1
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Shirodkar K, Hussein M, Balogh P, Azzopardi C, Botchu R. Painless knee mass in a young adult: answer. Skeletal Radiol 2024:10.1007/s00256-024-04682-8. [PMID: 38642303 DOI: 10.1007/s00256-024-04682-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 04/02/2024] [Accepted: 04/12/2024] [Indexed: 04/22/2024]
Affiliation(s)
- K Shirodkar
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK
| | - M Hussein
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK
| | - P Balogh
- Department of Musculoskeletal Pathology, University Hospitals of Birmingham, Birmingham, UK
| | - Christine Azzopardi
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK
| | - R Botchu
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK.
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2
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Vogin G, Lepage M, Salleron J, Cuenin M, Blum A, Gondim Teixeira PA. Evaluation of the Prognostic Value of Pretherapeutic Magnetic Resonance Imaging in Predicting Soft Tissue Sarcoma Radiation Response: A Retrospective Study from a Large Institutional Sarcoma Imaging Database. Cancers (Basel) 2024; 16:878. [PMID: 38473238 DOI: 10.3390/cancers16050878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/10/2024] [Accepted: 02/13/2024] [Indexed: 03/14/2024] Open
Abstract
Background: RT-induced hyalinization/fibrosis was recently evidenced as a significant independent predictor for complete response to neoadjuvant radiotherapy (RT) and survival in patients with soft tissue sarcoma (STS). Purpose: Non-invasive predictive markers of histologic response after neoadjuvant RT of STS are expected. Materials and Methods: From May 2010 to April 2017, patients with a diagnosis of STS who underwent neoadjuvant RT for limb STS were retrieved from a single center prospective clinical imaging database. Tumor Apparent Diffusion Coefficients (ADC) and areas under the time-intensity perfusion curve (AUC) were compared with the histologic necrosis ratio, fibrosis, and cellularity in post-surgical specimens. Results: We retrieved 29 patients. The median ADC value was 134.3 × 10-3 mm2/s. ADC values positively correlated with the post-treatment tumor necrosis ratio (p = 0.013). Median ADC values were lower in patients with less than 50% necrosis and higher in those with more than 50% (120.3 × 10-3 mm2/s and 202.0 × 10-3 mm2/s, respectively (p = 0.020). ADC values higher than 161 × 10-3 mm2/s presented a 95% sensitivity and a 55% specificity for the identification of tumors with more than 50% tumor necrosis ratio. Tumor-to-muscle AUC ratios were associated with histologic fibrosis (p = 0.036). Conclusions: ADC and perfusion AUC correlated, respectively, with radiation-induced tumor necrosis and fibrosis.
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Affiliation(s)
- Guillaume Vogin
- Department of Radiation Therapy, Institut de Cancérologie de Lorraine, 6 Avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
- Centre François Baclesse, Centre National de Radiothérapie du Luxembourg, BP436, L-4005 Esch-sur-Alzette, Luxembourg
- UMR 7365 CNRS-UL IMoPA, Biopôle de l'Université de Lorraine, Campus Brabois Santé, 9 Avenue de la Forêt de Haye, BP 20199, 54505 Vandœuvre-lès-Nancy, France
| | - Matthias Lepage
- Guilloz Imaging Department, University Hospital Center of Nancy, 29 Avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France
| | - Julia Salleron
- Biostatistics Unit, Institut de Cancérologie de Lorraine, 6 Avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
| | - Mathilde Cuenin
- Department of Radiation Therapy, Institut de Cancérologie de Lorraine, 6 Avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
| | - Alain Blum
- Guilloz Imaging Department, University Hospital Center of Nancy, 29 Avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France
| | - Pedro Augusto Gondim Teixeira
- Guilloz Imaging Department, University Hospital Center of Nancy, 29 Avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France
- Université de Lorraine, IADI, Inserm U1254, Bâtiment Recherche CHRU de Nancy Brabois, 5 Rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
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3
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Ghasemi A, Ahlawat S, Fayad LM. Magnetic Resonance Imaging Biomarkers of Bone and Soft Tissue Tumors. Semin Musculoskelet Radiol 2024; 28:39-48. [PMID: 38330969 DOI: 10.1055/s-0043-1776433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
Magnetic resonance imaging (MRI) is essential in the management of musculoskeletal (MSK) tumors. This review delves into the diverse MRI modalities, focusing on anatomical, functional, and metabolic sequences that provide essential biomarkers for tumor detection, characterization, disease extent determination, and assessment of treatment response. MRI's multimodal capabilities offer a range of biomarkers that enhance MSK tumor evaluation, aiding in better patient management.
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Affiliation(s)
- Ali Ghasemi
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Shivani Ahlawat
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Laura Marie Fayad
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Medical Institutions, Baltimore, Maryland
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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4
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Liu X, Duan Z, Fang S, Wang S. Imaging Assessment of the Efficacy of Chemotherapy in Primary Malignant Bone Tumors: Recent Advances in Qualitative and Quantitative Magnetic Resonance Imaging and Radiomics. J Magn Reson Imaging 2024; 59:7-31. [PMID: 37154415 DOI: 10.1002/jmri.28760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/13/2023] [Accepted: 04/14/2023] [Indexed: 05/10/2023] Open
Abstract
Recent studies have shown that MRI demonstrates promising results for evaluating the chemotherapy efficacy in bone sarcomas. This article reviews current methods for evaluating the efficacy of malignant bone tumors and the application of MRI in this area, and emphasizes the advantages and limitations of each modality. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Xiaoge Liu
- Department of Radiology, The Second Hospital, Dalian Medical University, Dalian, China
| | - Zhiqing Duan
- Department of Radiology, The Second Hospital, Dalian Medical University, Dalian, China
| | - Shaobo Fang
- Department of Medical Imaging, Zhengzhou University People's Hospital and Henan Provincial People's Hospital, Zhengzhou, Henan, China
- Academy of Medical Sciences, Zhengzhou University, Zhengzhou, Henan, China
| | - Shaowu Wang
- Department of Radiology, The Second Hospital, Dalian Medical University, Dalian, China
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5
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Lee S, Lee SY, Jung JY, Nam Y, Jeon HJ, Jung CK, Shin SH, Chung YG. Ensemble learning-based radiomics with multi-sequence magnetic resonance imaging for benign and malignant soft tissue tumor differentiation. PLoS One 2023; 18:e0286417. [PMID: 37256875 DOI: 10.1371/journal.pone.0286417] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 05/15/2023] [Indexed: 06/02/2023] Open
Abstract
Many previous studies focused on differentiating between benign and malignant soft tissue tumors using radiomics model based on various magnetic resonance imaging (MRI) sequences, but it is still unclear how to set up the input radiomic features from multiple MRI sequences. Here, we evaluated two types of radiomics models generated using different feature incorporation strategies. In order to differentiate between benign and malignant soft tissue tumors (STTs), we compared the diagnostic performance of an ensemble of random forest (R) models with single-sequence MRI inputs to R models with pooled multi-sequence MRI inputs. One-hundred twenty-five STT patients with preoperative MRI were retrospectively included and consisted of training (n = 100) and test (n = 25) sets. MRI included T1-weighted (T1-WI), T2-weighted (T2-WI), contrast-enhanced (CE)-T1-WI, diffusion-weighted images (DWIs, b = 800 sec/mm2) and apparent diffusion coefficient (ADC) maps. After tumor segmentation on each sequence, 100 original radiomic features were extracted from each sequence image and divided into three-feature sets: T features from T1- and T2-WI, CE features from CE-T1-WI, and D features from DWI and ADC maps. Four radiomics models were built using Lasso and R with four combinations of three-feature sets as inputs: T features (R-T), T+CE features (R-C), T+D features (R-D), and T+CE+D features (R-A) (Type-1 model). An ensemble model was built by soft voting of five, single-sequence-based R models (Type-2 model). AUC, sensitivity, specificity, and accuracy of each model was calculated with five-fold cross validation. In Type-1 model, AUC, sensitivity, specificity, and accuracy were 0.752, 71.8%, 61.1%, and 67.2% in R-T; 0.756, 76.1%, 70.4%, and 73.6% in R-C; 0.750, 77.5%, 63.0%, and 71.2% in R-D; and 0.749, 74.6%, 61.1%, and 68.8% R-A models, respectively. AUC, sensitivity, specificity, and accuracy of Type-2 model were 0.774, 76.1%, 68.5%, and 72.8%. In conclusion, an ensemble method is beneficial to incorporate features from multi-sequence MRI and showed diagnostic robustness for differentiating malignant STTs.
