What question did this study set out to answer?

The aim is to distinguish sinonasal inverted papilloma from squamous cell carcinoma arising in it using imaging features when no bone destruction is present.

April 1, 2026Open Access

Radiologic Features for Differentiating Sinonasal Inverted Papilloma and Squamous Cell Carcinoma Arising From Inverted Papilloma Without Bone Destruction

Key Points

The aim is to distinguish sinonasal inverted papilloma from squamous cell carcinoma arising in it using imaging features when no bone destruction is present.
Retrospective review of 30 patients with histologically confirmed sinonasal inverted papilloma or squamous cell carcinoma.
Preoperative CT and MRI were performed from 2010 to 2023.
Imaging variables assessed included tumor origin, volume, enhancement pattern, and signal intensity.
No significant difference in tumor origin between inverted papilloma and squamous cell carcinoma groups.
IP+SCC showed intermediate signal intensity more frequently on T2-weighted and contrast-enhanced T1-weighted MRI images. (p=0.025 and p=0.029)
Median apparent diffusion coefficient values were significantly lower in IP+SCC compared to IP (0.99×10-3 vs. 1.20×10-3 mm2/s; p=0.026).

Abstract

Background and Objectives: Differentiating inverted papilloma (IP) from squamous cell carcinoma arising in IP (IP+SCC) is challenging when computed tomography (CT) demonstrates no bone destruction. This study aimed to identify CT and magnetic resonance imaging (MRI) features that distinguish IP from IP+SCC in cases without bone destruction on CT.Methods: We retrospectively reviewed 30 patients with histologically confirmed sinonasal IP (n=15) or IP+SCC (n=15) who underwent preoperative CT and MRI between 2010 and 2023. Imaging variables assessed included tumor origin, tumor volume, CT enhancement pattern, signal intensity on T2-weighted and contrast-enhanced T1-weighted images, apparent diffusion coefficient (ADC), and the presence or loss of the convoluted cerebriform pattern (CCP). Group differences were analyzed using appropriate statistical tests, with p<0.05 considered statistically significant.Results: There was no statistically significant difference in tumor origin between the IP and IP+SCC groups. Tumor volume and CT enhancement patterns also did not differ significantly between the groups. On MRI, IP+SCC more frequently demonstrated intermediate signal intensity on both T2-weighted and contrast-enhanced T1-weighted images compared with IP (p=0.025 and p=0.029, respectively). Median ADC values were significantly lower in the IP+SCC group than in the IP group (0.99×10-3 vs. 1.20×10-3 mm2/s; p=0.026). Loss of the CCP was more common in the IP+SCC group, although the difference did not reach statistical significance.Conclusion: In sinonasal IP without bone destruction on CT, MRI appears to be more informative than CT for distinguishing IP+SCC from IP. Intermediate signal intensity on T2-weighted and contrast-enhanced T1-weighted images, along with lower ADC values, supports malignant transformation, whereas tumor size, CT enhancement, and CCP alone are less reliable discriminators.

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Cite This Study

Kim et al. (Tue,) studied this question.

synapsesocial.com/papers/69cd7b155652765b073a8dc7 https://doi.org/https://doi.org/10.18787/jr.2025.00062

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