Routine and dynamic MR imaging study of lobular capillary hemangioma of the nasal cavity with comparison to inverting papilloma

Radiological features of thyroid-like low-grade nasopharyngeal papillary adenocarcinoma: case series and systematic review

PURPOSE

To comprehensively summarize the clinical data and CT/MRI characteristics of thyroid-like low-grade nasopharyngeal papillary adenocarcinoma (TL-LGNPPA).

METHODS

Twenty-seven lesions from 25 study articles identified through a systematic review and three lesions from our institution associated with TL-LGNPPA were evaluated.

RESULTS

The mean age of the patients at diagnosis was 35.7 years, and the male-to-female ratio was nearly half. The chief complaint was nasal obstruction, followed by epistaxis. All patients underwent excision. None of the patients had neck nodes or distant metastases. All patients survived with no locoregional/distant recurrence during 3-93 months of follow-up. All lesions were located at the posterior edge of the nasal septum, attached to the nasopharyngeal parietal wall, and showed no laterality. The mean lesion diameter was 1.7 cm. The margins of lesions were well-defined and lobulated, followed by well-defined smooth margins. None of lesions were associated with parapharyngeal space or skull base destruction. All lesions were iso- and low-density on non-contrast CT. Adjacent skull base sclerosis was detected in 63.6% of lesions. High signal intensity on T2-weighted imaging and mostly iso-signal intensity on T1-weighted imaging compared to muscle tissue. Most lesions were heterogeneous and exhibited moderate contrast enhancement. Relatively large lesions (≥1.4 cm) tended to be more lobulated than smooth margins compared to relatively small lesions (<1.4 cm) (p = 0.016).

CONCLUSION

We summarized the clinical and radiological features of TL-LGNPPA to facilitate accurate diagnosis and appropriate management.

Solid and Vascular Neck Masses in Children

Neck masses are frequent in the pediatric population and are usually divided into congenital, inflammatory, and neoplastic. Many of these lesions are cystic and are often benign. Solid masses and vascular lesions are relatively less common, and the imaging appearances can be similar. This article reviews the clinical presentation and imaging patterns of pediatric solid and vascular neck masses.

Pediatric intranasal lobular capillary hemangioma: A case report

INTRODUCTION AND IMPORTANCE

Lobular capillary hemangioma (LCH) is a benign vascular lesion typically affecting the head and neck region, especially the nasal cavity. However, its occurrence in the nasal cavity of the pediatric population is rare, making its diagnosis and management crucial in such cases.

CASE PRESENTATION

A 7-year-old female presented with left-sided nasal obstruction and recurrent epistaxis for 4 months. Examination revealed a dark purplish-red nasal mass, which bled easily upon probing. CT scans showed a soft tissue lesion with post-contrast enhancement. Histopathological examination confirmed lobular capillary hemangioma. The patient successfully underwent surgical excision without pre-operative embolization.

CLINICAL DISCUSSION

LCH affects both the skin and mucous membranes. Although its exact etiology remains debated, trauma is a leading risk factor for its development. Biopsy and radiological investigations confirm its diagnosis. Differentiating LCH from other vascular disorders with similar presentations is essential for a thorough understanding and better management. Endoscopic surgical excision combined with electrodesiccation is the treatment of choice.

CONCLUSION

Intranasal LCH in children is infrequent. An accurate diagnosis is essential for a comprehensive understanding. Surgical excision with electrodesiccation is the preferred treatment, but the role of pre-operative embolization is still under discussion.

Malignant and Nonmalignant Sinonasal Tumors

Sinonasal tumors are rare, diverse, complex lesions with overlapping demographic and clinical features. Malignant tumors are more common, with a grave prognosis, and require biopsy for accurate diagnosis. This article briefly reviews the classification of sinonasal tumors and provides imaging examples and imaging characteristics of each clinically important nasal and paranasal mass lesions. Although there are no true pathognomonic imaging features, it is important for the radiologist to have a broad knowledge of the various CT and MR imaging findings that can help narrow the differential diagnosis and aid in early diagnosis and mapping of tumor for treatment planning.

Differentiation between atypical sinonasal non-Hodgkin's lymphoma and inverted papilloma

AIM

To seek additional magnetic resonance imaging (MRI) features to improve the accuracy of differentiation between atypical sinonasal non-Hodgkin's lymphoma (NHL) and inverted papilloma (IP) using conventional MRI and apparent diffusion coefficient (ADC) maps.