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Affiliation(s)
- Seungeun Lee
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - So-Yeon Lee
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joon-Yong Jung
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yoonho Nam
- Division of Biomedical Engineering, Hankuk University of Foreign Studies, Seoul, Gyeonggi-do, Republic of Korea
| | - Hyeon Jun Jeon
- Division of Biomedical Engineering, Hankuk University of Foreign Studies, Seoul, Gyeonggi-do, Republic of Korea
| | - Chan-Kwon Jung
- Department of Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seung-Han Shin
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yang-Guk Chung
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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6
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Morán LM, Vega J, Gómez-León N, Royuela A. Myxomas and myxoid liposarcomas of the extremities: Our preliminary findings in conventional, perfusion, and diffusion magnetic resonance. Acta Radiol Open 2022; 11:20584601221131481. [PMID: 36225896 PMCID: PMC9549112 DOI: 10.1177/20584601221131481] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 09/22/2022] [Indexed: 11/22/2022] Open
Abstract
Background The differentiation between myxomas and myxoid liposarcomas (MLPS) often is a serious challenge for the radiologists. Magnetic resonance imaging (MRI) is the most useful imaging technique in characterization of the soft tissue tumors (STT). Purpose To evaluate in a sample of myxomas and MLPS of the extremities, what morphological findings in conventional MRI allow us to differentiate these two types of myxoid tumors, in addition to analyzing the validity of the apparent diffusion coefficient (ADC) values of diffusion-weighted MRI (DW-MRI). Material and Methods Magnetic resonance imaging studies in myxomas and MLPS of extremities searched in our PACS between 2015 and 2019. All studies had conventional MRI with T1, T2, and PD SPAIR sequences, while DW-MRI with ADC mapping and perfusion MRI with a T1 sequence repeated for 4 minutes after contrast injection were additional sequences only in some explorations. Two radiologists evaluated independently the MRI studies by examining the qualitative parameters. Apparent diffusion coefficient values were calculated using two methods-ADC global and ADC solid, and Receiver Operating Characteristic (ROC) curves were applied for analysis. Results The features were consistent with MLPS: size greater than 10 cm, heterogeneous signal on T1, and nodular enhancement, while the common findings for myxomas were a homogenously hypointense signal on T1 and diffuse peritumoral enhancement. The solid and global ADC values were higher in myxomas. We observed that the solid ADC value less than 2.06 x 10-3mm2 x s would support the diagnosis of MLPS against myxoma. Conclusion Overall, MRI with its different modalities improved the diagnostic accuracy when differentiating myxomas from MLPS of extremities.
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Affiliation(s)
- Luz M Morán
- Department of Radiology,
Hospital
Universitario Puerta de Hierro,
Majadahonda, Madrid, Spain,Luz M Morán, Department of Radiology,
Hospital Universitario Puerta de Hierro, C/Manuel de Falla, Majadahonda, Madrid
28300, Spain.
| | - Jesús Vega
- Department of Patology,
Hospital
Universitario Clínico San Carlos,
Madrid, Spain
| | - Nieves Gómez-León
- Department of Radiology,
Hospital
Universitario La Princesa, Madrid,
Spain
| | - Ana Royuela
- Department of Statistics,
Hospital
Universitario Puerta de Hierro,
Majadahonda, Madrid, Spain
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7
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The Role of Imaging in Soft Tissue Sarcoma Diagnosis and Management. Surg Clin North Am 2022; 102:539-550. [DOI: 10.1016/j.suc.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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8
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Ram Kim B, Kang Y, Lee J, Choi D, Joon Lee K, Mo Ahn J, Lee E, Woo Lee J, Sik Kang H. Tumor grading of soft tissue sarcomas: assessment with whole-tumor histogram analysis of apparent diffusion coefficient. Eur J Radiol 2022; 151:110319. [DOI: 10.1016/j.ejrad.2022.110319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 04/09/2022] [Accepted: 04/12/2022] [Indexed: 11/28/2022]
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9
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Pu J, Liang Y, He Q, Shao JW, Zhou MJ, Xiang ST, Li YW, Li JB, Ji SJ. Correlation Between IVIM-DWI Parameters and Pathological Classification of Idiopathic Orbital Inflammatory Pseudotumors: A Preliminary Study. Front Oncol 2022; 12:809430. [PMID: 35359367 PMCID: PMC8963367 DOI: 10.3389/fonc.2022.809430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 02/08/2022] [Indexed: 12/04/2022] Open
Abstract
Objective To investigate the correlation between intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) and the pathological classification of idiopathic orbital inflammatory pseudotumors (IOIPs). Methods Nineteen patients who were diagnosed with IOIPs (a total of 24 affected eyes) between November 2018 and December 2020 were included in the study. All the patients underwent magnetic resonance imaging orbital plain scans and IVIM-DWI multiparameter scans before an operation. The true diffusion coefficient (D), pseudodiffusion coefficient (D*), and perfusion fraction (f) values were obtained. Based on histopathology, the lesions were divided into three types: lymphocytic infiltration, fibrosclerotic, and mixed. The correlation between IVIM-DWI parameters and pathological classification was tested with the histopathological results as the gold standard. The data were analyzed using SPSS version 17.0, with P < 0.05 defined as significant. Results Among the 19 patients (24 eyes) affected by IOIP, there were no significant differences between IOIP pathological classification and gender or age (P > 0.05). There were statistically significant differences between the D and f values for different pathological types of IOIP and IVIM parameters (P < 0.05), and there was no significant difference in D* value between the different pathological types (P > 0.05). Conclusion The D and f values showed correlation with different types of IOIP, and the sensitivity of the D value was higher than that of the f value. The D* value showed no significant distinction between pathological types of IOIP.
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Affiliation(s)
- Jian Pu
- Radiology Department, Affiliated Hospital of Yunnan University, Kunming, China
| | - Yi Liang
- Radiology Department, Shaanxi Province Tumor Hospital, Xi’an, China
| | - Qian He
- Radiology Department, Affiliated Hospital of Yunnan University, Kunming, China
- *Correspondence: Qian He,
| | - Ju-Wei Shao
- Radiology Department, Affiliated Hospital of Yunnan University, Kunming, China
| | - Min-Jie Zhou
- Radiology Department, Affiliated Hospital of Yunnan University, Kunming, China
| | - Shu-Tian Xiang
- Radiology Department, Affiliated Hospital of Yunnan University, Kunming, China
| | - Ying-Wen Li
- Radiology Department, Affiliated Hospital of Yunnan University, Kunming, China
| | - Jian-Bo Li
- Radiology Department, Affiliated Hospital of Yunnan University, Kunming, China
| | - Shun-Jun Ji
- Medical Imaging, Kunming Medical University, Kunming, China
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10
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Bajaj G, Callan AK, Weinschenk RC, Chhabra A. Multiparametric Evaluation of Soft Tissue Sarcoma: Current Perspectives and Future Directions. Semin Roentgenol 2022; 57:212-231. [DOI: 10.1053/j.ro.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/31/2022] [Accepted: 02/02/2022] [Indexed: 11/11/2022]
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11
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Wang Q, Xiao X, Liang Y, Wen H, Wen X, Gu M, Ren C, Li K, Yu L, Lu L. Diagnostic Performance of Diffusion MRI for differentiating Benign and Malignant Nonfatty Musculoskeletal Soft Tissue Tumors: A Systematic Review and Meta-analysis. J Cancer 2022; 12:7399-7412. [PMID: 35003360 PMCID: PMC8734420 DOI: 10.7150/jca.62131] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 10/02/2021] [Indexed: 01/15/2023] Open
Abstract
Objective: To evaluate the diagnostic performance of standard diffusion-weighted imaging (DWI), intravoxel incoherent motion (IVIM), and diffusion kurtosis imaging (DKI), for differentiating benign and malignant soft tissue tumors (STTs). Materials and methods: A thorough search was carried out to identify suitable studies published up to September 2020. The quality of the studies involved was evaluated using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). The pooled sensitivity (SEN), specificity (SPE), and summary receiver operating characteristic (SROC) curve were calculated using bivariate mixed effects models. A subgroup analysis was also performed to explore the heterogeneity. Results: Eighteen studies investigating 1319 patients with musculoskeletal STTs (malignant, n=623; benign, n=696) were enrolled. Thirteen standard DWI studies using the apparent diffusion coefficient (ADC) showed that the pooled SEN and SPE of ADC were 0.80 (95% CI: 0.77-0.82) and 0.63 (95% CI: 0.60-0.67), respectively. The area under the curve (AUC) calculated from the SROC curve was 0.806. The subgroup analysis indicated that the percentage of myxoid malignant tumors, magnet strength, study design, and ROI placement were significant factors affecting heterogeneity. Four IVIM studies showed that the AUCs calculated from the SROC curves of the parameters ADC and D were 0.859 and 0.874, respectively. The AUCs for the IVIM parameters pseudo diffusion coefficient (D*) and perfusion fraction (f) calculated from the SROC curve were 0.736 and 0.573, respectively. Two DKI studies showed that the AUCs of the DKI parameter mean kurtosis (MK) were 0.97 and 0.89, respectively. Conclusion: The DWI-derived ADC value and the IVIM DWI-derived D value might be accurate tools for discriminating musculoskeletal STTs, especially for non-myxoid SSTs, using more than two b values, with maximal b value ranging from 600 to 800 s/mm2, additionally, a high-field strength (3.0 T) optimizes the diagnostic performance.
