Differential Diagnosis of Sinonasal Lymphoma and Squamous Cell Carcinoma on CT, MRI, and PET/CT

Objective The purpose of this study was to analyze computed tomography (CT) and magnetic resonance (MR) images and to evaluate the maximum standardized uptake value (SUV max) of positron emission tomography (PET)/CT parameters between sinonasal non-Hodgkin’s lymphoma (NHL) and squamous cell carcinoma (SCC), knowing the imaging features that distinguish sinonasal NHL from SCC. Study Design Case series with chart review. Setting University tertiary care facility. Subjects and Methods We analyzed the features on CT, MR imaging, and PET/CT of 78 patients diagnosed with sinonasal NHL or SCC histopathologically. The CT (n = 34), MRI (n = 25), and PET/CT (n = 33) images of 39 patients with sinonasal NHL and the CT (n = 38), MR (n = 28), and PET/CT (n = 31) images of 39 patients with SCC were evaluated. The sinonasal NHL was diagnosed as natural killer/T-cell lymphoma (n = 28) and diffuse large B-cell lymphoma (n = 11). Results Patients with sinonasal NHL had a larger tumor volume and higher tumor homogeneity than patients with SCC on T2-weighted and postcontrast MR images. Most of the sinonasal NHL and SCC showed a high degree of enhancement. The apparent diffusion coefficient (ADC) values and adjacent bone destruction were significantly lower in sinonasal NHL than in SCC. However, cervical lymphadenopathy, Waldeyer’s ring involvement, and PET/CT SUV max showed no significant differences between sinonasal NHL and SCC. Conclusion CT and MR images of sinonasal masses showing a bulky lesion, marked homogeneity, and low ADC values without adjacent bone destruction are more suggestive of sinonasal NHL than SCC.