An advance in imaging for sinonasal tumours?
Reviewed by Joanna Stephens

Benign sinonasal growths are incredibly common, and malignant sinonasal growths thankfully rare. We know that malignant tumours often present late, and the imaging can sometimes be misleading, so the authors here compare using diffusion weighted imaging (DWI), dynamic contrast enhanced MRI (DCE-MRI) and combined DWI & DCE-MRI in differentiating malignant and benign sinonasal tumours. All 43 consecutive patients had full advanced imaging including DWI and DCE-MRI, and the scans were independently assessed by two experienced head and neck radiologists. Some patients were excluded as they had purely inflammatory lesions or a history of previous head and neck cancer and chemo/radiotherapy to the area. The radiological findings and diagnosis were then compared to the histological diagnosis (the gold standard.) The authors found that combined DWI and DCE-MRI were superior to either of the modalities alone in differentiating benign from malignant masses, and that overall, DWI is consistently a better tool, particularly when using the quantitative rather than qualitative assessment. They found that DCE-MRI is not accurate in evaluating hypervascular masses (62.5% accuracy). They conclude that, as these advanced techniques are easy to acquire and quick to interpret and would help reduce the number of false positives and negatives whilst adding only eight minutes to the duration of the MRI scan, consideration should be given to routinely incorporating these into the standard MRI examination in this difficult area. Interesting and worth thinking about, certainly.

Differentiation of Benign from Malignant Sinonasal Masses Using Diffusion Weighted Imaging and Dynamic Contrast Enhanced Magnetic Resonance Imaging.
Daga R, Kumar J, Pradhan G, et al.
AM J RHINOL ALLERGY
2022;36(2):207-15.