鼻窦内翻性乳头状瘤的预设结构化CT和MRI评分：一项双读者诊断准确性研究
Prespecified Structured CT and MRI Scores for Sinonasal Inverted Papilloma: A Dual-reader Diagnostic Accuracy Study.
文献信息
| PMID | 42827063 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Buket Yağcı |
| 作者单位 | Department of Radiology, Antalya Training and Research Hospital, Antalya, Turkiye (B.Y., T.P., and E.H.I.). Electronic address: buketyagci@hotmail.com. |
| 期刊 | Academic radiology |
| SCI 分区 | Q1 |
| IF | 4 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻科 |
中文摘要
背景与目的： 比较结构化计算机断层扫描（CT）和磁共振成像（MRI）评分在鉴别内翻性乳头状瘤（IP）与其他良性和恶性单侧鼻窦浑浊原因方面的价值。
材料与方法： 在这项回顾性单中心研究中，179例经组织病理学证实的单侧鼻窦浑浊患者被分类为IP谱系（n = 72）或非IP（n = 107）。两名设盲读者独立使用预设IP评分评估CT（n = 172）和MRI（n = 109；两种模态均评估，n = 102）；读者1的最终评估作为主要分析。诊断性能通过曲线下面积（AUC）分析及配对DeLong检验进行比较，独立预测因素通过多变量、Firth惩罚和简约逻辑回归确定。
结果： 在配对队列（n = 102）中，MRI在区分IP谱系与非IP病变方面表现出数值上更高但未达到统计学优效的性能（AUC 0.915 vs. 0.869；ΔAUC +0.045；p = 0.076）。联合CT和MRI评分并未在MRI单独基础上改善区分能力（联合AUC 0.891；交叉验证AUC 0.883）。脑回状卷曲模式和骨质破坏是唯一的独立预测因素。MRI在鉴别IP与单侧鼻窦息肉方面显著优于CT（AUC 0.965 vs. 0.811；q < 0.001），尤其是在缺乏局灶性骨肥厚的病变中。
结论： CT和MRI在单侧鼻窦浑浊评估中提供互补而非可互换的信息。尽管总体诊断性能相当，且联合评估较MRI单独无增量获益，但MRI在区分IP与单侧息肉方面显著优于CT。这些发现支持结构化多参数成像方法，尤其是在诊断困难的病例中，并值得前瞻性多中心验证。
英文摘要
RATIONALE AND OBJECTIVES: To compare structured computed tomography (CT) and magnetic resonance imaging (MRI) scores for differentiating inverted papilloma (IP) from other benign and malignant causes of unilateral sinonasal opacification.
MATERIALS AND METHODS: In this retrospective single-center study, 179 patients with histopathologically confirmed unilateral sinonasal opacification were classified as IP spectrum (n = 72) or non-IP (n = 107). Two blinded readers independently assessed CT (n = 172) and MRI (n = 109; both modalities, n = 102) using prespecified IP scores; Reader 1's final assessment served as the primary analysis. Diagnostic performance was compared using area under the curve (AUC) analysis with paired DeLong testing, and independent predictors were identified with multivariable, Firth-penalized, and parsimonious logistic regression.
RESULTS: In the paired cohort (n = 102), MRI demonstrated a numerically higher, but not statistically superior, performance than CT for distinguishing IP-spectrum from non-IP lesions (AUC 0.915 vs. 0.869; ΔAUC +0.045; p = 0.076). Combining CT and MRI scores did not improve discrimination beyond MRI alone (combined AUC 0.891; cross-validated AUC 0.883). Convoluted cerebriform pattern and bone destruction were the only independent predictors. MRI demonstrated a significant advantage over CT in differentiating IP from unilateral sinonasal polyps (AUC 0.965 vs. 0.811; q < 0.001), particularly in lesions lacking focal hyperostosis.
CONCLUSION: CT and MRI provide complementary rather than interchangeable information in the evaluation of unilateral sinonasal opacification. Although overall diagnostic performance was comparable and the combined assessment offered no incremental benefit over MRI alone, MRI significantly outperformed CT in distinguishing IP from unilateral polyps. These findings support a structured multiparametric imaging approach, particularly in diagnostically challenging cases, and warrant prospective multicenter validation.