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Affiliation(s)
- Qian Wang
- Department of Medical Imaging, Zhengzhou Central Hospital Affiliated to Zhengzhou University, 195 Tongbai Road, 455007, Zhengzhou, China
| | - Xinguang Xiao
- Department of Medical Imaging, Zhengzhou Central Hospital Affiliated to Zhengzhou University, 195 Tongbai Road, 455007, Zhengzhou, China
| | - Yanchang Liang
- Guangzhou University of Chinese Medicine, 510006, Guangzhou, China
| | - Hao Wen
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang West Road, Guangzhou, China
| | - Xiaopeng Wen
- Department of neurological rehabilitation, Zhengzhou Central Hospital Affiliated to Zhengzhou University, 450000, Zhengzhou, China
| | - Meilan Gu
- Department of Medical Imaging, Zhengzhou Central Hospital Affiliated to Zhengzhou University, 195 Tongbai Road, 455007, Zhengzhou, China
| | - Cuiping Ren
- Department of Medical Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Kunbin Li
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang West Road, Guangzhou, China
| | - Liangwen Yu
- Guangzhou University of Chinese Medicine, 510006, Guangzhou, China
| | - Liming Lu
- Clinical Research and Data Center, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
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12
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Kim M, Jee WH, Lee Y, Hong JH, Jung CK, Chung YG, Lee SY. Tumor Margin Infiltration in Soft Tissue Sarcomas: Prediction Using 3T MRI Texture Analysis. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:112-126. [PMID: 36237350 PMCID: PMC9238208 DOI: 10.3348/jksr.2021.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/27/2021] [Accepted: 05/11/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Minji Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Radiology, Uijeongbu St. Mary's hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Won-Hee Jee
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Youngjun Lee
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Radiology, Uijeongbu St. Mary's hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Hyun Hong
- Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Chan Kwon Jung
- Department of Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yang-Guk Chung
- Departments of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - So-Yeon Lee
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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13
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Rodriguez JD, Selleck AM, Abdel Razek AAK, Huang BY. Update on MR Imaging of Soft Tissue Tumors of Head and Neck. Magn Reson Imaging Clin N Am 2021; 30:151-198. [PMID: 34802577 DOI: 10.1016/j.mric.2021.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article reviews soft tissue tumors of the head and neck following the 2020 revision of WHO Classification of Soft Tissue and Bone Tumours. Common soft tissue tumors in the head and neck and tumors are discussed, along with newly added entities to the classification system. Salient clinical and imaging features that may allow for improved diagnostic accuracy or to narrow the imaging differential diagnosis are covered. Advanced imaging techniques are discussed, with a focus on diffusion-weighted and dynamic contrast imaging and their potential to help characterize soft tissue tumors and aid in distinguishing malignant from benign tumors.
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Affiliation(s)
- Justin D Rodriguez
- Department of Radiology, Duke University, 2301 Erwin Rd, Durham, NC 27705, USA
| | - A Morgan Selleck
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina Hospitals, 170 Manning Drive, CB 7070, Physicians Office Building, Rm G190A, Chapel Hill, NC 27599, USA
| | | | - Benjamin Y Huang
- Department of Radiology, UNC School of Medicine, 101 Manning Drive, CB#7510, Chapel Hill, NC 27599, USA.
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14
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Koike H, Nishida Y, Ito S, Shimoyama Y, Ikuta K, Urakawa H, Sakai T, Shimizu K, Ito K, Imagama S. Diffusion-Weighted Magnetic Resonance Imaging Improves the Accuracy of Differentiation of Benign from Malignant Peripheral Nerve Sheath Tumors. World Neurosurg 2021; 157:e207-e214. [PMID: 34624521 DOI: 10.1016/j.wneu.2021.09.130] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE In patients with neurofibromatosis type 1 (NF1), it is important to accurately determine when plexiform neurofibroma (pNF) transforms to a malignant peripheral nerve sheath tumor (MPNST). The purpose of this study is to investigate the usefulness of diffusion-weighted imaging (DWI) in differentiating pNF and MPNST in NF1 patients. METHODS Among the NF1 patients who were referred to our hospital between 1985 and 2015, 10 cases of MPNST and 19 cases of pNF were included. We evaluated features of standard magnetic resonance imaging according to the differentiation criteria of malignancy from benignancy as previously reported, apparent diffusion coefficient (ADC) value based on the DWI and the correlation between ADC value and benignancy/malignancy. ROC analysis was performed to determine the appropriate cutoff value of ADC. RESULTS There were significant differences between MPNST and pNF in the size of the tumor (P = 0.009), peripheral enhancement pattern (P = 0.002), perilesional edema-like zone (P = 0.0008), and intratumoral cystic change (P = 0.02). The mean and minimum values of ADC were significantly lower in MPNST than those in pNF (P = 0.03 and P = 0.003, respectively). When we set a cutoff value of mean ADC as 1.85 × 10-3 mm2/s, the sensitivity and specificity were 80% and 74%, respectively. The area under the curve value improved by adding the Wasa score to the mean ADC evaluation. CONCLUSIONS ADC values determined by DWI are useful in differentiating MPNST from pNF and adding ADC evaluation to standard MRI evaluation improved the diagnostic accuracy.
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Affiliation(s)
- Hiroshi Koike
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Showa, Nagoya, Japan
| | - Yoshihiro Nishida
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Showa, Nagoya, Japan; Department of Rehabilitation, Nagoya University Hospital, Showa, Nagoya, Japan.
| | - Shinji Ito
- Department of Radiology, Nagoya University Hospital, Showa, Nagoya, Japan
| | - Yoshie Shimoyama
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Showa, Nagoya, Japan
| | - Kunihiro Ikuta
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Showa, Nagoya, Japan
| | - Hiroshi Urakawa
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Showa, Nagoya, Japan; Department of Clinical Oncology and Chemotherapy, Nagoya University Hospital, Showa, Nagoya, Japan
| | - Tomohisa Sakai
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Showa, Nagoya, Japan
| | - Koki Shimizu
- Department of Orthopedic Surgery, Nagoya Memorial Hospital, Hirabari, Tenpaku, Nagoya, Japan
| | - Kan Ito
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Showa, Nagoya, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Showa, Nagoya, Japan
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Lomoro P, Simonetti I, Nanni AL, Corsani G, Togni G, Fichera V, Verde F, Formica M, Trovato P, Vallone G, Gorone MSP. Imaging of head and neck lipoblastoma: case report and systematic review. J Ultrasound 2021; 24:231-239. [PMID: 32141045 PMCID: PMC8363689 DOI: 10.1007/s40477-020-00439-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 02/17/2020] [Indexed: 12/13/2022] Open
Abstract
Lipoblastoma is a rare and benign tumour arising from embryonal fat cells, predominantly diagnosed in children younger than 3 years old. The most frequent locations are the extremities and trunk, while the head and neck areas are more rarely affected (10-15% of total cases). Clinically, the most common presentation is a fast-growing painless mass. Ultrasound is the first-line imaging examination, but Magnetic Resonance Imaging (MRI) allows for better definition of the relationships with the adjacent vascular and muscular structures. It can help to identify the lipomatous components, and it is useful for preoperative planning. However, the definitive diagnosis is provided by histopathological examination. Complete surgical excision is the first-line treatment, with a good prognosis in case of total eradication. We report the case of a 7-month-old male child with a rapidly growing mass that had typical radiological features of lipoblastoma.
