Metabolic Imaging of Sinonasal Lesions: Diagnostic Value of F18-FDG PET/CT in a Retrospective Cohort

Abstract

Objective: The objective of this study was to explore the diagnostic value of F18-FDG PET/CT in distinguishing benign from malignant sinonasal lesions and, to examine its association with histological subtypes, metastatic spread, and clinical outcomes. Material and Methods: This study retrospectively analysed a cohort of 64 individuals (43 males and 21 females; average age: 52.2 years) who had histopathologically confirmed sinonasal lesions and underwent F18-FDG PET/CT imaging. The quantitative assessment included the measurement of SUVmax, MTV (metabolic tumour volume), and TLG (total lesion glycolysis). Receiver operating characteristic curve analysis was performed to determine the most appropriate threshold values for the diagnostic parameters. The relationships between the PET/CT f indings and the metastatic status, as well as the clinical outcomes, were assessed. Information regarding lymph node involvement, distant dissemination, and patient outcomes was systematically documented. Results: Of the 67 PET/CT scans, 57 (89.1%) were malignant. A higher mean SUVmax was observed in the malignant lesions relative to the benign counterparts (18.34 vs. 10.83), demonstrating moderate accuracy for malignancy detection, as reflected by an AUC of 0.708 (p=0.076). The optimal SUVmax cut-off (9.47) yielded 57.1% specificity and 82.5% sensitivity (AUC: 0.708; 95% CI: 0.464–0.925). MTV and TLG showed limited discriminatory power. PET/CT detected distant metastases and regional lymph nodes in 52.6% of the malignant cases, influencing treatment decisions. No meaningful correlation could be established between the PET-derived parameters and overall survival in the study cohort. Conclusion: F18-FDG PET/CT provides moderate diagnostic accuracy in sinonasal lesions, with SUVmax being the most informative parameter. Its greatest clinical value lies in the staging and detection of metastatic disease, supporting its use as a complementary imaging modality in sinonasal tumour management. The findings highlight the value of incorporating PET/CT into the initial staging process for sinonasal tumours to enhance therapeutic decision-making.

Keywords

• Head and neck neoplasms
• sinonasal tumours
• F18-FDG PET/CT
• metabolic imaging
• metabolic charac terisation

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