title: Differentiation of squamous cell carcinoma and inverted papilloma using non-invasive MR perfusion imaging.
abstract: OBJECTIVE
  To investigate the diagnostic value of tumour blood flow (TBF) obtained with pseudocontinuous arterial spin labelling for the differentiation of squamous cell carcinoma (SCC) and inverted papilloma (IP) in the nasal or sinonasal cavity.
  
  
  METHODS
  We retrospectively analysed the cases of 33 patients with SCC and 8 patients with IP in the nasal or sinonasal cavity. Pseudocontinuous arterial spin labelling scanning was performed for all patients using a 3.0-T MR unit. Quantitative TBF values were measured by two neuroradiologists by respectively delineating the whole-tumour regions of interest, and the mean of them was determined as TBF value in each patient. Additionally, the presence of imaging findings of convoluted cerebriform pattern (CCP) on MR T2 weighted images was determined in all patients. As a subgroup analysis, patients with IP were divided into aggressive and non-aggressive IPs depending on their progression range. First, an intraclass correlation coefficient (ICC) of TBF values between two neuroradiologists was determined. Next, a statistical comparison of the TBF value by a Mann-Whitney U test between the patients with SCC and IP was performed. Additionally, the comparison by an ANOVA with a post hoc test of Tukey's method among the SCC, non-aggressive IP and aggressive IP groups was also performed. If significance was observed, the diagnostic accuracy to differentiate SCCs from IPs was calculated. Diagnostic accuracy by CCP findings alone and by the combination of CCP findings and TBF were also assessed.
  
  
  RESULTS
  The ICC of TBF values between two neuroradiologists was 0.82. The mean TBF values in the patients with SCC, all patients with IP, those with aggressive IP and those with non-aggressive IP were 141.2 ± 33.1, 77.8 ± 31.5, 109.4 ± 16.7 and 58.8 ± 19.9 ml 100 g⁻¹ min⁻¹, respectively. A significant difference was observed between SCC and IP (p < 0.001), SCC and non-aggressive IP (p < 0.01) and non-aggressive IP and aggressive IP (p < 0.01). The diagnostic accuracy values obtained with receiver operating characteristic curve analysis for the differentiation of SCC from IP and for SCC from non-aggressive IP were 0.90 and 0.92, respectively. The diagnostic accuracy was elevated (0.95 from 0.88) by adding the TBF value to CCP findings.
  
  
  CONCLUSIONS
  The pseudocontinuous arterial spin labelling technique can be a useful non-invasive diagnostic tool to differentiate SCC from IP in nasal or sinonasal cavity.
authors.affiliation: 1 Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Fujima
authors.affiliation: 2 Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Nakamaru
authors.affiliation: 2 Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Sakashita
authors.affiliation: 2 Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Homma
authors.affiliation: 1 Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Tsukahara
authors.affiliation: 1 Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Kudo
authors.affiliation: 3 Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.|4 The Global Station for Quantum Medical Science and Engineering, Global Institution for collaborative research and education, Sapporo, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Shirato
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D002294:Carcinoma, Squamous Cell / Q000098:blood supply / Q000175:diagnosis*; D003937:Diagnosis, Differential; D017352:Echo-Planar Imaging / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods / Q000706:statistics & numerical data; D008279:Magnetic Resonance Imaging / Q000379:methods* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods; D009361:Neoplasm Invasiveness; D009669:Nose Neoplasms / Q000098:blood supply / Q000175:diagnosis; D018308:Papilloma, Inverted / Q000098:blood supply / Q000175:diagnosis*; D010255:Paranasal Sinus Neoplasms / Q000098:blood supply / Q000175:diagnosis; D012372:ROC Curve; D012039:Regional Blood Flow / Q000502:physiology; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013113:Spin Labels; D013382:Subtraction Technique
chemical_list: D013113:Spin Labels
keywords: carcinoma; head and neck neoplasms; inverted; magnetic resonance imaging; papilloma; perfusion; squamous cell