Axial T1W SE before (a-b) and after (c-d) Gd IV
Large tumour of the maxillary sinus and ethmoid with nasal bleeding, proptosis, and facial hypoesthesia
This patient complaints of nasal obstruction, epistaxis, proptosis and right hemifacial hypoesthesy. ENT examination shows a right nasal tumour. MRI is performed with pre- and post contrast sequences and different spatial resolutions. The relevant questions to answer to are: What about the upper limits of the lesion? How may you explain the high signal in the right maxillary sinus on the T1 pre-contrast images? Describe and explain the signal characteristics of the lesion.
The following sequences were used: T2w FSE coronal T1w SE axial and coronal pre- and post-Gd DOTA This tumour, centred on the ethmoid extends to the anterior skull base and anterior cranial fossa, with brain infiltration, to the right orbit, the right maxillary sinus. The T1 high signal is due to proteinaceous viscous contents of the retention material. The tumour before contrast appears heterogeneous due to combined necrosis and haemorrhages (see the necrotic areas appearing hypersignal on T2w images). Another explanation for high signal areas on T1 is retention of mucous substances in tumour. The histology showed a glandular epithelioma of the right maxillary sinus. The patient was treated with surgery and radiotherapy, unfortunately the disease evolved and he died a few months later.
Differential Diagnosis List
Glandular epithelioma of the maxillary sinus