Skip to main content
Top
Published in: Skeletal Radiology 2/2016

01-02-2016 | Scientific Article

Diffusion-weighted magnetic resonance imaging for the initial characterization of non-fatty soft tissue tumors: correlation between T2 signal intensity and ADC values

Authors: Pedro Augusto Gondim Teixeira, Frederique Gay, Bailiang Chen, Marie Zins, François Sirveaux, Jacques Felblinger, Alain Blum

Published in: Skeletal Radiology | Issue 2/2016

Login to get access

Abstract

Objective

To evaluate the performance of quantitative diffusion-weighted imaging (DWI) correlated with T2 signal in differentiating non-fatty benign from malignant tumors.

Material and methods

A total of 76 patients with a histologically confirmed non-fatty soft tissue tumors (46 benign and 30 malignant) were prospectively included in this ethics committee approved study. All patients signed an informed consent and underwent MRI with DWI with two b values (0 and 600). ADC values from the solid components of these tumors were obtained and were correlated with the lesion’s signal intensity on T2-weighted fat-saturated sequences. ADC values were obtained from adjacent normal muscle to allow calculation of tumor/muscle ADC ratios.

Results

There were 58 hyperintense and 18 iso or hypointense lesions. All hypointense lesions were benign. The mean ADC values for benign and malignant tumors were 1.47 ± 0.54 × 10−3 and 1.17 ± 0.38 × 10−3 mm2/s respectively (p < 0.005). The mean ADC ratio in benign iso or hypointense tumors was significantly lower than that of hyperintense ones (0.76 ± 0.21 versus 1.58 ± 0.82 – p < 0.0001). An ADC ratio lower than 0.915 was highly specific for malignancy (96.4 %), whereas an ADC ratio higher than 1.32 was highly sensitive for benign lesions (90 %).