MATERIALS AND METHODS

MRI examinations from 44 atypical cases (21 NHLs and 23 IPs) in sinonasal regions were reviewed retrospectively. Imaging features included tumour laterality, extension, T1-weighted imaging (WI)/T2WI signal intensity homogeneity and ratios, enhancement homogeneity and ratios, and ADC_mean.

RESULTS

In cases of NHL, homogeneous signal intensity was often observed on T2WI, which was homogeneous and significantly less enhanced than the turbinate, with lower ADC_mean. Whereas in IPs, heterogeneous signal intensity was seen on T2WI, which was heterogeneous and of comparable enhancement to the turbinate, and higher ADC_mean values were commonly seen. An ADC_mean cut-off point of 1.10 × 10^-3 mm²/s achieved 100% sensitivity, 90% specificity, and 90% accuracy. In addition, special features were observed that support the distinction between the two tumours, including intestinal pattern enhancement in NHL and spot-like appearance on T2WI and enhancement in IP.

CONCLUSIONS

ADC_mean was the most valuable metric for differentiating between the atypical sinonasal NHLs and IPs.

A Rare Case of Nasal Lobular Capillary Hemangioma Centered at the Pyriform Aperture

SIGNIFICANCE STATEMENT

We present the rare case of a nasal lobular capillary hemangioma with bony erosion atypically localized to the left piriform aperture. This fast-growing lesion caused both physical and emotional distress due to recurrent epistaxis and prominent esthetic deformity evidenced by a large nasal growth. While the final diagnosis was benign, the clinical and radiological findings caused concern. This case serves as a reminder that prompt referral, work-up, and diagnosis are essential to optimize patient care.

MR and CT imaging features of sino-nasal organized hematomas

AIM

To describe the MR and CT imaging features of organized hematomas [OH].

METHODS

A retrospective analysis of MR imaging and CT of eight patients [6 male, 2 females; age range is 6-86 years] with pathological proven OH was performed. Routine contrast MR and CT scan were done for all patients, and diffusion-weighted imaging and dynamic contrast CT were done for only five patients. Imaging analysis was done for the signal intensity, the enhancement pattern at MR imaging, the ADC value at DWI, bone remodeling at CT, and the neo-vascularization at dynamic contrast CT.

RESULTS

OH revealed T2 hypo-intense of the matrix in all patients with complete [n = 3] and incomplete [n = 5] marginal hypo-intensity rim. The lesions revealed a frond-like pattern of contrast enhancement of the central part of the lesion that associated with a peripheral rim of contrast enhancement. OH revealed unrestricted diffusion with high ADC value [1.7-2.5 × 10^-3 cm²/s] in 5 patients. CT scan showed geographic bone remodeling and thinning of the nasal turbinates, and the sinus wall and contrast CT showed neo-vascularization with frond-like branching arteries of the central part of the lesions in five patients.

CONCLUSION

We conclude that MR and CT imaging findings can help in the diagnosis of OH.

The Specific Magnetic Resonance Imaging Indicators in Predicting Clear-Cell Renal Cell Carcinoma Metastatic to the Sinonasal Region

PURPOSE

The aim of this study was to determine the valuable magnetic resonance imaging (MRI) features of sinonasal metastatic clear-cell renal cell carcinoma (cc-RCC), especially focusing on its dynamic-enhanced characteristics.

METHODS

The conventional and dynamic-enhanced MRI findings of 8 patients with histopathologically confirmed sinonasal metastatic cc-RCC were reviewed by 2 radiologists. The control group of 8 patients with capillary hemangioma underwent the same MRI protocol.

RESULTS

Metastatic cc-RCCs arose from the nasoethmoid region, maxillary sinus, posterior ethmoid and sphenoid sinus, and nasal cavity in 2 patients in each. These lesions were well circumscribed and the mean maximum dimension was 42 mm. The signal intensity of these lesions was isointense to brain stem on both MR T1- and T2-weighted images. All metastatic tumors showed vivid enhancement on enhanced T1-weighted image. Multiple flow voids within these metastatic lesions were identified in 6 patients. Peripheral cyst was detected around the metastatic tumor in 4 patients. Metastatic cc-RCCs exhibited a characteristic type 4 time intensity curve (TIC) similar to that of the internal carotid artery, whereas capillary hemangiomas showed a type 3 TIC on dynamic-enhanced MRI.

