Abstract
Background: Diffusion-weighted imaging (DWI) provides added value to conventional MRI imaging in diagnosing and differentiating various benign and malignant musculoskeletal tumors.Objective: The study aims to evaluate the diagnostic efficacies of diffusion-weighted imaging along with the conventional MRI sequences for differentiating benign and malignant musculoskeletal tumors using sensitivity and specificity.Materials and methods: This retrospective study was carried out on 73 histopathologically proven patients of various musculoskeletal tumors who presented to a tertiary care center between March 2017 to October 2018. Relevant clinical examinations and MRI scan of the requested body part of the musculoskeletal system were performed. Mean apparent diffusion coefficient (ADC) values were calculated in the bone as well as soft tissue tumors after placing uniform-sized region of interest (ROI) in the non-necrotic portion of the tumor.Statistical analysis: Independent t-test and one-way analysis of variance (ANOVA) test were used to compare the mean ADC values of the various tumors with the histopathology. Receiver operating characteristic (ROC) curve analysis was done to determine the cut-off mean ADC values in the various bone and soft tissue tumors.Results: Of 73 patients with musculoskeletal tumors (benign=20, malignant = 53), 47 patients were bone tumors (benign=12, malignant=35) and 26 patients were soft tissue tumors (benign=eight, malignant=18). Mean ADC value of benign bone tumor was 1.257±0.327[SD] x 10-3mm2/s and malignant was 0.951 ± 0.177[SD] x 10-3mm2/s. The mean ADC value of benign soft tissue tumor was 1.603±0.444[SD] x 10-3mm2/s and malignant was 1.036 ± 0.186[SD] x 10-3mm2/s. The cut-off mean ADC value was 1.058 x 10-3mm2/s for differentiating benign from malignant bone tumor with a sensitivity of 83.3%, specificity of 66.7% and accuracy of 78.7% while the cut-off mean ADC value of 1.198 x 10-3mm2/s for differentiating benign from malignant soft tissue tumors with a sensitivity of 83.3%, specificity of 87.5% and accuracy of 84.6%.Conclusions: DWI with ADC mapping can be used as an additional reliable tool along with conventional MRI sequences in discriminating benign and malignant musculoskeletal tumors.
Highlights
MRI is one of the imaging modalities of choice to detect intramedullary bony abnormality even with a negative bone scan [1]
The cut-off mean apparent diffusion coefficient (ADC) value was 1.058 x 10 -3mm2/s for differentiating benign from malignant bone tumor with a sensitivity of 83.3%, specificity of 66.7% and accuracy of 78.7% while the cut-off mean ADC value of 1.198 x 10-3mm2/s for differentiating benign from malignant soft tissue tumors with a sensitivity of 83.3%, specificity of 87.5% and accuracy of 84.6%
diffusion-weighted imaging (DWI) with ADC mapping can be used as an additional reliable tool along with conventional MRI sequences in discriminating benign and malignant musculoskeletal tumors
Summary
MRI is one of the imaging modalities of choice to detect intramedullary bony abnormality even with a negative bone scan [1]. Adding other MRI sequences like diffusion-weighted imaging (DWI), dynamic contrast-enhanced MRI (DCEMRI), and MR spectroscopy helps to more accurately differentiate benign from malignant bone as well as soft tissue tumors [3,4]. Because of this property, DWI is able to provide both qualitative and quantitative assessments of intra-tumoral cellularity [6]. Various literature have shown the added advantage of DWI and ADC mapping over the conventional MRI sequences in differentiating various musculoskeletal tumors, diffuse bone marrow infiltrative lesions, benign and pathological vertebral collapse [6,7,8]. Diffusion-weighted imaging (DWI) provides added value to conventional MRI imaging in diagnosing and differentiating various benign and malignant musculoskeletal tumors
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