Conclusion

ADC analysis can be useful in the initial characterization of T2 hyperintense non-fatty soft tissue masses, although this technique alone is not likely to change patient management.
Literature
1.
go back to reference Costa FM, Ferreira EC, Vianna EM. Diffusion-weighted magnetic resonance imaging for the evaluation of musculoskeletal tumors. Magn Reson Imaging Clin N Am. 2011;19:159–80.CrossRefPubMed Costa FM, Ferreira EC, Vianna EM. Diffusion-weighted magnetic resonance imaging for the evaluation of musculoskeletal tumors. Magn Reson Imaging Clin N Am. 2011;19:159–80.CrossRefPubMed
3.
go back to reference Gielen JL, De Schepper AM, Vanhoenacker F, et al. Accuracy of MRI in characterization of soft tissue tumors and tumor-like lesions: a prospective study in 548 patients. Eur Radiol. 2004;14:2320–30.CrossRefPubMed Gielen JL, De Schepper AM, Vanhoenacker F, et al. Accuracy of MRI in characterization of soft tissue tumors and tumor-like lesions: a prospective study in 548 patients. Eur Radiol. 2004;14:2320–30.CrossRefPubMed
4.
go back to reference Wu JS, Hochman MG. Soft-tissue tumors and tumorlike lesions: a systematic imaging approach. Radiology. 2009;253:297–316.CrossRefPubMed Wu JS, Hochman MG. Soft-tissue tumors and tumorlike lesions: a systematic imaging approach. Radiology. 2009;253:297–316.CrossRefPubMed
5.
go back to reference Fletcher CD. The evolving classification of soft tissue tumours: an update based on the new WHO classification. Histopathology. 2006;48:3–12.CrossRefPubMed Fletcher CD. The evolving classification of soft tissue tumours: an update based on the new WHO classification. Histopathology. 2006;48:3–12.CrossRefPubMed
6.
go back to reference Koh DM, Collins DJ. Diffusion-weighted MRI in the body: applications and challenges in oncology. AJR Am J Roentgenol. 2007;188:1622–35.CrossRefPubMed Koh DM, Collins DJ. Diffusion-weighted MRI in the body: applications and challenges in oncology. AJR Am J Roentgenol. 2007;188:1622–35.CrossRefPubMed
7.
go back to reference Koh DM, Takahara T, Imai Y, Collins DJ. Practical aspects of assessing tumors using clinical diffusion-weighted imaging in the body. Magn Reson Med Sci. 2007;6:211–24.CrossRefPubMed Koh DM, Takahara T, Imai Y, Collins DJ. Practical aspects of assessing tumors using clinical diffusion-weighted imaging in the body. Magn Reson Med Sci. 2007;6:211–24.CrossRefPubMed
8.
go back to reference Vermoolen MA, Kwee TC, Nievelstein RA. Apparent diffusion coefficient measurements in the differentiation between benign and malignant lesions: a systematic review. Insights Imaging. 2012;3:395–409.CrossRefPubMedCentralPubMed Vermoolen MA, Kwee TC, Nievelstein RA. Apparent diffusion coefficient measurements in the differentiation between benign and malignant lesions: a systematic review. Insights Imaging. 2012;3:395–409.CrossRefPubMedCentralPubMed
9.
go back to reference Fayad LM, Jacobs MA, Wang X, Carrino JA, Bluemke DA. Musculoskeletal tumors: how to use anatomic, functional, and metabolic MR techniques. Radiology. 2012;265:340–56.CrossRefPubMedCentralPubMed Fayad LM, Jacobs MA, Wang X, Carrino JA, Bluemke DA. Musculoskeletal tumors: how to use anatomic, functional, and metabolic MR techniques. Radiology. 2012;265:340–56.CrossRefPubMedCentralPubMed
10.
go back to reference Subhawong TK, Jacobs MA, Fayad LM. Insights into quantitative diffusion-weighted MRI for musculoskeletal tumor imaging. AJR Am J Roentgenol. 2014;203:560–72.CrossRefPubMed Subhawong TK, Jacobs MA, Fayad LM. Insights into quantitative diffusion-weighted MRI for musculoskeletal tumor imaging. AJR Am J Roentgenol. 2014;203:560–72.CrossRefPubMed
11.
go back to reference Bley TA, Wieben O, Uhl M. Diffusion-weighted MR imaging in musculoskeletal radiology: applications in trauma, tumors, and inflammation. Magn Reson Imaging Clin N Am. 2009;17:263–75.CrossRefPubMed Bley TA, Wieben O, Uhl M. Diffusion-weighted MR imaging in musculoskeletal radiology: applications in trauma, tumors, and inflammation. Magn Reson Imaging Clin N Am. 2009;17:263–75.CrossRefPubMed
12.
go back to reference Colagrande S, Carbone SF, Carusi LM, Cova M, Villari N. Magnetic resonance diffusion-weighted imaging: extraneurological applications. Radiol Med. 2006;111:392–419.CrossRefPubMed Colagrande S, Carbone SF, Carusi LM, Cova M, Villari N. Magnetic resonance diffusion-weighted imaging: extraneurological applications. Radiol Med. 2006;111:392–419.CrossRefPubMed