CONCLUSIONS

A hypervascular mass with the characteristic type 4 TIC in the sinonasal region is highly suggestive of a metastatic cc-RCC.

CT and MRI Findings of Glomangiopericytoma in the Head and Neck: Case Series Study and Systematic Review

Glomangiopericytoma is a rare sinonasal mesenchymal tumor of borderline or low malignant potential. We reviewed the CT and MR imaging findings of head and neck glomangiopericytoma via a retrospective case series study and systematic review. Our study revealed that glomangiopericytoma is a well-defined lobulated avidly enhancing soft-tissue mass with erosive bony remodeling that is most commonly found in the sinonasal cavity. Typically, it is hyperintense on T2-weighted images with vascular signal voids, has a high mean ADC value, and a wash-in and washout pattern on dynamic contrast-enhanced MR imaging. Although the CT findings are nonspecific, typical MR imaging findings, including those on the ADC map and dynamic contrast-enhanced MR imaging, may be helpful for differentiating glomangiopericytomas from other hypervascular tumors in the head and neck.

Pyogenic granuloma gravidarum: a case in the nasal cavity and the use of MRI as a preoperative surgical aide

Pyogenic granuloma gravidarum is a benign fibrovascular proliferative lesion usually involving the oral gingivae in pregnant patients. While it also occurs, although less frequently, on other oral sites such as lips, tongue and palate, it is relatively unusual to find it in the nasal cavity. Furthermore, lesions normally involute spontaneously after childbirth. For persistent lesions requiring surgical management, imaging has historically been limited to CT. This case is notable not only for its uncommon location but also for its recurrent nature, failure to regress post partum and the use of MRI in the preoperative planning.

MR imaging and CT features of oncocytic papilloma of the sinonasal tract with comparison to inverted papilloma

OBJECTIVE:

To evaluate and compare the imaging feature of sinonasal oncocytic papilloma (OP) with inverted papilloma (IP).

METHODS:

The CT and MR imaging manifestations of 17 pathology proven sinonasal OPs were reviewed and compared with 17 IPs randomly selected as a control group over the same period.

RESULTS:

Seventeen sinonasal OPs had unilateral occurrence and 16 of them (94.1%) had a lobulated configuration.The distribution of original sites differed significantly between OPs and IPs (p < 0.05).OPs (47.1%) particularly involved the maxillary sinus,while IPs (64.7%) usually arose from the lateral nasal wall.OPs exhibited isointense in 5 cases and grape- or patchy-like hyperintense in 12 on T₁ weighted image, and isointense in 13 and hyperintense in 4 on T₂ weighted image, with moderate enhancement. 10 OPs appeared as a Type II time intensity curve (TIC).There was significant difference of pre-contrast T₁ signal intensity between OPs and IPs (p < 0.05).The prevalence of the imaging findings of "focal osteitis" (11.8% vs 94.1%) and "cystic change" (94.1% vs 17.6%) differed significantly between OPs and IPs (p < 0.05), but not for "cerebriform"sign (82.4% vs 94.1%) (p > 0.05).

CONCLUSION:

Three imaging features including high signal on T₁ weighted image, cystic change and only a rare association of focal osteitis may help the diagnosis of OP distinguished from IP.

ADVANCES IN KNOWLEDGE:

The typical imaging characteristics should prompt an accurate diagnosis of sinonasal OPs in routine clinical practice. Combination of CT and MR imaging characteristics can be more helpful in discriminating OPs from IPs.

Fibrosarcoma arising in the paranasal sinus: a clinicopathological and radiological analysis

OBJECTIVES

To analyze the clinicopathological features and the CT and MRI features of patients with paranasal sinus fibrosarcoma.

METHODS

Seven patients with surgically and pathologically confirmed paranasal sinus fibrosarcoma were enrolled. Their CT and MRI data and imaging features were retrospectively analyzed in detail.

RESULTS

The study participants were two males and five females (median age, 43 years; range, 22-73 years). CT or MRI showed a well-defined (n = 5) or ill-defined (n = 2), irregular (n = 6) or oval (n = 1) mass, with heterogeneous (n = 7) density. The lesions were isointense (n = 4) or hypointense (n = 2) on T₁ weighted images, and showed heterogeneous (n = 6) mild hypointensity on T₂ weighted images. Expansive (n = 6) and osteolytic (n = 1) bone destruction were observed. The tumors showed marked heterogeneous delayed enhancement (n = 6) on contrast-enhanced MRI images.

