomas.
        Clin Radiol. 2014; 69: 1149-1156
        • Thoeny H.C.
        Diffusion-weighted MRI in head and neck radiology: applications in oncology.
        Cancer Imaging. 2010; 10: 209-214
        • Jansen J.F.
        • Stambuk H.E.
        • Koutcher J.A.
        • Shukla-Dave A.
        Non-Gaussian analysis of diffusion-weighted MR imaging in head and neck squamous cell carcinoma: a feasibility study.
        AJNR Am J Neuroradiol. 2010; 31: 741-748
        • Razek A.A.
        Diffusion-weighted magnetic resonance imaging of head and neck.
        J Comput Assist Tomogr. 2010; 34: 808-815
        • Srinivasan A.
        • Mohan S.
        • Mukherji S.K.
        Biologic imaging of head and neck cancer: the present and the future.
        AJNR Am J Neuroradiol. 2011; 33: 586-594
        • White M.L.
        • Zhang Y.
        • Robinson R.A.
        Evaluating tumors and tumorlike lesions of the nasal cavity, the paranasal sinuses, and the adjacent skull base with diffusion-weighted MRI.
        J Comput Assist Tomogr. 2006; 30: 490-495
        • Lydiatt W.M.
        • Patel S.G.
        • O'Sullivan B.
        • Brandwein M.S.
        • Ridge J.A.
        • Migliacci J.C.
        • et al.
        Head and Neck cancers—major changes in the American Joint Committee on cancer eighth edition cancer staging manual.
        CA Cancer J Clin. 2017; 67: 122-137
        • Tajudeen B.A.
        • Arshi A.
        • Suh J.D.
        • Palma-Diaz M.F.
        • Bergsneider M.
        • Abemayor E.
        • et al.
        Esthesioneuroblastoma: an update on the UCLA experience, 2002–2013.
        J Neurol Surg B Skull Base. 2014; 76: 43-49
        • Vandecaveye V.
        • De Keyzer F.
        • Dirix P.
        • Lambrecht M.
        • Nuyts S.
        • Hermans R.
        Applications of diffusion-weighted magnetic resonance imaging in head and neck squamous cell carcinoma.
        Neuroradiology. 2010; 52: 773-784
        • Kolff-Gart A.S.
        • Pouwels P.J.W.
        • Noij D.P.
        • Ljumanovic R.
        • Vandecaveye V.
        • de Keyzer F.
        • et al.
        Diffusion-weighted imaging of the head and neck in healthy subjects: reproducibility of ADC values in different MRI systems and repeat sessions.
        AJNR Am J Neuroradiol. 2014; 36: 384-390
        • Driessen J.P.
        • van Kempen P.M.W.
        • van der Heijden G.J.
        • Philippens M.E.P.
        • Pameijer F.A.
        • Stegeman I.
        • et al.
        Diffusion-weighted imaging in head and neck squamous cell carcinomas: a systematic review.
        Head Neck. 2014; 37: 440-448
        • Razek A.A.
        • Sieza S.
        • Maha B.
        Assessment of nasal and paranasal sinus masses by diffusion-weighted MR imaging.
        J Neuroradiol. 2009; 36: 206-211
        • Schafer J.
        • Srinivasan A.
        • Mukherji S.
        Diffusion magnetic resonance imaging in the head and neck.
        Magn Reson Imaging Clin N Am. 2011; 19: 55-67
        • Yun T.J.
        • Kim J.H.
        • Kim K.H.
        • Sohn C.H.
        • Park S.W.
        Head and neck squamous cell carcinoma: differentiation of histologic grade with standard-and high-b-value diffusion-weighted MRI.
        Head Neck. 2012; 35: 626-631
        • Fong D.
        • Bhatia K.S.
        • Yeung D.
        • King A.D.
        Diagnostic accuracy of diffusion-weighted MR imaging for nasopharyngeal carcinoma, head and neck lymphoma and squamous cell carcinoma at the primary site.
        Oral Oncol. 2010; 46: 603-606
        • Slootweg P.J.
        • Ferlito A.
        • Cardesa A.
        • Thompson L.D.R.
        • Hunt J.L.
        • Strojan P.
        • et al.
        Sinonasal tumors: a clinicopathologic update of selected tumors.
        Eur Arch Otorhinolaryngol. 2012; 270: 5-20
        • Eida S.
        • Sumi M.
        • Sakihama N.
        • Takahashi H.
        • Nakamura T.
        Apparent diffusion coefficient mapping of salivary gland tumors: prediction of the benignancy and malignancy.
        AJNR Am J Neuroradiol. 2007; 28: 116-121
        • Hakyemez B.
        • Aksoy U.
        • Yildiz H.
        • Ergin N.
        Intracranial epidermoid cysts: diffusion-weighted, FLAIR and conventional MR findings.
        Eur J Radiol. 2005; 54: 214-220
        • Bridge J.A.
        • Bowen J.M.
        • Smith R.B.
        The small round blue cell tumors of the sinonasal area.
        Head Neck Pathol. 2010; 4: 84-93
        • Sasaki M.
        • Eida S.
        • Sumi M.
        • Nakamura T.
        Apparent diffusion coefficient mapping for sinonasal diseases: differentiation of benign and malignant lesions.
        AJNR Am J Neuroradiol. 2011; 32: 1100-1106
        • Wang X.
        • Song L.
        • Chong V.
        • Wang Y.
        • Li J.
        • Xian J.
        Multiparametric MRI findings of sinonasal rhabdomyosarcoma in adults with comparison to carcinoma.
        J Magn Reson Imaging. 2016; 45: 998-1004
        • Das A.
        • Bhalla A.S.
        • Sharma R.
        • Kumar A.
        • Thakar A.
        • Sreenivas V.
        • et al.
        Can diffusion weighted imaging aid in differentiating benign from malignant sinonasal masses?: a useful adjunct.
        Pol J Radiol. 2017; 82: 345-355
        • Chen X.
        • Xian J.
        • Wang X.
        • Wang Y.
        • Zhang Z.
        • Guo J.
        • et al.
        Role of periodically rotated overlapping parallel lines with enhanced reconstruction diffusion-weighted imaging in correcting distortion and evaluating head and neck masses using 3 T MRI.
        Clin Radiol. 2014; 69: 403-409