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Affiliation(s)
- P Lomoro
- Radiology Department, Valduce Hospital, Como, Italy
| | - I Simonetti
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
| | - A L Nanni
- Department of Diagnostic Medicine, Institute of Radiology Irccs San Matteo University Hospital Foundation, Pavia, Italy
| | - G Corsani
- Department of Diagnostic Medicine, Institute of Radiology Irccs San Matteo University Hospital Foundation, Pavia, Italy
| | - G Togni
- Radiology Department, Valduce Hospital, Como, Italy
| | - V Fichera
- Department of Paediatrics, Anna Meyer Children's University Hospital, Florence, Italy
| | - F Verde
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - M Formica
- Department of Diagnostic Medicine, Institute of Radiology Irccs San Matteo University Hospital Foundation, Pavia, Italy
| | - P Trovato
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - G Vallone
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - M S Prevedoni Gorone
- Department of Diagnostic and Interventional Radiology and Neuroradiology of IRCCS, San Matteo University Hospital Foundation, Pavia, Italy
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Hong JH, Jee WH, Whang S, Jung CK, Chung YG, Cho SG. Differentiation of soft-tissue lymphoma from undifferentiated sarcoma: apparent diffusion coefficient histogram analysis. Acta Radiol 2021; 62:1045-1051. [PMID: 32847366 DOI: 10.1177/0284185120951959] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Making the preoperative diagnosis of soft-tissue lymphoma is important because the treatments for lymphoma and sarcoma are different. PURPOSE To determine the reliability and accuracy of single-slice and whole-tumor apparent diffusion coefficient (ADC) histogram analysis when differentiating soft-tissue lymphoma from undifferentiated sarcoma. MATERIAL AND METHODS Patients with confirmed soft-tissue lymphoma or undifferentiated sarcoma who underwent 3-T magnetic resonance imaging (MRI), including diffusion-weighted imaging, were included. Single-slice and whole-tumor ADC histogram analyses were performed using software. Mean, standard deviation (SD), 5th and 95th percentiles, skewness, and kurtosis were compared between groups, and a receiver operating characteristic curve with area under the curve (AUC) was obtained. RESULTS Thirteen patients with soft-tissue lymphoma and 12 patients with undifferentiated sarcoma were included. ADC histogram analysis of single-slice and whole-tumor, mean, SD, and 5th and 95th percentiles was significantly lower in lymphoma than in undifferentiated sarcoma. Whole-tumor analysis kurtosis was significantly higher in lymphoma than in undifferentiated sarcoma. All AUCs were high in single-slice and whole-tumor analysis: 0.987 vs. 1.000 in mean; 0.821 vs. 0.782 in SD; 0.949 vs. 0.949 in 5th percentile; and 1.000 vs. 1.000 in 95th percentile without significant difference. AUC of kurtosis in whole-tumor ADC histogram analysis was 0.750. CONCLUSION Single-slice and whole-tumor ADC histogram analysis seems to be reliable and accurate for differentiating soft-tissue lymphoma from undifferentiated sarcoma.
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Affiliation(s)
- Ji Hyun Hong
- Department of Radiology, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea
- Current affiliation: Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Won-Hee Jee
- Department of Radiology, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sunyoung Whang
- Department of Radiology, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chan-Kwon Jung
- Department of Pathology, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yang-Guk Chung
- Department of Orthopedic Surgery, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seok-Goo Cho
- Department of Hematology, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea
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Radiomics of diffusion-weighted MRI compared to conventional measurement of apparent diffusion-coefficient for differentiation between benign and malignant soft tissue tumors. Sci Rep 2021; 11:15276. [PMID: 34315971 PMCID: PMC8316538 DOI: 10.1038/s41598-021-94826-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 07/19/2021] [Indexed: 11/13/2022] Open
Abstract
Diffusion-weighted imaging (DWI) is proven useful to differentiate benign and malignant soft tissue tumors (STTs). Radiomics utilizing a vast array of extracted imaging features has a potential to uncover disease characteristics. We aim to assess radiomics using DWI can outperform the conventional DWI for STT differentiation. In 151 patients with 80 benign and 71 malignant tumors, ADCmean and ADCmin were measured on solid portion within the mass by two different readers. For radiomics approach, tumors were segmented and 100 original radiomic features were extracted on ADC map. Eight radiomics models were built with training set (n = 105), using combinations of 2 different algorithms—multivariate logistic regression (MLR) and random forest (RF)—and 4 different inputs: radiomics features (R), R + ADCmin (I), R + ADCmean (E), R + ADCmin and ADCmean (A). All models were validated with test set (n = 46), and AUCs of ADCmean, ADCmin, MLR-R, RF-R, MLR-I, RF-I, MLR-E, RF-E, MLR-A and RF-A models were 0.729, 0.753 0.698, 0.700, 0.773, 0.807, 0.762, 0.744, 0.773 and 0.807, respectively, without statistically significant difference. In conclusion, radiomics approach did not add diagnostic value to conventional ADC measurement for differentiating benign and malignant STTs.
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Abstract
OBJECTIVE To develop and validate an Osseous Tumor Reporting and Data System (OT-RADS) with the hypothesis that the proposed guideline is reliable and assists in separating benign from malignant osseous tumors with a good area under the curve, and that could assist further patient management. METHODS In this multireader cross-sectional validation study, an agreement was reached for OT-RADS categories based on previously described magnetic resonance imaging features and consensus of expert musculoskeletal radiologists. World Health Organization classification was used, and a wide spectrum of benign and malignant osseous tumors was evaluated. Magnetic resonance imaging categories were as follows: OT-RADS 0-incomplete imaging; OT-RADS I-negative; OT-RADS II-definitely benign; OT-RADS III-probably benign; OT-RADS IV-suspicious for malignancy or indeterminate; OT-RADS V-highly suggestive of malignancy; and OT-RADS VI-known biopsy-proven malignancy or recurrent malignancy in the tumor bed. Four blinded readers categorized each tumor according to OT-RADS classification. Intraclass correlation (ICC) and Conger κ were used. Diagnostic performance measures including area under the receiver operating curve were reported. Osseous Tumor Reporting and Data System was dichotomized as benign (I-III) and malignant (IV and V) for calculating sensitivity and specificity. RESULTS Interreader agreement for OT-RADS (ICC = 0.78) and binary distinction of benign versus malignant (κ = 0.67) were good to excellent, while agreement for individual tumor feature characteristics were poor to fair (ICC = 0.25-0.36; κ = 0.16-0.39). The sensitivities, specificities, and area under the receiver operating curve of the readers ranged from 0.93-1.0, 0.71-0.86, and 0.92-0.97, respectively. CONCLUSIONS Osseous Tumor Reporting and Data System lexicon is reliable and helps stratify tumors into benign and malignant categories. It can be practically used by radiologists to guide patient management, improve multidisciplinary communications, and potentially impact outcomes.
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19
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Mansour TMM, El-Barody MM, Tammam H, Okasha A. Role of diffusion-weighted MRI in differentiating between benign and malignant bone lesions: a prospective study. Clin Radiol 2021; 76:576-584. [PMID: 33865551 DOI: 10.1016/j.crad.2021.02.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 02/11/2021] [Indexed: 01/12/2023]
Abstract
AIM To evaluate the ability of diffusion-weighted magnetic resonance imaging (DW-MRI) to differentiate between benign and malignant bony tumours. MATERIALS AND METHODS This prospective study was conducted from October, 2018 to December, 2019. The study included 62 patients (37 male and 25 female) with clinically suspected bony lesions referred to the Radiology Department. Patients underwent clinical examination, radiography, computed tomography (CT), and ultrasonography examinations. MRI studies were conducted using a 1.5-T MRI machine, and post-processing analysis was done using a Philips Extended MRI workspace workstation. RESULTS The mean apparent diffusion coefficient (ADC) value of benign lesions ranged between 0.85 × 10-3 and 2.44 × 10-3 mm2/s. The lowest ADC values were measured in a giant cell tumour and in an inclusion epidermoid cyst (0.85 × 10-3 and 0.93 × 10-3 mm2/s, respectively). The highest measurement was in bony cysts (2.44 × 10-3 mm2/s) followed by osteoid osteoma (2.2 × 10-3 mm2/s) and osteochondroma (1.85 × 10-3 mm2/s). Amongst malignant lesions, ADC values ranged from 0.42 × 10-3 to 2.4 × 10-3 mm2/s. The lowest value was measured in malignant round cell tumour Ewing's/primitive neuroectodermal tumour (PNET), and the highest was measured in conventional chondrosarcoma. Metastatic lesions were observed in 11 patients with a mean ADC value of 0.71 × 10-3 mm2/s, followed by osteosarcoma in six patients with a mean ADC value of 0.74 × 10-3 mm2/s. CONCLUSION There was a significant difference between the mean, minimum, and maximum ADC values of benign and malignant tumours. The present findings indicate that the best cut-off ADC range to predict malignancy is 0.78-0.86 × 10-3 mm2/s, with a sensitivity of 89.47%, specificity of 97.22%, and accuracy of 94.55%.
