ABSTRACT BACKGROUND AND PURPOSE: Sinonasal inverted papilloma (IP) can harbor squamous cell carcinoma (SCC). Consequently, differentiating these tumors is important. The objective of this study was to determine if MRI-based texture analysis can differentiate SCC from IP and provide supplementary information to the radiologist. MATERIALS AND METHODS: Adult patients who had IP or SCC resected were eligible (coexistent IP and SCC were excluded). Inclusion required tumor size greater than 1.5 cm and a pre-operative MRI with axial T1, axial T2, and axial T1 post-contrast sequences. Five well- established texture analysis algorithms were applied to an ROI from the largest tumor cross- section. For a training dataset, machine-learning algorithms were used to identify the most accurate model, and performance was also evaluated in a validation dataset. Based on three separate blinded reviews of the ROI, isolated tumor, and entire images, two neuroradiologists predicted tumor type in consensus. RESULTS: The IP and SCC cohorts were matched for age and gender, while SCC tumor volume was larger (p=0.001). The best classification model achieved similar accuracies for training (17 SCC, 16 IP) and validation (7 SCC, 6 IP) datasets of 90.9% and 84.6% respectively (p=0.537). The machine-learning accuracy for the entire cohort (89.1%) was better than that of the neuroradiologist ROI review (56.5%, p=0.0004) but not significantly different from the neuroradiologist review of the tumors (73.9%, p=0.060) or entire images (87.0%, p=0.748). CONCLUSION: MRI-based texture analysis has potential to differentiate SCC from IP and may provide incremental information to the neuroradiologist, particularly for small or heterogeneous tumors.
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