CONCLUSION

Paranasal sinus fibrosarcomas should be included in the differential diagnosis when a sinonasal neoplasm appears as a well- or ill-defined unilateral large irregular mass with characteristic mild hypointensity on T₂ weighted MR images and shows expansive or osteolytic bone destruction and a marked heterogeneous delayed contrast-enhancement pattern.

Ossifying inverted papilloma and ossifying polyp of the sinonasal tract: comparison of CT and MRI features

AIM

To investigate the key imaging points in distinguishing ossifying inverted papilloma (IP) from polyps.

MATERIALS AND METHODS

The native computed tomography (CT), conventional and enhanced MRI manifestations of 20 ossifying IPs and eight polyps, which were confirmed histopathologically, were retrospectively evaluated by two doctors majoring in head and neck imaging.

RESULTS

A significant difference was detected between the two entities for the involved sites (p<0.05). Although two lesions had similar CT findings, the MRI features differed significantly (p<0.05). Twenty ossifying IPs demonstrated heterogeneously isointense with moderate gadolinium enhancement, and a convoluted "cerebriform" configuration. Seven ossifying polyps revealed low T1 and high T2 signal, with marginal enhancement, and one showed isointense with moderate enhancement. The ossification appeared as oval or striped bone-like high attenuation, which consisted of peripheral hyperattenuating cortical bone and central fat-like attenuation of the medullary cavity. The corresponding MRI findings of the ossifying regions were peripherally low signal and centrally high signal on both T1- and T2-weighted images. The occurrence of two key MRI features of cystic appearance and the "cerebriform" sign were significantly different between two entities (p<0.05).

CONCLUSIONS

CT can better detect intralesional ossification, but MRI is the optimal imaging technique for discriminating between two disease entities.

Pediatric intranasal lobular capillary hemangioma: Report of two new cases and review of the literature

Background

Lobular capillary hemangioma (LCH) is an acquired benign vascular tumor of unknown origin. It usually affects skin and mucous membranes of the oropharynx. It rarely involves the nasal cavity which most commonly manifests as epistaxis. To our knowledge, only fifteen pediatric intranasal LCH cases have been reported in the literature. None of these occurred in the inferior turbinate. We report two new pediatric cases of LCH, one of them on the inferior turbinate and the other one on the anterior nasal septum. Our principal aim was to highlight the importance of considering this lesion as a differential diagnosis for pediatric unilateral nasal obstruction and epistaxis.

Methods

Retrospective case series and review of current literature regarding the possible causes, diagnosis, and treatment of nasal LCH.

Description of cases

Two adolescents presented with symptoms of unilateral nasal obstruction and epistaxis. Plain and contrast enhanced computed tomography revealed a well-defined intensely enhancing lesion in both cases. Patients underwent transnasal endoscopic excision and bipolar electrocautery at the base of the tumor for hemostasis. Histopathological examination confirmed the diagnosis of LCH.

Discussion

Current epidemiological and pathophysiological data suggests that the development of LCH may be associated to previous nasal trauma or endocrine disorders. LCH should be considered in the differential diagnosis of all pediatric endonasal masses associated with unilateral epistaxis and nasal obstruction. Endoscopic total excision with bipolar electrocautery for hemostasis is an appropriate treatment.

Magnetic Resonance Imaging Features of Schwannoma of the Sinonasal Tract

PURPOSE

The purpose of the study was to explore the characteristic magnetic resonance imaging (MRI) findings of schwannoma of the sinonasal tract.

METHODS

Eighteen patients with histopathologically confirmed sinonasal schwannoma underwent conventional MRI, and 12 had dynamic contrast-enhanced MRI studies synchronously. The morphology feature, signal intensity, enhancement degree, and time intensity curve (TIC) pattern of schwannomas were retrospectively analyzed.

RESULTS

This entity appeared as a well-circumscribed, oval or fusiform soft tissue mass with a mean greatest diameter of 38 mm. Schwannomas exhibited isointense on T1-weighted image in 12 patients and hypointense in 6. On T2-weighted image, the lesions were heterogeneously isointense in 14 patients and hyperintense in 4. The lesions had heterogeneously moderate and marked contrast enhancement in 2 and 16, respectively. The mottled-, island-, and multicyst-like appearance were identified in 3, 4, and 11, respectively. Compared with inverted papilloma and lobular capillary hemangioma, the type I TIC is characteristic of schwannoma.