13.
go back to reference Del Grande F, Subhawong T, Flammang A, Fayad LM. Chemical shift imaging at 3 Tesla: effect of echo time on assessing bone marrow abnormalities. Skeletal Radiol. 2014;43:1139–47.CrossRefPubMed Del Grande F, Subhawong T, Flammang A, Fayad LM. Chemical shift imaging at 3 Tesla: effect of echo time on assessing bone marrow abnormalities. Skeletal Radiol. 2014;43:1139–47.CrossRefPubMed
14.
go back to reference Herneth AM, Guccione S, Bednarski M. Apparent diffusion coefficient: a quantitative parameter for in vivo tumor characterization. Eur J Radiol. 2003;45:208–13.CrossRefPubMed Herneth AM, Guccione S, Bednarski M. Apparent diffusion coefficient: a quantitative parameter for in vivo tumor characterization. Eur J Radiol. 2003;45:208–13.CrossRefPubMed
15.
go back to reference van Rijswijk CS, Kunz P, Hogendoorn PC, Taminiau AH, Doornbos J, Bloem JL. Diffusion-weighted MRI in the characterization of soft-tissue tumors. J Magn Reson Imaging. 2002;15:302–7.CrossRefPubMed van Rijswijk CS, Kunz P, Hogendoorn PC, Taminiau AH, Doornbos J, Bloem JL. Diffusion-weighted MRI in the characterization of soft-tissue tumors. J Magn Reson Imaging. 2002;15:302–7.CrossRefPubMed
16.
go back to reference Nagata S, Nishimura H, Uchida M, et al. Diffusion-weighted imaging of soft tissue tumors: usefulness of the apparent diffusion coefficient for differential diagnosis. Radiat Med. 2008;26:287–95.CrossRefPubMed Nagata S, Nishimura H, Uchida M, et al. Diffusion-weighted imaging of soft tissue tumors: usefulness of the apparent diffusion coefficient for differential diagnosis. Radiat Med. 2008;26:287–95.CrossRefPubMed
17.
go back to reference Costa FM, Canella C, Gasparetto E. Advanced magnetic resonance imaging techniques in the evaluation of musculoskeletal tumors. Radiol Clin North Am. 2011;49:1325–58. vii–viii.CrossRefPubMed Costa FM, Canella C, Gasparetto E. Advanced magnetic resonance imaging techniques in the evaluation of musculoskeletal tumors. Radiol Clin North Am. 2011;49:1325–58. vii–viii.CrossRefPubMed
18.
go back to reference Koyama H, Ohno Y, Seki S, et al. Value of diffusion-weighted MR imaging using various parameters for assessment and characterization of solitary pulmonary nodules. Eur J Radiol. 2015;84:509–15.CrossRefPubMed Koyama H, Ohno Y, Seki S, et al. Value of diffusion-weighted MR imaging using various parameters for assessment and characterization of solitary pulmonary nodules. Eur J Radiol. 2015;84:509–15.CrossRefPubMed
19.
go back to reference Noij DP, Pouwels PJ, Ljumanovic R, et al. Predictive value of diffusion-weighted imaging without and with including contrast-enhanced magnetic resonance imaging in image analysis of head and neck squamous cell carcinoma. Eur J Radiol. 2015;84:108–16.CrossRefPubMed Noij DP, Pouwels PJ, Ljumanovic R, et al. Predictive value of diffusion-weighted imaging without and with including contrast-enhanced magnetic resonance imaging in image analysis of head and neck squamous cell carcinoma. Eur J Radiol. 2015;84:108–16.CrossRefPubMed
20.
go back to reference Kang TW, Kim SH, Jang KM, et al. Gastrointestinal stromal tumours: correlation of modified NIH risk stratification with diffusion-weighted MR imaging as an imaging biomarker. Eur J Radiol. 2015;84:33–40.CrossRefPubMed Kang TW, Kim SH, Jang KM, et al. Gastrointestinal stromal tumours: correlation of modified NIH risk stratification with diffusion-weighted MR imaging as an imaging biomarker. Eur J Radiol. 2015;84:33–40.CrossRefPubMed
21.
go back to reference Wu LM, Chen XX, Li YL, et al. On the utility of quantitative diffusion-weighted MR imaging as a tool in differentiation between malignant and benign thyroid nodules. Acad Radiol. 2014;21:355–63.CrossRefPubMed Wu LM, Chen XX, Li YL, et al. On the utility of quantitative diffusion-weighted MR imaging as a tool in differentiation between malignant and benign thyroid nodules. Acad Radiol. 2014;21:355–63.CrossRefPubMed
22.
go back to reference Wu LM, Xu JR, Ye YQ, Lu Q, Hu JN. The clinical value of diffusion-weighted imaging in combination with T2-weighted imaging in diagnosing prostate carcinoma: a systematic review and meta-analysis. AJR Am J Roentgenol. 2012;199:103–10.CrossRefPubMed Wu LM, Xu JR, Ye YQ, Lu Q, Hu JN. The clinical value of diffusion-weighted imaging in combination with T2-weighted imaging in diagnosing prostate carcinoma: a systematic review and meta-analysis. AJR Am J Roentgenol. 2012;199:103–10.CrossRefPubMed
