214 AJR:193, July 2009 type) [3], maxillary sinus papilloma (un- specified type) [4], pulmonary glandular papilloma [5], choroid plexus papilloma [6], and intraductal papilloma of the breast [7]. A case of inverted papilloma with intense FDG uptake (standardized uptake value [SUV], 9.0 at 1 hour and 18.1 at 2 hours) [8] and a case of sphenoid sinus oncocytic papilloma with intense uptake (mean SUV, 11.26; max- imum SUV, 18.86) [9] have also been report- ed. Two reports have indicated that PET can be used to differentiate squamous cell carci- noma from inverted papilloma. Significant- ly higher FDG uptake was reported in five cases of carcinoma (SUVs, 10.40–19.3) than in five cases of sinonasal inverted papilloma (SUVs, 1.98–4.65) [10], whereas another se- ries reported SUVs of 4.9–7.3 associated with three cases of benign inverted papilloma and higher SUVs of 8.9 and 20.9 associated with squamous cell carcinoma [11]. We performed a retrospective review of our experience with FDG PET/CT scintigraphy in the preoperative evaluation of patients with histopathology-proven sinonasal papilloma. Materials and Methods This study was performed under an institu- tional review board–approved protocol. Relevant cases were identified through a search of a com- puterized database of patients who underwent PET/ CT scintigraphy at the University of Medicine and Dentistry of New Jersey–University Hospital be- tween April 2001 and January 2008. Medical re- cords were retrospectively reviewed. PET/CT scans were re-reviewed by nuclear medicine physicians. 18 F-FDG PET Evaluation of Sinonasal Papilloma Erik G. Cohen 1 Soly Baredes 1 Lionel S. Zuckier 2 Neena M. Mirani 3 Yiyan Liu 2 Nasrin V. Ghesani 2 Cohen EG, Baredes S, Zuckier LS, Mirani NM, Liu Y, Ghesani NV 1 Department of Surgery, Division of Otolaryngology- Head and Neck Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, 140 Bergen St., Ste. E1620, Newark, NJ 07103. Address correspondence to E. G. Cohen (coheneg@umdnj.edu). 2 Department of Radiology, Division of Nuclear Medicine, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ. 3 Department of Pathology, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ. Nuclear฀Medicine฀and฀Molecular฀Imaging฀•฀Clinical฀Observations AJR 2009; 193:214–217 0361–803X/09/1931–214 © American Roentgen Ray Society S inonasal papillomas are benign tumors that occur in several his- tologic forms by Hyams [1] clas- sification, including fungiform, inverted, and cylindric. Inverted papilloma is locally aggressive and has been associated with concurrent invasive squamous cell car- cinoma in approximately 9% of cases [2]. Papillomas can be difficult to differentiate from squamous cell carcinoma on clinical and radiologic grounds. Preoperative imag- ing studies and transnasal biopsy are gener- ally performed before definitive resection. However, squamous cell carcinoma, when present, may not involve all areas of the pap- illoma, making preoperative diagnosis of malignancy problematic. CT and MRI are commonly used to evaluate bone destruction and soft-tissue extension, but neither tech- nique is useful in differentiating sinonasal papilloma from squamous cell carcinoma. Treatment of sinonasal papillomas is pri- marily by complete surgical resection, most commonly either open or endoscopic medial maxillectomy. Recurrence of inverted papillo- ma has been reported in 18% of patients treat- ed by standard open surgical techniques in a pooled analysis [2]. Common postsurgical follow-up consists of serial nasal endoscopy and CT or MRI. It is often difficult to differ- entiate postoperative mucosal thickening and fibrosis from recurrent papilloma on clinical examination and routine radiologic imaging. Case reports of FDG uptake in several types of papillomas have been published, including tonsillar papilloma (unspecified Keywords: FDG PET, inverted papilloma, PET/CT, sinonasal papilloma, squamous cell carcinoma DOI:10.2214/AJR.08.1656 Received August 11, 2008; accepted after revision September 17, 2008. OBJECTIVE. It has been suggested that 18 F-FDG uptake determined by PET can differ- entiate squamous cell carcinoma from benign sinonasal papilloma. We wish to present our experience with sinonasal papillomas and PET/CT to determine if the degree of FDG uptake is indicative of benign or malignant disease. CONCLUSION. Benign sinonasal papilloma may be associated with intense FDG up- take on PET/CT. FDG PET/CT does not appear to reliably differentiate benign from malig- nant sinonasal papilloma. Cohen et al. FDG PET of Sinonasal Papilloma Nuclear Medicine and Molecular Imaging Clinical Observations Downloaded from www.ajronline.org by 52.73.204.196 on 05/16/22 from IP address 52.73.204.196. Copyright ARRS. For personal use only; all rights reserved