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Abstract
BackgroundIn pediatric patients, soft tissue masses encompass a wide heterogeneous group of benign and malignant lesions. MRI is a powerful diagnostic tool in the workup of soft tissue tumors in children, and it helps in characterization of lesion and evaluation of the extent of the lesion. However, conventional MRI techniques are not specific in differentiating benign from malignant lesions. So to improve characterization of tumors, DWI was added to MRI techniques as it increases sensitivity and specificity by detecting the micro-diffusion changes of water into intra- and extracellular spaces. The aim of this work was to highlight the diagnostic value of DWI in detection and characterization of different musculoskeletal soft tissue masses in pediatrics.ResultsThere was a statistically significant difference regarding the mean ADC value of benign and malignant masses (P value = 0.001*). The mean ADC value for all benign masses (n = 41) was 1.495 ± 0.55 SD × 10–3 mm2/s, while the mean ADC value for all malignant masses (n = 21) was 0.449 ± 0.27 SD × 10–3 mm2/s. The cutoff ADC value between benign and malignant masses was 0.88 × 10–3 mm2/s. This cutoff ADC value has sensitivity of 100.0%, specificity of 92.3%, PPV of 66.7%, NPV of 100.0% and diagnostic accuracy of 93.3%.ConclusionIn pediatric patients, DWI is an innovative valuable noninvasive imaging technique for characterization of musculoskeletal soft tissue masses and discrimination between benign and malignant masses.
Highlights
In pediatric patients, soft tissue masses encompass a wide heterogeneous group of benign and malig‐ nant lesions
The specificity of conventional Magnetic resonance imaging (MRI) in differentiating benign from malignant soft tissue tumors was variable among previous studies, presumably because benign and malignant soft tissue tumors may share the same morphologic features regarding the size, margin, location, signal intensities and contrast enhancement [4, 5]
The cutoff point for all mean apparent diffusion coefficient (ADC) value was 0.88 × 10–3 mm2/s with a high statistically significant difference between benign and malignant masses (P ≤ 0.001*), sensitivity of 100.0%, specificity of 92.3%, Positive predictive value (PPV) of 66.7%, Negative predic‐ tive value (NPV) of 100.0% and overall diagnostic accuracy of 93.3% as shown in Fig. 5 and Table 4
Summary
Soft tissue masses encompass a wide heterogeneous group of benign and malig‐ nant lesions. Conventional MRI techniques are not specific in differentiating benign from malignant lesions. Musculoskeletal soft tissue masses encompass a wide heterogeneous group of benign and malignant lesions that developed from connective tissue other than bone. Benign in most cases, a significant proportion of pediatric musculoskeletal soft tissue masses constitutes malignant tumors [1]. A detailed history and physical examination are sufficient to make a diagnosis, but in circumstances when the diagnosis is MRI is a powerful diagnostic tool in the workup of soft tissue tumors in children due to its high spatial and contrast resolution [3]. The specificity of conventional MRI in differentiating benign from malignant soft tissue tumors was variable among previous studies, presumably because benign and malignant soft tissue tumors may share the same morphologic features regarding the size, margin, location, signal intensities and contrast enhancement [4, 5]
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