MRI and Apparent Diffusion Coefficient values enable differentiation between edematous and fibrotic tissue in chronic rhinosinusitis with nasal polyps.
T2-weighted MRI sequences and Apparent Diffusion Coefficient (ADC) values enable tissue characterization in chronic rhinosinusitis with nasal polyps (CRSwNP), according to findings published in the Brazilian Journal of Otorhinolaryngology.
Andrew Thamboo, MD, and colleagues examined the ability of MRI to illustrate and characterize the remodeling process in CRSwNP. Two radiologists blinded to other radiological and histological data independently assessed the results. A pathologist blinded to MRI results also compared the tissue samples from the most central and the most peripheral portion of the polypoid tissue adjacent to the floor of the nasal fossa. MRI findings were compared with polyp tissue histological findings, IL-6 concentrations in tissue, and eosinophil counts in blood.
Clinician Assessments, MRI Findings & ADC Values
The study included 30 patients (mean age, 53; 43% women) who met diagnostic criteria for CRSwNP and had no history of rhinosinusitis surgery.
The results showed a high degree of agreement, approximately 90%, in the radiologists’ ratings of fibrosis and edema. On MRI, 93.5% of patients showed some degree of fibrosis in the central portion of the middle meatus, while only 6.6% showed signs of fibrosis in the most peripheral portion of the polyp. A significant agreement was seen with the radiologist’s assessment of the fibrotic.
Mean ADC values of the peripheral region were significantly higher than those of the central region of the nasal polyps. According to the study results, a finding that aligned with the T2 signal pattern was seen. The MRI-based fibrosis rating illustrated significantly higher fibrosis in the central than in the peripheral region of the nasal polyposis (P<0.001). In addition, the MRI-based edema rating indicated higher edema in the peripheral than in the central region of the middle meatus.
ADC values measured in the peripheral portion of the nasal polyps in the group with severe fibrosis in the central region varied significantly from those of the other groups (absence or mild fibrosis) as rated by radiologists and pathologists. The histological analysis was comparable to the MRI findings.
Identifying Edematous & Fibrotic Components
According to Dr. Thamboo and colleagues, this study represents “the first standardized proposal of MRI analysis for CRSwNP, despite its application in other inflammatory conditions.” They continued that MRI is an effective tool for differentiating between edematous and fibrotic components.
“Further studies are necessary to demonstrate a significant correlation between the remodeling process and the severity of eosinophilic CRSwNP,” they wrote.
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