Routine and dynamic MR imaging study of lobular capillary hemangioma of the nasal cavity with comparison to inverting papilloma

Abstract

Background and purpose: Lobular capillary hemangioma is an uncommon lesion, and its MR imaging appearance has not been fully characterized. The purpose of this study was to determine the MR imaging features of nasal lobular capillary hemangioma and contrast its imaging characteristics to inverting papilloma.

Materials and methods: The MR imaging signals of 32 patients with histopathologically proven nasal lobular capillary hemangiomas and 53 patients with nasal inverted papillomas were retrospectively studied. The findings of dynamic contrast-enhanced MR imaging in 24 lobular capillary hemangiomas and in 53 inverted papillomas were also analyzed. The Monte Carlo exact test was used for comparison of the time-intensity curve patterns of lobular capillary hemangioma and inverted papilloma.

Results: All lobular capillary hemangiomas appeared to be homogeneously isointense to gray matter on T1-weighted images. On T2-weighted images, all lesions showed heterogeneous hyperintensity, and a thin peripheral isointense or hypointense ring was seen in 28 patients. All lesions showed marked enhancement on enhanced images, with the exception of enhancement of the T2 isointense or hypointense ring. Forty-three (81.1%) inverted papillomas had moderate heterogeneous T2 signal intensity, and a characteristic "cerebriform" appearance was detected in 45 (84.91%) of 53 inverted papillomas. The time-intensity curves showed a washout pattern in 18 and a plateau pattern in 6 patients, whereas inverted papillomas showed a washout pattern in 12, a plateau pattern in 35, and a persistent pattern in 6 patients. There was a statistically significant difference as to time-intensity curve pattern between the 2 groups (P < .05).

Conclusions: Hyperintensity on T2-weighted images, marked enhancement of tumor with a nonenhancing thin peripheral ring, and a washout time-intensity curve pattern are characteristic MR imaging features of nasal lobular capillary hemangiomas.

Fig 1.

Woman, 74 years old. A, Axial T1-weighted MR imaging shows a homogeneous isointense signal mass in the left nasal cavity. B, Axial T2-weighted MR imaging shows a heterogeneous high signal mass with a thin peripheral isointense signal ring (↗). C, Axial enhanced MR imaging shows marked tumor enhancement with a nonenhanced thin peripheral ring (↗). D, The round cursor marks the region of interest of the lesion selected for signal intensity measurement at dynamic MR imaging. E, Corresponding axial DCE MR imaging depicts a plateau pattern (type II) TIC.

Fig 2.

Man, 30 years old. A, Axial T2-weighted MR imaging shows a heterogeneously hyperintense signal mass in the right nasal cavity with a thin peripheral low signal ring (↘). B, Axial enhanced MR imaging shows marked tumor enhancement with a nonenhanced thin peripheral ring (↘). C, The round cursor marks the region of interest of the lesion selected for signal intensity measurement at dynamic MR imaging. D, Corresponding axial DCE-MR imaging depicts a washout pattern (type III) TIC.

Fig 3.

Man, 44 years old. A, Axial T1-weighted MR imaging shows a heterogeneously isointense signal mass in the left nasal cavity with patchy high signal area (↗), corresponding to hemorrhage. B, Lesion shows heterogeneously hyperintense on axial T2-weighted MR imaging with multiple flow voids (↙).

Fig 4.

Woman, 56 years old. A, Axial T2-weighted MR imaging shows a heterogeneously isointense signal mass in the right nasal cavity with associated obstructive maxillary sinusitis. B, Lesion shows a characteristic “cerebriform” appearance on sagittal enhanced T1-weighted MR imaging with associated obstructive sphenoid sinusitis.