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European Radiology
Published in: European Radiology 3/2014

01-03-2014 | Chest

Diffusion-weighted MRI for distinguishing non-neoplastic cysts from solid masses in the mediastinum: problem-solving in mediastinal masses of indeterminate internal characteristics on CT

Authors: Kyung Eun Shin, Chin A Yi, Tae Sung Kim, Ho Yun Lee, Young Soo Choi, Hong Kwan Kim, Jhingook Kim

Published in: European Radiology | Issue 3/2014

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Abstract

Objectives

To evaluate the usefulness of diffusion-weighted (DW) magnetic resonance images for distinguishing non-neoplastic cysts from solid masses of indeterminate internal characteristics on computed tomography (CT) in the mediastinum.

Methods

We enrolled 25 patients with pathologically proved mediastinal masses who underwent both thoracic CT and magnetic resonance imaging (MRI) including diffusion-weighted imaging (DWI). MRI was performed in patients with mediastinal masses of indeterminate internal characteristics on CT. Two thoracic radiologists evaluated the morphological features and quantitatively measured the net enhancement of the masses at CT. They also reviewed MR images including unenhanced T1- and T2-weighted images, gadolinium-enhanced images and DW images.

Results

The enrolled patients had 15 solid masses and ten non-neoplastic cysts. Although the morphological features and the extent of enhancement on CT did not differ significantly between solid and cystic masses in the mediastinum (P > 0.05), non-neoplastic cysts were distinguishable from solid masses by showing signal suppression on high-b-value DW images or high apparent diffusion coefficient (ADC) values of more than 2.5 × 10-3 mm2/s (P < 0.001). ADC values of non-neoplastic cysts (3.67 ± 0.87 × 10-3 mm2/s) were significantly higher than that of solid masses (1.46 ± 0.50 × 10-3 mm2/s) (P < 0.001).

Conclusions

DWI can help differentiate solid and cystic masses in the mediastinum, even when CT findings are questionable.

Key Points

• Non-invasive diagnosis of non-neoplastic cysts can save surgical biopsy or excision.
• Conventional CT or MRI findings cannot always provide a confident diagnosis.
• Mediastinal masses can be well-characterised with DWI.
• Non-neoplastic mediastinal cysts show significantly higher ADC values than cystic tumours.
• DWI is useful to determine treatment strategy.
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Metadata
Title
Diffusion-weighted MRI for distinguishing non-neoplastic cysts from solid masses in the mediastinum: problem-solving in mediastinal masses of indeterminate internal characteristics on CT
Authors
Kyung Eun Shin
Chin A Yi
Tae Sung Kim
Ho Yun Lee
Young Soo Choi
Hong Kwan Kim
Jhingook Kim
Publication date
01-03-2014
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 3/2014
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-013-3054-0

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