title: Utility of apparent diffusion coefficient in characterization of different sinonasal pathologies.
abstract: BACKGROUND
  Sinonasal lesions are a heterogeneous group of lesions that span from a tumor to tumor-like nature. Characterization of such cases preoperatively can improve the surgical control and the overall outcome of these patients.
  
  
  OBJECTIVE
  In this prospective study, we aimed at evaluation of the role of apparent diffusion coefficient (ADC) in the differentiation between benign and malignant sinonasal lesions.
  
  
  METHODS
  All patients scheduled to have sinonasal surgical intervention at Ain Shams University Hospitals, Cairo, Egypt, were enrolled. Diffusion-weighted (DW) magnetic resonance imaging (MRI) with calculation of ADC were done for all cases. Radiologic findings were then compared with histologic findings, and the sensitivity, specificity, negative and positive predictive values (PPVs) of the conventional MRI, DW-MRI, and ADC value in differentiation of benign from malignant sinonasal lesions were then calculated.
  
  
  RESULTS
  There were 59 patients with median age of 43 years old. There were 20 cases of inflammatory lesions, 16 cases of benign tumors, and 23 cases of malignant lesions. The ADC values of all cases ranged from 0.4 × 10(-3) to 2 × 10(-3) (median = 1.5 × 10(-3)). The median ADC value for the malignant lesions was 0.6 × 10(-3), whereas that for the inflammatory conditions was 1.6 × 10(-3) and that for the benign tumors was 1.5 × 10(-3) with a highly significant difference (p < .001). Analysis of the conventional MRI and DW-MRI to differentiate between malignant and benign lesions showed that the sensitivity, specificity, PPV, and negative predictive value (NPV) were 100%, 97%, 96%, and 100% and 91%, 97%, 95%, and 95%, respectively.
  
  
  CONCLUSIONS
  DW-MRI did not add significantly to the information gained from conventional MRI. It should be considered complimentary only to standard MRI in uncertain cases when malignancy is still a concern.
authors.affiliation: Department of Otorhinolaryngology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
authors.forename: Mohamed S
authors.initials: MS
authors.lastname: Taha
authors.forename: Lobna M
authors.initials: LM
authors.lastname: El Fiky
authors.forename: Togan M
authors.initials: TM
authors.lastname: Taha
authors.forename: Reda M
authors.initials: RM
authors.lastname: Sabra
authors.forename: Tamer A
authors.initials: TA
authors.lastname: Youssef
authors.forename: Ihab M
authors.initials: IM
authors.lastname: Nada
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D004058:Diffusion; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009668:Nose Diseases / Q000175:diagnosis / Q000473:pathology*; D010254:Paranasal Sinus Diseases / Q000175:diagnosis / Q000473:pathology; D011446:Prospective Studies