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Affiliation(s)
- T M M Mansour
- Radio-diagnosis Department, Faculty of Medicine, Al-Azhar University, Assuit, Egypt.
| | - M M El-Barody
- Radio-diagnosis Department, South Egypt Cancer Institute, Assuit University, Assuit, Egypt
| | - H Tammam
- Orthopedic Department, Faculty of Medicine, South Valley University, Qena, Egypt
| | - A Okasha
- Radio-diagnosis Department, Faculty of Medicine, South Valley University, Qena, Egypt
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Utility of multiparametric pre-operative magnetic resonance imaging in differentiation of chordoid meningioma from the other histopathological subtypes of meningioma-a retrospective study. Neuroradiology 2021; 64:253-264. [PMID: 33837805 DOI: 10.1007/s00234-021-02690-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To determine the magnetic resonance imaging (MRI) features which could pre-operatively differentiate chordoid meningioma (CM) from other histopathological subtypes of meningioma. METHODS Retrospective analysis of pre-operative MRI of cases with histopathologically confirmed diagnosis of meningioma during the last 5 years at our institute was done. T1W, T2W, FLAIR sequences, and post-contrast enhancement were evaluated on a qualitative scale. Normalized ADC ratios (nADCR) and normalized fractional anisotropy ratios (nFAR) were derived. The intratumoral susceptibility score (ITSS), presence of sunburst pattern of vasculature, bone changes, tumour-parenchyma interface, and oedema-to-tumour ratio were also determined. RESULTS A total of 81 lesions were analyzed out of which 15 were CM. CM showed a higher relative contrast enhancement as compared to all other subtypes except for angiomatous and microcystic meningioma. Relative signal intensity on FLAIR could differentiate CM from transitional meningioma. nFAR was found to be significantly higher in fibroblastic meningioma and significantly lower in microcystic meningiomas as compared to CM. Anaplastic meningiomas were remarkable for bone changes and an ill-defined tumour-brain interface in significantly higher proportion of cases as compared to CM. nADCR > 1.5 was found to be an independent predictor of CM with a sensitivity of 84.6%, specificity of 89.8%, positive predictive value of 64.7%, and negative predictive value of 96.4%. CONCLUSION Routine pre-operative MRI may be able to differentiate CM from other meningioma subtypes and a cut-off value of greater than 1.5 for nADCR could be predictive of > 50% chordoid histology of meningioma with a high sensitivity, specificity, and negative predictive value.
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21
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Giannitto C, Mercante G, Spriano G, Natoli R, Gaino F, Lofino L, Esposito AA, Giannitto N, Vatteroni G, Fiamengo B, Vidiri A, Politi LS, Balzarini L. CT and MRI Findings of Head and Neck Masson’s Tumor: A Rare Case Report and Systematic Review of the Literature. REPORTS IN MEDICAL IMAGING 2021. [DOI: 10.2147/rmi.s292961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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22
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Setiawati R, Suarnata MS, Rahardjo P, Filippo DG, Guglielmi G. Correlation of quantitative diffusion weighted MR imaging between benign, malignant chondrogenic and malignant non-chondrogenic bone tumors with histopathologic type. Heliyon 2021; 7:e06402. [PMID: 33748474 PMCID: PMC7969897 DOI: 10.1016/j.heliyon.2021.e06402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/14/2020] [Accepted: 02/25/2021] [Indexed: 11/23/2022] Open
Abstract
Objectives This study aims to determine the diffusion on weighted imaging which may help in providing characterization of Apparent Diffusion Coefficient (ADC) values in benign, malignant chondrogenic and malignant non-chondrogenic bone tumors. Material and methods A retrospective study with 84 samples was conducted from October 2017 to December 2019. The samples consisted of 44 males and 40 females; the age range of 10–73 years (mean age of 32.7 years old). A Diffusion-weighted Magnetic Resonance (MR) utilizes a single-shot echo-planar imaging sequence technique with the 3T MR Scanner. We classified the types of tumors into benign, malignant chondrogenic and malignant non-chondrogenic bone tumors. The mean of ADC values from the area with lowest ADC values was selected for statistical analysis. ADC values were compared between benign, malignant chondrogenic and malignant non-chondrogenic bone tumors. Therefore, Receiver Operating Curve (ROC) analysis was done to determine optimal cut-off values. The correlation of ADC values between benign, malignant chondrogenic and malignant non-chondrogenic bone tumor with histopathologic type was also evaluated. Results The mean of ADC values from the area of benign, malignant chondrogenic and malignant non-chondrogenic bone tumor were 1.55 × 10−3 mm2/s, 1.84 × 10−3 mm2/s and 1.12 × 10−3 mm2/s respectively. As a matter of fact, there was a significant difference between benign and malignant bone tumor with cut-off value of 1.15 × 10−3 mm2/s and had a sensitivity of 82%, and a specificity of 92.3%. Moreover, a significant correlation was also found between ADC values with the histopathology type of bone tumors. Conclusion The ADC values of benign and malignant (chondrogenic and non-chondrogenic groups) bone tumors are different. Thus, the measurement of ADC values improves the accuracy of the diagnosis of bone tumors.
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Affiliation(s)
- Rosy Setiawati
- Department of Radiology, Faculty of Medicine Airlangga University, Surabaya, Indonesia
| | - M S Suarnata
- Department of Radiology, Faculty of Medicine Airlangga University, Surabaya, Indonesia
| | - Paulus Rahardjo
- Department of Radiology, Faculty of Medicine Airlangga University, Surabaya, Indonesia
| | - Del Grande Filippo
- Department of Radiology, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Giuseppe Guglielmi
- Department of Clinical and Experimental Medicine, School of Medicine, Foggia University, Foggia, Italy.,Department of Radiology, School of Medicine, Foggia University, Foggia, Italy
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23
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Spinnato P, Sambri A, Fujiwara T, Ceccarelli L, Clinca R, Medellin MR, Paolis MD, Donati DM, Bianchi G. Myxofibrosarcoma: Clinical and Prognostic Value of MRI Features. Curr Med Imaging 2021; 17:217-224. [PMID: 32729425 DOI: 10.2174/1573405616999200729152135] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 05/02/2020] [Accepted: 05/13/2020] [Indexed: 12/16/2022]
Abstract
Myxofibrosarcoma is one of the most common soft tissue sarcomas in the elderly. It is characterized by an extremely high rate of local recurrence, higher than other soft tissue tumors, and a relatively low risk of distant metastases.Magnetic resonance imaging (MRI) is the imaging modality of choice for the assessment of myxofibrosarcoma, which plays a key role in the preoperative setting of these patients. MRI features associated with the high risk of local recurrence are: high myxoid matrix content (water-like appearance of the lesions), high grade of contrast enhancement and presence of an infiltrative pattern ("tail sign"). On the other hand, MRI features associated with worse sarcoma specific survival are: large size of the lesion, deep location, high grade of contrast enhancement. Recognizing the above-mentioned imaging features of myxofibrosarcoma may be helpful in stratifying the risk for local recurrence and disease-specific survival. Moreover, the surgical planning should be adjusted according to the MRI features.
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Affiliation(s)
- Paolo Spinnato
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Andrea Sambri
- Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Tomohiro Fujiwara
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Luca Ceccarelli
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Roberta Clinca
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | | | - Davide M Donati
- Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giuseppe Bianchi
- Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Ashikyan O, Bradshaw SB, Dettori NJ, Hwang H, Chhabra A. Conventional and advanced MR imaging insights of synovial sarcoma. Clin Imaging 2021; 76:149-155. [PMID: 33607418 DOI: 10.1016/j.clinimag.2021.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/26/2021] [Accepted: 02/05/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Synovial sarcomas commonly involve extremities. The purpose of this study was to systematically assess and describe the appearance of pathologically proven synovial sarcomas on conventional MR sequences, diffusion weighted imaging and dynamic contrast enhanced imaging. METHODS In this cross-sectional retrospective study, fifteen pre-operative MRIs were analyzed separately by two musculoskeletal radiologists and a fellow. MRI features of synovial sarcomas were evaluated in a systematic fashion on conventional and advanced MR sequences. RESULTS The tumors demonstrated heterogeneous appearance on conventional MR sequences. Peritumoral edema was absent in four of 15 (27%) lesions including grade 2 and grade 3 tumors. Average minimum ADC was 0.8 × 10-3 mm2/s and average mean ADC was 1.2 × 10-3 mm2/s. There was avid early arterial phase enhancement on contrast imaging. Average relative enhancement of the tumors was 5.7 times compared to the adjacent skeletal muscle. CONCLUSION Synovial sarcomas demonstrate avid early arterial phase post-contrast enhancement on contrast images, low ADC values, and heterogeneous appearance on conventional MRI sequences. Peritumoral edema may be absent in such tumors despite being high grade tumors.
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Affiliation(s)
- Oganes Ashikyan
- Department of Radiology, UT Southwestern, United States of America.
| | | | - Nathan J Dettori
- Department of Radiology, UT Southwestern, United States of America
| | - Helena Hwang
- Department of Pathology, UT Southwestern, United States of America
| | - Avneesh Chhabra
- Department of Radiology, UT Southwestern, United States of America; Department of Orthopedic Surgery, UT Southwestern, United States of America
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25
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Boruah DK, Gogoi B, Patni RS, Sarma K, Hazarika K. Added Value of Diffusion-Weighted Magnetic Resonance Imaging in Differentiating Musculoskeletal Tumors Using Sensitivity and Specificity: A Retrospective Study and Review of Literature. Cureus 2021; 13:e12422. [PMID: 33542870 PMCID: PMC7849915 DOI: 10.7759/cureus.12422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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.
