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MRI Predictors of Malignant Transformation in Patients with Inverted Papilloma: A Decision Tree Analysis Using Conventional Imaging Features and Histogram Analysis of Apparent Diffusion Coefficients

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Abstract
Objective: Preoperative differentiation between inverted papilloma (IP) and its malignant transformation to squamous cell carcinoma (IP-SCC) is critical for patient management. We aimed to determine the diagnostic accuracy of conventional imaging features and histogram parameters obtained from whole tumor apparent diffusion coefficient (ADC) values to predict IP-SCC in patients with IP, using decision tree analysis. Materials and Methods: In this retrospective study, we analyzed data generated from the records of 180 consecutive patients with histopathologically diagnosed IP or IP-SCC who underwent head and neck magnetic resonance imaging, including diffusion-weighted imaging and 62 patients were included in the study. To obtain whole tumor ADC values, the region of interest was placed to cover the entire volume of the tumor. Classification and regression tree analyses were performed to determine the most significant predictors of IP-SCC among multiple covariates. The final tree was selected by cross-validation pruning based on minimal error. Results: Of 62 patients with IP, 21 (34%) had IP-SCC. The decision tree analysis revealed that the loss of convoluted cerebriform pattern and the 20th percentile cutoff of ADC were the most significant predictors of IP-SCC. With these decision trees, the sensitivity, specificity, accuracy, and C-statistics were 86% (18 out of 21; 95% confidence interval [CI], 65-95%), 100% (41 out of 41; 95% CI, 91-100%), 95% (59 out of 61; 95% CI, 87-98%), and 0.966 (95% CI, 0.912-1.000), respectively. Conclusion: Decision tree analysis using conventional imaging features and histogram analysis of whole volume ADC could predict IP-SCC in patients with IP with high diagnostic accuracy.
Author(s)
서종현이정현정미선Xiao Quan Xu성유섭정새롬최영준백정환
Issued Date
2021
Type
Article
Keyword
DiffusionInverted papillomaMagnetic resonance imagingNeuroimaging and head & Neck방사선과학
DOI
10.3348/kjr.2020.0576
URI
https://oak.ulsan.ac.kr/handle/2021.oak/7414
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_nrf_kci_oai_kci_go_kr_ARTI_9776474&context=PC&vid=ULSAN&lang=ko_KR&search_scope=default_scope&adaptor=primo_central_multiple_fe&tab=default_tab&query=any,contains,MRI%20Predictors%20of%20Malignant%20Transformation%20in%20Patients%20with%20Inverted%20Papilloma:%20A%20Decision%20Tree%20Analysis%20Using%20Conventional%20Imaging%20Features%20and%20Histogram%20Analysis%20of%20Apparent%20Diffusion%20Coefficients&offset=0&pcAvailability=true
Publisher
KOREAN JOURNAL OF RADIOLOGY
Location
대한민국
Language
영어
ISSN
1229-6929
Citation Volume
22
Citation Number
5
Citation Start Page
751
Citation End Page
758
Appears in Collections:
Medicine > Medicine
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