Abstract
BackgroundDifferentiation between malignant and benign masses is essential for treatment planning and helps in improving the prognosis of malignant tumors; the aim of this work is to determine the role of diffusion-weighted magnetic resonance imaging (DW-MRI) and the apparent diffusion coefficient (ADC) in the differentiation between benign and malignant solid head and neck masses by comparing diagnostic performance of low b values (0.50 and 400 s/mm2) versus high b values (800 and 1000 s/mm2) and comparing the result with histopathological finding.ResultsThe study included 60 patients (34 male and 26 female) with solid head and neck masses > 1 cm who referred to radiodiagnosis department for MRI evaluation. Multiple b values were used 50, 400, 800, and 1000 s/mm2 (at least 2 b values). DWI and ADC value of all 60 patients were acquired. Mean ADC values of both malignant and benign masses were statistically measured and compared, and cut off value was determined. Solid head and neck masses in our study DWI with the use of high b value 800 and 1000 s/mm2 were of higher significance (P value 0.001*). There was a significant difference in the mean ADC value between benign and malignant masses (P < 0.01); solid masses were divided into 2 categories: (a) malignant lesions 46.7% (n = 28) with mean ADC value (0.82 ± 0.19) × 10−3 s/mm2 and (b) benign lesions 53.3% (n = 32) with mean ADC value (2.05 ± 0.46) × 10−3 s/mm2) with ADC cutoff value of 1.0 × 10−3 s/mm2 and 94% sensitivity, 93% specificity, negative predictive value (NPV) = 94%, positive predictive value (PPV) 93%, and an accuracy of 93.5%.ConclusionThe DWI with ADC mapping were valuable as non-invasive tools in differentiating between benign and malignant solid head and neck masses. The use of high b value 800 and 1000 s/mm2 was of higher significance (P value 0.001*) in differentiation between benign and malignant lesion than that with low b values 0, 50, and 400 s/mm2 (0.01). The mean ADC values were significantly lower in malignant solid masses. Attention had to be paid to the choice of b values in MRI-DWI in the head and neck region.
Highlights
Differentiation between malignant and benign masses is essential for treatment planning and helps in improving the prognosis of malignant tumors; the aim of this work is to determine the role of diffusionweighted magnetic resonance imaging (DW-Magnetic resonant imaging (MRI)) and the apparent diffusion coefficient (ADC) in the differentiation between benign and malignant solid head and neck masses by comparing diagnostic performance of low b values (0.50 and 400 s/mm2) versus high b values (800 and 1000 s/mm2) and comparing the result with histopathological finding
Qualitative analyses of lesions were divided according to b values: in low b values (0, 50, 400 s/mm2), benign lesions displayed low signal intensity (SI) in 37.5% (n = 12) and high SI in 62.5% (n = 20), while malignant lesion displayed high SI in 100.0% (n = 28) (Table 2)
This was in agreement with our study that had been conducted on 60 patients with solid masses; Diffusion-weighted imaging (DWI) with the use of high b value 800 and 1000 s/mm2 was of higher significance (P value 0.001*)
Summary
Differentiation between malignant and benign masses is essential for treatment planning and helps in improving the prognosis of malignant tumors; the aim of this work is to determine the role of diffusionweighted magnetic resonance imaging (DW-MRI) and the apparent diffusion coefficient (ADC) in the differentiation between benign and malignant solid head and neck masses by comparing diagnostic performance of low b values (0.50 and 400 s/mm2) versus high b values (800 and 1000 s/mm2) and comparing the result with histopathological finding. The head and neck regions were constituted to have high anatomical and functional difficulties, making the accurate diagnosis and staging of regional tumors a challenging task. MRI sequences provided us with very accurate data about tumor size, site, and morphological criteria of tumors in the head and neck areas. It was not enough for the evaluation of biological behavior of tumors. Functional MRI imaging techniques were newly developed which can provide us with information on biological and functional aspects of tumor vascularization and internal microarchitecture [2]. Diffusion-weighted imaging (DWI) was an emerging non-invasive functional MRI technique made without administration of intravenous contrast agent and had reliable ability in discrimination between benign and malignant tissues [3]
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