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Affiliation(s)
- Deb K Boruah
- Radiodiagnosis, Tezpur Medical College, Tezpur, IND.,Radiodiagnosis, Assam Medical College, Dibrugarh, IND
| | - Bidyut Gogoi
- Pathology, Assam Medical College, Dibrugarh, IND
| | - Ruchi S Patni
- Radiodiagnosis, Assam Medical College, Dibrugarh, IND
| | - Kalyan Sarma
- Radiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
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26
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Lee SK, Jee WH, Jung CK, Chung YG. Multiparametric quantitative analysis of tumor perfusion and diffusion with 3T MRI: differentiation between benign and malignant soft tissue tumors. Br J Radiol 2020; 93:20191035. [PMID: 32649224 DOI: 10.1259/bjr.20191035] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To evaluate multiparametric MRI for differentiating benign and malignant soft tissue tumors. METHODS This retrospective study included 67 patients (mean age, 55 years; 18-82 years) with 35 benign and 32 malignant soft tissue tumors. Intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI)-derived parameters (D, D*, f), apparent diffusion coefficient (ADC), and dynamic contrast-enhanced (DCE)-MRI parameters (Ktrans, Kep, Ve, iAUC) were calculated. Myxoid and non-myxoid soft tissue tumors were divided for subgroup analysis. The parameters were compared between benign and malignant tumors. RESULTS ADC and D were significantly lower in malignant than benign soft tissue tumors (1170 ± 488 vs 1472 ± 349 µm2/s; 1132 ± 500 vs 1415 ± 374 µm2/s; p < 0.05). Ktrans, Kep, Ve, and iAUC were significantly different between malignant and benign soft tissue tumors (0.209 ± 0.160 vs 0.092 ± 0.067 min-1; 0.737 ± 0.488 vs 0.311 ± 0.230 min-1; 0.32 ± 0.17 vs 0.44 ± 0.28; 0.23 ± 0.14 vs 0.12 ± 0.09, p < 0.05, respectively). ADC (0.752), D (0.742), and Kep (0.817) had high AUCs. Subgroup analysis showed that only Ktrans, and iAUC were significantly different in myxoid tumors, while, ADC, D, Ktrans, Kep, and iAUC were significantly different in non-myxoid tumor for differentiating benign and malignant tumors. D, Kep, and iAUC were the most significant parameters predicting malignant soft tissue tumors. CONCLUSION Multiparametric MRI can be useful to differentiate benign and malignant soft tissue tumors using IVIM-DWI and DCE-MRI. ADVANCES IN KNOWLEDGE 1. Pure tissue diffusion (D), transfer constant (Ktrans), rate constant (Kep), and initial area under time-signal intensity curve (iAUC) can be used to differentiate benign malignant soft tissue tumors.2. Ktrans and iAUC enable differentiation of benign and malignant myxoid soft tissue tumors.
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Affiliation(s)
- Seul Ki Lee
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Won-Hee Jee
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Department of Radiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chan Kwon Jung
- Departments of Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yang-Guk Chung
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Visser JJ, Goergen SK, Klein S, Noguerol TM, Pickhardt PJ, Fayad LM, Omoumi P. The Value of Quantitative Musculoskeletal Imaging. Semin Musculoskelet Radiol 2020; 24:460-474. [DOI: 10.1055/s-0040-1710356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AbstractMusculoskeletal imaging is mainly based on the subjective and qualitative analysis of imaging examinations. However, integration of quantitative assessment of imaging data could increase the value of imaging in both research and clinical practice. Some imaging modalities, such as perfusion magnetic resonance imaging (MRI), diffusion MRI, or T2 mapping, are intrinsically quantitative. But conventional morphological imaging can also be analyzed through the quantification of various parameters. The quantitative data retrieved from imaging examinations can serve as biomarkers and be used to support diagnosis, determine patient prognosis, or monitor therapy.We focus on the value, or clinical utility, of quantitative imaging in the musculoskeletal field. There is currently a trend to move from volume- to value-based payments. This review contains definitions and examines the role that quantitative imaging may play in the implementation of value-based health care. The influence of artificial intelligence on the value of quantitative musculoskeletal imaging is also discussed.
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Affiliation(s)
- Jacob J. Visser
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Stacy K. Goergen
- Department of Imaging, Monash Imaging, Clayton, Victoria, Australia
- School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Stefan Klein
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | | | - Perry J. Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Laura M. Fayad
- The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Patrick Omoumi
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Dodin G, Salleron J, Jendoubi S, Abou Arab W, Sirveaux F, Blum A, Gondim Teixeira PA. Added-value of advanced magnetic resonance imaging to conventional morphologic analysis for the differentiation between benign and malignant non-fatty soft-tissue tumors. Eur Radiol 2020; 31:1536-1547. [PMID: 32885297 DOI: 10.1007/s00330-020-07190-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/01/2020] [Accepted: 08/12/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the added value of DWI, qualitative proton MR spectroscopy (H-MRS) and dynamic contrast-enhanced perfusion (DCE-P) to conventional MRI in differentiating benign and malignant non-fatty soft tissue tumors (NFSTT). METHODS From November 2009 to August 2017, 288 patients with NFSTT that underwent conventional and advanced MRI were prospectively evaluated. The study was approved by the local ethics committee. All patients signed an informed consent. A musculoskeletal (R1) and a general (R2) radiologist classified all tumors as benign, malignant, or indeterminate according to morphologic MRI features. Then, DWI, H-MRS, and DCE-P data of indeterminate tumors were analyzed by two additional radiologists (R3 and R4). Advanced techniques were considered individually and in combination for tumor benign-malignant differentiation using histology as the gold standard. RESULTS There were 104 (36.1%) malignant and 184 (63.9%) benign tumors. Conventional MRI analysis classified 99 tumors for R1 and 135 for R2 as benign or malignant, an accuracy for the identification of malignancy of 87.9% for R1 and 83.7% for R2, respectively. There were 189 indeterminate tumors for R1. For these tumors, the combination of DWI and H-MRS yielded the best accuracy for malignancy identification (77.4%). DWI alone provided the best sensitivity (91.8%) while the combination of DCE-P, DWI, and H-MRS yielded the best specificity (100%). The reproducibility of the advanced imaging parameters was considered good to excellent (Kappa and ICC > 0.86). An advanced MRI evidence-based evaluation algorithm was proposed allowing to characterize 28.1 to 30.1% of indeterminate non-myxoid tumors. CONCLUSION The prioritized use of advanced MRI techniques allowed to decrease by about 30% the number of non-myxoid NFSTT deemed indeterminate after conventional MRI analysis alone. KEY POINTS • When morphological characterization of non-fatty soft tissue tumors is possible, the diagnostic performance is high and there is no need for advanced imaging techniques. • Following morphologic analysis, advanced MRI techniques reduced by about 30% the number of non-myxoid indeterminate tumors. • DWI is the keystone of advanced imaging techniques yielding the best sensitivity (91.8%). Optimal specificity (> 90%) is obtained by a combination of advanced techniques.
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Affiliation(s)
- Gauthier Dodin
- Service d'imagerie Guilloz, Hôpital Central, Centre Hospitalier Régional Universitaire de Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035, Nancy cedex, France.