23.
go back to reference Oka K, Yakushiji T, Sato H, et al. Usefulness of diffusion-weighted imaging for differentiating between desmoid tumors and malignant soft tissue tumors. J Magn Reson Imaging. 2011;33:189–93.CrossRefPubMed Oka K, Yakushiji T, Sato H, et al. Usefulness of diffusion-weighted imaging for differentiating between desmoid tumors and malignant soft tissue tumors. J Magn Reson Imaging. 2011;33:189–93.CrossRefPubMed
24.
go back to reference Oka K, Yakushiji T, Sato H, et al. Ability of diffusion-weighted imaging for the differential diagnosis between chronic expanding hematomas and malignant soft tissue tumors. J Magn Reson Imaging. 2008;28:1195–200.CrossRefPubMed Oka K, Yakushiji T, Sato H, et al. Ability of diffusion-weighted imaging for the differential diagnosis between chronic expanding hematomas and malignant soft tissue tumors. J Magn Reson Imaging. 2008;28:1195–200.CrossRefPubMed
25.
go back to reference Einarsdottir H, Karlsson M, Wejde J, Bauer HC. Diffusion-weighted MRI of soft tissue tumours. Eur Radiol. 2004;14:959–63.CrossRefPubMed Einarsdottir H, Karlsson M, Wejde J, Bauer HC. Diffusion-weighted MRI of soft tissue tumours. Eur Radiol. 2004;14:959–63.CrossRefPubMed
26.
go back to reference Chen CK, Wu HT, Chiou HJ, et al. Differentiating benign and malignant soft tissue masses by magnetic resonance imaging: role of tissue component analysis. J Chin Med Assoc JCMA. 2009;72:194–201.CrossRef Chen CK, Wu HT, Chiou HJ, et al. Differentiating benign and malignant soft tissue masses by magnetic resonance imaging: role of tissue component analysis. J Chin Med Assoc JCMA. 2009;72:194–201.CrossRef
27.
go back to reference Maeda M, Matsumine A, Kato H, et al. Soft-tissue tumors evaluated by line-scan diffusion-weighted imaging: influence of myxoid matrix on the apparent diffusion coefficient. J Magn Reson Imaging. 2007;25:1199–204.CrossRefPubMed Maeda M, Matsumine A, Kato H, et al. Soft-tissue tumors evaluated by line-scan diffusion-weighted imaging: influence of myxoid matrix on the apparent diffusion coefficient. J Magn Reson Imaging. 2007;25:1199–204.CrossRefPubMed
28.
go back to reference Lang P, Wendland MF, Saeed M, et al. Osteogenic sarcoma: noninvasive in vivo assessment of tumor necrosis with diffusion-weighted MR imaging. Radiology. 1998;206:227–35.CrossRefPubMed Lang P, Wendland MF, Saeed M, et al. Osteogenic sarcoma: noninvasive in vivo assessment of tumor necrosis with diffusion-weighted MR imaging. Radiology. 1998;206:227–35.CrossRefPubMed
29.
go back to reference Schmidt H, Gatidis S, Schwenzer NF, Martirosian P. Impact of measurement parameters on apparent diffusion coefficient quantification in diffusion-weighted-magnetic resonance imaging. Investig Radiol. 2015;50:6–56.CrossRef Schmidt H, Gatidis S, Schwenzer NF, Martirosian P. Impact of measurement parameters on apparent diffusion coefficient quantification in diffusion-weighted-magnetic resonance imaging. Investig Radiol. 2015;50:6–56.CrossRef
30.
go back to reference Chung BM, Park SB, Lee JB, Park HJ, Kim YS, Oh YJ. Magnetic resonance imaging features of ovarian fibroma, fibrothecoma, and thecoma. Abdom Imaging. 2015;40:1263–72.CrossRefPubMed Chung BM, Park SB, Lee JB, Park HJ, Kim YS, Oh YJ. Magnetic resonance imaging features of ovarian fibroma, fibrothecoma, and thecoma. Abdom Imaging. 2015;40:1263–72.CrossRefPubMed
31.
go back to reference Padhani AR, Liu G, Koh DM, et al. Diffusion-weighted magnetic resonance imaging as a cancer biomarker: consensus and recommendations. Neoplasia. 2009;11:102–25.CrossRefPubMedCentralPubMed Padhani AR, Liu G, Koh DM, et al. Diffusion-weighted magnetic resonance imaging as a cancer biomarker: consensus and recommendations. Neoplasia. 2009;11:102–25.CrossRefPubMedCentralPubMed
32.
go back to reference Bonarelli C, Teixeira PAG, Hossu G, Meyer JB, Bailiang C, Gay F, et al. Impact of ROI positioning and lesion morphology on ADC value analysis for the differentiation between benign and malignant non-fatty soft tissue lesions. AJR Am J Roentgenol. 2015;205:W106–13.CrossRefPubMed Bonarelli C, Teixeira PAG, Hossu G, Meyer JB, Bailiang C, Gay F, et al. Impact of ROI positioning and lesion morphology on ADC value analysis for the differentiation between benign and malignant non-fatty soft tissue lesions. AJR Am J Roentgenol. 2015;205:W106–13.CrossRefPubMed
