Apparent diffusion coefficient measurements in the differentiation between benign and malignant lesions: a systematic review

M A Vermoolen,T C Kwee,R A J Nievelstein

doi:10.1007/s13244-012-0175-y

Abstract

ObjectivesTo systematically review the value of apparent diffusion coefficient (ADC) measurement in the differentiation between benign and malignant lesions.MethodsA systematic search of the Medline/Pubmed and Embase databases revealed 109 relevant studies. Quality of these articles was assessed using the Quality Assessment of the Studies of Diagnostic Accuracy Included in Systematic Reviews (QUADAS) criteria. Reported ADC values of benign and malignant lesions were compared per organ.ResultsThe mean quality score of the reviewed articles was 50%. Comparison of ADC values showed marked variation among studies and between benign and malignant lesions in various organs. In several organs, such as breast, liver, and uterus, ADC values discriminated well between benign and malignant lesions. In other organs, such as the salivary glands, thyroid, and pancreas, ADCs were not significantly different between benign and malignant lesions.ConclusionThe potential utility of ADC measurement for the characterisation of tumours differs per organ. Future well-designed studies are required before ADC measurements can be recommended for the differentiation of benign and malignant lesions. These future studies should use standardised acquisition protocols and provide complete reporting of study methods, to facilitate comparison of results and clinical implementation of ADC measurement for tumour characterisation.Electronic supplementary materialThe online version of this article (doi:10.1007/s13244-012-0175-y) contains supplementary material, which is available to authorized users.

Highlights

Over the past two decades, magnetic resonance (MR) imaging (MRI) has proven to be a valuable diagnostic tool in oncology [1,2,3,4]
We identified 109 articles that described and compared mean apparent diffusion coefficient (ADC) values for malignant and benign tumours in various body regions, of which 14 were intracranial and 95 extracranial
The functional information provided by diffusion-weighted MR imaging (DWI) and ADC measurement may be of value in tumour characterisation, complementary to the anatomical information obtained with conventional MRI sequences

Summary

Introduction

Over the past two decades, magnetic resonance (MR) imaging (MRI) has proven to be a valuable diagnostic tool in oncology [1,2,3,4]. Using conventional MRI sequences, difficulty in differentiating benign from malignant lesions may arise when malignant and benign lesions share certain morphologic and contrast-enhancement characteristics In these cases, diffusion-weighted MR imaging (DWI) might be of value in tumour assessment, as it has the ability to provide tissue contrast based on molecular diffusion [5]. Since the 1990s, DWI using single-shot echo-planar imaging (EPI) has been successfully applied in the field of neuroradiology It is valuable in the assessment of acute cerebral ischemia [6, 7]. Technical advances in MRI, such as the development of parallel imaging, high gradient amplitudes, and multichannel coils, have enabled the performance of DWI in the body These developments have initiated the investigation of applicability of DWI for tumour characterisation, both intra- and extracranially.

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