| | - Julia Salleron
- Département de Biostatistique, Institut de Cancérologie de Lorraine, 6 avenue de Bourgogne, F-54519, Vandœuvre-lès-Nancy cedex, France
| | - Salma Jendoubi
- Service d'imagerie Guilloz, Hôpital Central, Centre Hospitalier Régional Universitaire de Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035, Nancy cedex, France
| | - Waled Abou Arab
- Service d'imagerie Guilloz, Hôpital Central, Centre Hospitalier Régional Universitaire de Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035, Nancy cedex, France
| | - François Sirveaux
- Centre Chirurgical Emile-Gallé, Centre Hospitalier Régional Universitaire de Nancy, 49, rue Hermite, 54000, Nancy cedex, France
| | - Alain Blum
- Service d'imagerie Guilloz, Hôpital Central, Centre Hospitalier Régional Universitaire de Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035, Nancy cedex, France
| | - Pedro Augusto Gondim Teixeira
- Service d'imagerie Guilloz, Hôpital Central, Centre Hospitalier Régional Universitaire de Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035, Nancy cedex, France
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Sebastian NT, Miller ED, Yang X, Diaz DA, Tan Y, Dowell J, Spain J, Rikabi A, Elliott E, Knopp M, Williams TM. A Pilot Trial Evaluating Stereotactic Body Radiation Therapy to Induce Hyperemia in Combination With Transarterial Chemoembolization for Hepatocellular Carcinoma. Int J Radiat Oncol Biol Phys 2020; 108:1276-1283. [PMID: 32712254 DOI: 10.1016/j.ijrobp.2020.07.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 07/12/2020] [Accepted: 07/17/2020] [Indexed: 01/14/2023]
Abstract
PURPOSE Despite the survival benefit of transarterial chemoembolization (TACE) for unresectable hepatocellular carcinoma (HCC), a majority of tumors recur, attributed to hypovascularity and treatment resistance. Preclinical studies show that moderate radiation doses induce changes in tumor permeability and perfusion, suggesting an opportunity for TACE sensitization by radiation. In this prospective phase 1 trial, we evaluated the feasibility, safety, tolerability, response, and functional magnetic resonance imaging (MRI) changes associated with single-fraction stereotactic body radiation therapy (SBRT) followed by TACE within 24 hours. METHODS AND MATERIALS Patients with HCC, 1 to 3 lesions, Childs-Pugh A/B liver function, and no major vascular invasion were enrolled. The primary objective was to establish the feasibility of single-dose SBRT (7.5 or 10 Gy) followed by TACE within 24 hours. Secondary endpoints included safety, tolerability, perfusional changes via functional MRI, overall response rate (ORR), clinical benefit rate (CBR), freedom from local progression, progression-free survival, and overall survival. RESULTS Sixteen patients were enrolled, and 13 received SBRT and TACE. Median follow-up was 15.3 months. Best overall ORR and CBR were 76.9% and 92.3%, respectively. The 1- and 3-month ORR was 76.9% and 69.2%, respectively, and 1- and 3-month CBR was 92.3% and 69.2%, respectively. Median overall survival, progression-free survival, and freedom from local progression were 14.0, 5.2, and 5.9 months, respectively. Crude rates of grade 1+ and grade 2+ toxicity were 85% and 38%, respectively. No grade 3 to 4 toxicities were recorded. One grade 5 toxicity occurred due to hemorrhage 4 days after TACE. On dynamic contrast-enhanced MRI, the transfer rate constant from blood plasma to extracellular extravascular space (kpe) increased within 6 hours post-SBRT but decreased by 24 hours. CONCLUSIONS We hypothesized a strategy of SBRT preceding TACE for the purpose of enhancing TACE delivery and efficacy and tested this strategy in a small pilot study. We found that single-dose SBRT followed by TACE within 24 hours is feasible and tolerable. Dynamic contrast-enhanced MRI revealed acute changes in tumor permeability/perfusion after SBRT. Additional studies are needed to establish the safety and efficacy of this combination and the effects of SBRT on the HCC microenvironment.
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Affiliation(s)
- Nikhil T Sebastian
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio
| | - Eric D Miller
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio
| | - Xiangyu Yang
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Dayssy Alexandra Diaz
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio
| | - Yubo Tan
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Joshua Dowell
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - James Spain
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Ali Rikabi
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Eric Elliott
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Michael Knopp
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Terence M Williams
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio.
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Lee JH, Kim HS, Yoon YC, Seo SW, Cha MJ, Jin W, Cha JG. Characterization of small, deeply located soft-tissue tumors: Conventional magnetic resonance imaging features and apparent diffusion coefficient for differentiation between non-malignancy and malignancy. PLoS One 2020; 15:e0232622. [PMID: 32379793 PMCID: PMC7205250 DOI: 10.1371/journal.pone.0232622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 04/18/2020] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES To compare magnetic resonance imaging (MRI) parameters of small, deeply located non-malignant and malignant soft-tissue tumors (STTs). METHODS Between May 2011 and December 2017, 95 MRIs in 95 patients with pathologically proven STTs of small size (<5 cm) and deep location (66 non-malignant and 29 malignant) were identified. For qualitative parameters, consensus reading was performed by three radiologists for presence of necrosis, infiltration, lobulation, and the tail sign. Apparent diffusion coefficient (ADC) was analyzed by two other radiologists independently. Univariable and multivariable analyses were performed to determine the diagnostic performances of MRI parameters in differentiating non-malignancy and malignancy, and for non-myxoid, non-hemosiderin STTs and myxoid STTs as subgroups. Interobserver agreement for ADC measurement was calculated with the intraclass correlation coefficient. RESULTS Interobserver agreement on ADC measurement was almost perfect. On univariable analysis, the malignant group showed a significantly larger size, lower ADC, and higher incidence of all qualitative MRI parameters for all STTs. Size (p = 0.012, odds ratio [OR] 2.57), ADC (p = 0.041, OR 3.85), and the tail sign (p = 0.009, OR 6.47) were independently significant on multivariable analysis. For non-myxoid, non-hemosiderin STTs, age, size, ADC, frequency of infiltration, lobulation, and the tail sign showed significant differences between non-malignancy and malignancy on univariable analysis. Only ADC (p = 0.032, OR 142.86) retained its independence on multivariable analysis. For myxoid STTs, only size and tail sign were significant on univariable analysis without independent significance. CONCLUSIONS Size, ADC, and incidence of qualitative MRI parameters were significantly different between small, deeply located non-malignant and malignant STTs. Only ADC was independently significant for both overall analysis and the non-myxoid, non-hemosiderin subgroup.
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Affiliation(s)
- Ji Hyun Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Su Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- * E-mail:
| | - Young Cheol Yoon
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Wook Seo
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Jae Cha
- Department of Radiology, Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Wook Jin
- Department of Radiology, Kyung Hee University School of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Jang Gyu Cha
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
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Ashikyan O, Chalian M, Moore D, Xi Y, Pezeshk P, Chhabra A. Evaluation of giant cell tumors by diffusion weighted imaging-fractional ADC analysis. Skeletal Radiol 2019; 48:1765-1773. [PMID: 31001688 DOI: 10.1007/s00256-019-03219-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/13/2019] [Accepted: 04/08/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND A single ADC value is used in clinical practice on multi b-value acquisitions. Low b-value acquisitions are affected by intravoxel incoherent motion, which is dependent on perfusion. Giant cell tumors (GCTs) are known to exhibit early arterial enhancement and low ADC values. Mean, minimum and fractional ADC characteristics of osseous and tenosynovial GCTs are systematically evaluated. METHODS Tenosynovial and osseous GCTs were included. Each lesion was evaluated on conventional MRI and DWI by two musculoskeletal radiologists. ADC was measured by placing an ROI on the most confluent enhancing portion of the lesion. Fractional and best fit ADC calculations were performed using MATLAB software. RESULTS No statistically significant difference was found between tenosynovial and osseous lesions' ADC values. Mean ADC for all lesions was 1.0 × 10-3 mm2/s (SD = 0.2 × 10-3 mm2/s) and minimum ADC was 0.5 × 10-3 mm2/s (SD = 0.3 × 10-3 mm2/s). Average mean ADC value obtained from B50-B400 slope was 1.1 × 10-3 mm2/s (SD = 0.2 × 10-3 mm2/s), and the average mean ADC value obtained from B400-B800 slope was 0.8 × 10-3 mm2/s (SD = 0.1 × 10-3 mm2/s) [p-value <0.01]. CONCLUSION Tenosynovial and osseous GCTs demonstrate similar and low ADC values, which become even lower when using high b-value pairs. Our study also supports the theory of intravoxel incoherent motion that becomes apparent at low b values as related to giant cell tumors, which are known to be hyperperfused.