33.
go back to reference Hirano M, Satake H, Ishigaki S, Ikeda M, Kawai H, Naganawa S. Diffusion-weighted imaging of breast masses: comparison of diagnostic performance using various apparent diffusion coefficient parameters. AJR Am J Roentgenol. 2012;198:717–22.CrossRefPubMed Hirano M, Satake H, Ishigaki S, Ikeda M, Kawai H, Naganawa S. Diffusion-weighted imaging of breast masses: comparison of diagnostic performance using various apparent diffusion coefficient parameters. AJR Am J Roentgenol. 2012;198:717–22.CrossRefPubMed
34.
go back to reference Obuchowski NA. Receiver operating characteristic curves and their use in radiology. Radiology. 2003;229:3–8.CrossRefPubMed Obuchowski NA. Receiver operating characteristic curves and their use in radiology. Radiology. 2003;229:3–8.CrossRefPubMed
35.
go back to reference Geith T, Schmidt G, Biffar A, et al. Comparison of qualitative and quantitative evaluation of diffusion-weighted MRI and chemical-shift imaging in the differentiation of benign and malignant vertebral body fractures. AJR Am J Roentgenol. 2012;199:1083–92.CrossRefPubMed Geith T, Schmidt G, Biffar A, et al. Comparison of qualitative and quantitative evaluation of diffusion-weighted MRI and chemical-shift imaging in the differentiation of benign and malignant vertebral body fractures. AJR Am J Roentgenol. 2012;199:1083–92.CrossRefPubMed
36.
go back to reference Neubauer H, Evangelista L, Hassold N, et al. Diffusion-weighted MRI for detection and differentiation of musculoskeletal tumorous and tumor-like lesions in pediatric patients. World J Pediatr WJP. 2012;8:342–9.CrossRef Neubauer H, Evangelista L, Hassold N, et al. Diffusion-weighted MRI for detection and differentiation of musculoskeletal tumorous and tumor-like lesions in pediatric patients. World J Pediatr WJP. 2012;8:342–9.CrossRef
37.
38.
go back to reference Sundaram M, McGuire MH, Schajowicz F. Soft-tissue masses: histologic basis for decreased signal (short T2) on T2-weighted MR images. AJR Am J Roentgenol. 1987;148:1247–50.CrossRefPubMed Sundaram M, McGuire MH, Schajowicz F. Soft-tissue masses: histologic basis for decreased signal (short T2) on T2-weighted MR images. AJR Am J Roentgenol. 1987;148:1247–50.CrossRefPubMed
39.
go back to reference Petscavage-Thomas JM, Walker EA, Logie CI, et al. Soft-tissue myxomatous lesions: review of salient imaging features with pathologic comparison. Radiographics. 2014;34:964–80.CrossRefPubMed Petscavage-Thomas JM, Walker EA, Logie CI, et al. Soft-tissue myxomatous lesions: review of salient imaging features with pathologic comparison. Radiographics. 2014;34:964–80.CrossRefPubMed
40.
go back to reference Baheti AD, Tirumani SH, Rosenthal MF, et al. Myxoid soft-tissue neoplasms: comprehensive update of the taxonomy and MRI features. AJR Am J Roentgenol. 2015;204:374–85.CrossRefPubMed Baheti AD, Tirumani SH, Rosenthal MF, et al. Myxoid soft-tissue neoplasms: comprehensive update of the taxonomy and MRI features. AJR Am J Roentgenol. 2015;204:374–85.CrossRefPubMed
41.
go back to reference Bogner W, Gruber S, Pinker K, et al. Diffusion-weighted MR for differentiation of breast lesions at 3.0 T: how does selection of diffusion protocols affect diagnosis? Radiology. 2009;253:341–51.CrossRefPubMed Bogner W, Gruber S, Pinker K, et al. Diffusion-weighted MR for differentiation of breast lesions at 3.0 T: how does selection of diffusion protocols affect diagnosis? Radiology. 2009;253:341–51.CrossRefPubMed
Metadata
Title
Diffusion-weighted magnetic resonance imaging for the initial characterization of non-fatty soft tissue tumors: correlation between T2 signal intensity and ADC values
Authors
Pedro Augusto Gondim Teixeira
Frederique Gay
Bailiang Chen
Marie Zins
François Sirveaux
Jacques Felblinger
Alain Blum
Publication date
01-02-2016
Publisher
Springer Berlin Heidelberg
Published in
Skeletal Radiology / Issue 2/2016
Print ISSN: 0364-2348
Electronic ISSN: 1432-2161
DOI
https://doi.org/10.1007/s00256-015-2302-6

Other articles of this Issue 2/2016

Skeletal Radiology 2/2016 Go to the issue