CONCLUSIONS

A well-circumscribed mass displaying T2 intermediate signal intensity, marked enhancement, and type I TIC, with cystic changes, strongly suggests the diagnosis of sinonasal schwannoma.

Improved performance in differentiating benign from malignant sinonasal tumors using diffusion-weighted combined with dynamic contrast-enhanced magnetic resonance imaging

Background:

Differentiating benign from malignant sinonsal lesions is essential for treatment planning as well as determining the patient's prognosis, but the differentiation is often difficult in clinical practice. The study aimed to determine whether the combination of diffusion-weighted (DW) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) can improve the performance in differentiating benign from malignant sinonasal tumors.

Methods:

This retrospective study included 197 consecutive patients with sinonasal tumors (116 malignant tumors and 81 benign tumors). All patients underwent both DW and DCE-MRI in a 3-T magnetic resonance scanner. Two different settings of b values (0,700 and 0,1000 s/mm²) and two different strategies of region of interest (ROI) including whole slice (WS) and partial slice (PS) were used to calculate apparent diffusion coefficients (ADCs). A DW parameter with WS ADCs_b0,1000 and two DCE-MRI parameters (time intensity curve [TIC] and time to peak enhancement [Tpeak]) were finally combined to use in differentiating the benign from the malignant tumors in this study.

Results:

The mean ADCs of malignant sinonasal tumors (WS ADCs_b0,1000 = 1.084 × 10⁻³ mm²/s) were significantly lower than those of benign tumors (WS ADCs_b0,1000 = 1.617 × 10⁻³ mm²/s, P < 0.001). The accuracy using WS ADCs_b0,1000 alone was 83.7% in differentiating the benign from the malignant tumors (85.3% sensitivity, 81.2% specificity, 86.4% positive predictive value [PPV], and 79.5% negative predictive value [NPV]). The accuracy using DCE with Tpeak and TIC alone was 72.1% (69.1% sensitivity, 74.1% specificity, 77.5% PPV, and 65.1% NPV). Using DW-MRI parameter was superior than using DCE parameters in differentiation between benign and malignant sinonasal tumors (P < 0.001). The accuracy was 87.3% (90.5% sensitivity, 82.7% specificity, 88.2% PPV, and 85.9% NPV) using DW-MRI combined with DCE-MRI, which was superior than that using DCE-MRI alone or using DW-MRI alone (both P < 0.001) in differentiating the benign from the malignant tumors.

Conclusions:

Diffusion-weighted combined with DCE-MRI can improve imaging performance in differentiating benign from malignant sinonasal tumors, which has the potential to improve diagnostic accuracy and to provide added value in the management for these tumors.

Computed tomography and magnetic resonance imaging findings of nasal cavity hemangiomas according to histological type

Objective

To compare computed tomography (CT) and magnetic resonance imaging (MRI) findings between two histological types of nasal hemangiomas (cavernous hemangioma and capillary or lobular capillary hemangioma).

Materials and Methods

CT (n = 20; six pre-contrast; 20 post-enhancement) and MRI (n = 7) images from 23 patients (16 men and seven women; mean age, 43 years; range, 13-73 years) with a pathologically diagnosed nasal cavity hemangioma (17 capillary and lobular capillary hemangiomas and six cavernous hemangiomas) were reviewed, focusing on lesion location, size, origin, contour, enhancement pattern, attenuation or signal intensity (SI), and bony changes.

Results

The 17 capillary and lobular hemangiomas averaged 13 mm (range, 4-37 mm) in size, and most (n = 13) were round. Fourteen capillary hemangiomas had marked or moderate early phase enhancement on CT, which dissipated during the delayed phase. Four capillary hemangiomas on MRI showed marked enhancement. Bony changes were usually not seen on CT or MRI (seen on five cases, 29.4%). Half of the lesions (2/4) had low SI on T1-weighted MRI images and heterogeneously high SI with signal voids on T2-weighted images. The six cavernous hemangiomas were larger than the capillary type (mean, 20.5 mm; range, 10-39 mm) and most had lobulating contours (n = 4), with characteristic enhancement patterns (three centripetal and three multifocal nodular), bony remodeling (n = 4, 66.7%), and mild to moderate heterogeneous enhancement during the early and delayed phases.

Conclusion

CT and MRI findings are different between the two histological types of nasal hemangiomas, particularly in the enhancement pattern and size, which can assist in preoperative diagnosis and planning of surgical tumor excision.