Abstract
Objectives:To investigate the feasibility of intravoxel incoherent motion (IVIM) diffusion MR and diffusion kurtosis imaging (DKI) in discriminating atypical bone metastasis from benign bone lesion in patients with tumors.Methods:Patients with bone lesions in lower extremity suspected of metastases were enrolled in this prospective study. IVIM diffusion MR and DKI were performed before biopsy. Apparent diffusion coefficient (ADC), true diffusion (D), perfusion fraction (f) and perfusion-related pseudodiffusion (D*) were generated with IVIM, while mean kurtosis (MK) and mean diffusion (MD) generated with DKI. Two radiologists blinded to pathology results separately measured these parameters for each lesion through drawing region of interest. Intraclass correlation coefficient was used to determine the inter-reader viability in measurement. The patients with pathology-confirmed metastasis or benign lesion were analyzed. The Mann–Whitney test was used to compare IVIM and DKI parameters between metastasis group and benign lesion group. Receiver operating characteristic curves were constructed to evaluate the ability of discrimination.Results:Bone lesions from 28 patients (metastasis, n = 15; benign lesion, n = 13; mean age = 55 years; age range, 34~77) were analyzed with IVIM and DKI. Intraclass correlation coefficient was greater than 0.8 for all parameters. ADC, D and MD were significantly lower in metastases versus benign lesions (p<0.05). MK and f value were significantly higher in metastases versus benign lesions (p<0.05). D* was not significantly different between the two groups (p>0.05). Areas under curve for ADC, D, f, MK and MD were 0.935, 0.939, 0.891, 0.840 and 0.844 respectively.Conclusions:IVIM and DKI derived parameters distinguish between atypical bone metastasis and benign bone lesion in selected patients with tumors.Advances in knowledge:Bone metastasis and benign bone lesion differ in water molecular diffusion.Intravoxel incoherent motion derived true diffusion distinguishes between atypical bone metastasis and benign lesion.
Highlights
It is of great importance to discriminate bone metastasis from benign bone lesion in patients with primary tumors, as the treatment paths differ greatly.[1,2,3] CT and MR can identify typical bone metastasis, such as multiple metastases
From July 2015 to June 2018, 28 patients with primary tumors and bone lesions suspected of metastases underwent intravoxel incoherent motion (IVIM) diffusion MR, diffusion kurtosis imaging (DKI) and bone biopsy
The most important findings were: (1) atypical metastasis and benign lesion differed in Apparent diffusion coefficient (ADC), D, f, mean diffusion (MD) and mean kurtosis (MK); (2) IVIM derived D value was the best parameter for identification of metastasis
Summary
It is of great importance to discriminate bone metastasis from benign bone lesion in patients with primary tumors, as the treatment paths differ greatly.[1,2,3] CT and MR can identify typical bone metastasis, such as multiple metastases. Conventional CT and MR are poor in distinguishing between atypical bone metastasis and benign bone lesion, because they have similar image characteristics. Bone biopsy is the gold standard for identification of metastasis.[4] bone biopsy was not widely used for this purpose in clinical practice due to invasiveness. Noninvasive diagnositic techniques that could discriminate atypical metastasis from benign lesion were urgently required
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