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Affiliation(s)
- Oganes Ashikyan
- Department of Radiology, Musculoskeletal Imaging, UT Southwestern Medical Center, 5323 Harry Hines Blvd, E230-C, Dallas, TX, 75390-9316, USA.
| | - M Chalian
- Department of Radiology, Musculoskeletal Imaging, UT Southwestern Medical Center, 5323 Harry Hines Blvd, E230-C, Dallas, TX, 75390-9316, USA
| | - D Moore
- Department of Radiology, Musculoskeletal Imaging, UT Southwestern Medical Center, 5323 Harry Hines Blvd, E230-C, Dallas, TX, 75390-9316, USA
| | - Y Xi
- Department of Radiology, Musculoskeletal Imaging, UT Southwestern Medical Center, 5323 Harry Hines Blvd, E230-C, Dallas, TX, 75390-9316, USA
| | - P Pezeshk
- Department of Radiology, Musculoskeletal Imaging, UT Southwestern Medical Center, 5323 Harry Hines Blvd, E230-C, Dallas, TX, 75390-9316, USA
| | - A Chhabra
- Department of Radiology, Musculoskeletal Imaging, UT Southwestern Medical Center, 5323 Harry Hines Blvd, E230-C, Dallas, TX, 75390-9316, USA.,Department of Orthopedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
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Moustafa AFI, Eldaly MM, Zeitoun R, Shokry A. Is MRI diffusion-weighted imaging a reliable tool for the diagnosis and post-therapeutic follow-up of extremity soft tissue neoplasms? Indian J Radiol Imaging 2019; 29:378-385. [PMID: 31949339 PMCID: PMC6958890 DOI: 10.4103/ijri.ijri_146_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 09/19/2019] [Accepted: 11/30/2019] [Indexed: 11/04/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate the benefit of using quantitative diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) mapping in the initial diagnosis and post-therapeutic follow-up of extremity soft tissue masses. PATIENTS AND METHODS This study included 90 patients with extremity soft tissue masses. The DWI was obtained with 3 b values, including 0, 400, and 800 s/mm2. Calculation of the ADC value of the lesion was done by placing the region of interest (ROI) to include the largest area of the lesion. ADC values were compared with the histopathology. Eighteen patients had posttherapeutic magnetic resonance imaging (MRI). RESULTS Benign masses, fibromatosis, and malignant soft tissue masses had mean ADC values of 1.18 ± 1.0191 × 10-3 mm2/s; 1.31 ± 0.245 × 10-3 mm2/sec; and 1.3 ± 0.7 × 10-3 mm2/s, respectively. Myxomatous malignant masses had an ADC value of 2.6 ± 0.55 × 10-3 mm2/s, while nonmyxomatous malignant masses had an ADC value of 1.1 ± 0.8 × 10-3 mm2/s. ADC cutoff value between benign and non-benign (including malignant and locally aggressive masses) was 0.6 × 10-3 mm2/sec with 98.3% sensitivity and 50% specificity (P = 0.5123). The statistical difference between malignant soft tissue masses (mean ADC 1.309 ± 0.723 × 10-3 mm2/s) and fibromatosis masses (mean ADC value 1.31 ± 0.245 × 10-3 mm2/s) using a comparative T-test proved to be of poor significance level (P value ~ 0.9757). Nine patients with soft tissue sarcomas (STSs) had pre and post-therapeutic MRI examinations showing a mean increase of the recorded ADC values by about 0.28 × 10-3 mm2/s in the post-therapy study as compared with the recorded initial pretreatment values. Analysis of the post-therapy follow-up studies of fibromatosis showed that lesions with favorable response to chemotherapy or radiotherapy (8/12) exhibited significantly lower ADC values than those showing progressive disease course. CONCLUSION DWI with ADC mapping of extremity soft tissue tumors are so complicated that they alone may not be of much value in differentiating between benign and malignant tumors; however, it can be used as a tool for monitoring response to treatment.
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Affiliation(s)
| | - Mai Maher Eldaly
- Department of Diagnostic and Interventional Radiology, National Cancer Institute, Cairo University, Egypt
| | - Rania Zeitoun
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Cairo University, Egypt
| | - Ahmed Shokry
- Department of Diagnostic and Interventional Radiology, National Cancer Institute, Cairo University, Egypt
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Usefulness of Diffusion-Weighted Magnetic Resonance Imaging Using Apparent Diffusion Coefficient Values for Diagnosis of Infantile Hemangioma. J Comput Assist Tomogr 2019; 43:563-567. [PMID: 31162233 DOI: 10.1097/rct.0000000000000884] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The objective of this study was to determine whether apparent diffusion coefficient (ADC) values obtained from diffusion-weighted imaging allow differentiation between infantile hemangiomas (IHs) and malignant soft tissue tumors. METHODS A retrospective review was performed on magnetic resonance images of pediatric patients with IHs and malignant soft tissue tumors from January 2014 to December 2016, which comprised 7 patients with 8 IHs and 6 patients with 6 malignant soft tissue tumors. We calculated and compared the ADC values of each lesion. Receiver operating characteristic curve analysis was performed to determine a cutoff value for the ADC. RESULTS There was a statistically significant difference between the ADC values of IHs and those of malignant soft tissue tumors (1.32 [1.27-1.72] × 10 mm/s vs 0.67 [0.57-0.79] × 10 mm/s; P < 0.001), with no overlap between the 2 groups. CONCLUSIONS The ADC values obtained from diffusion-weighted imaging were useful in differentiating IHs from malignant soft tissue tumors in pediatric patients.
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Gimber LH, Chadaz TS, Flake W, Taljanovic MS. Advanced MR Imaging of Musculoskeletal Tumors: An Overview. Semin Roentgenol 2019; 54:149-161. [PMID: 31128738 DOI: 10.1053/j.ro.2018.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Lana Hirai Gimber
- Department of Medical Imaging, Banner University Medical Center, The University of Arizona, College of Medicine, Tucson, AZ.
| | - Tyson S Chadaz
- Department of Medical Imaging, Banner University Medical Center, The University of Arizona, College of Medicine, Tucson, AZ.
| | - William Flake
- Department of Medical Imaging, Banner University Medical Center, The University of Arizona, College of Medicine, Tucson, AZ.
| | - Mihra S Taljanovic
- Department of Medical Imaging, Banner University Medical Center, The University of Arizona, College of Medicine, Tucson, AZ
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Yamada K, Abiko K, Kido A, Minamiguchi S, Horie A, Mandai M. Solitary fibrous tumor arising from pelvic retroperitoneum: A report of two cases and a review of the literature. J Obstet Gynaecol Res 2019; 45:1391-1397. [PMID: 30957324 DOI: 10.1111/jog.13965] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 03/02/2019] [Accepted: 03/10/2019] [Indexed: 12/18/2022]
Abstract
Solitary fibrous tumors (SFT) rarely arise in the pelvis. Here, we report two cases of SFT arising from the pelvic retroperitoneum. The first case involves a 64-year-old woman diagnosed with a 5-cm pelvic mass. Magnetic resonance imaging revealed a solid and cystic mass with marked enhancement, but limited water restriction. During surgery, intraligamental tumor arising near the round ligament was resected. Pathologically, the tumor comprised dilated vessels and spindle-shaped cells positive for STAT6 and CD34. The second case involves a 53-year-old woman diagnosed with a 4.5-cm pelvic mass through computed tomography. Magnetic resonance imaging demonstrated a solid mass with multiple cysts with strong enhancement and slight water restriction. During surgery, the tumor was found in the retroperitoneum. Pathologically, spindle-shaped tumor cells positive for STAT6 and CD34 had proliferated around the prominent hyalinized vessels. Although rare in the pelvis, SFT should be suspected when a mass with strong enhancement is found.
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Affiliation(s)
- Kaori Yamada
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kaoru Abiko
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Aki Kido
- Diagnostic Radiology and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Sachiko Minamiguchi
- Diagnostic Pathology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akihito Horie
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masaki Mandai
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Baal JD, Chen WC, Solomon DA, Pai JS, Lucas CH, Hara JH, Oberheim Bush NA, McDermott MW, Raleigh DR, Villanueva-Meyer JE. Preoperative MR Imaging to Differentiate Chordoid Meningiomas from Other Meningioma Histologic Subtypes. AJNR Am J Neuroradiol 2019; 40:433-439. [PMID: 30819773 DOI: 10.3174/ajnr.a5996] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 01/14/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND PURPOSE Chordoid meningiomas are uncommon WHO grade II primary intracranial neoplasms that possess unique chordoid histology and follow an aggressive clinical course. Our aim was to assess the utility of qualitative MR imaging features and quantitative apparent diffusion coefficient values as distinguishing preoperative MR imaging metrics to identify and differentiate chordoid histology from other meningioma histologic subtypes. MATERIALS AND METHODS Twenty-one patients with meningiomas with chordoid histology, which included both chordoid meningiomas (>50% chordoid histology) and meningiomas with focal chordoid histology (<50% chordoid histology) with available preoperative MR imaging examinations, including diffusion-weighted imaging, were identified. Qualitative imaging features and quantitative ADC values were compared between meningiomas with chordoid histology and 42 nonchordoid meningiomas (29 WHO grade I, eleven WHO grade II, and 2 WHO grade III). RESULTS The median ADC (10-3mm2/s) of meningiomas with chordoid histology was significantly higher than nonchordoid meningiomas (1.16 versus 0.92, P < .001), as was the median normalized ADC (1.60 versus 1.19, P < .001). In subgroup analysis, the median and normalized ADC values of chordoid meningiomas (n = 11) were significantly higher than those in meningiomas with focal chordoid histology (n = 10, P < .001 and P < .001, respectively) or nonchordoid meningiomas (n = 42, P < .001 and <0.001, respectively). Median and normalized ADC values were not significantly different between the meningiomas with focal chordoid histology and nonchordoid meningiomas (P = .816 and .301, respectively). Among the qualitative imaging features, only DWI signal intensity was significantly associated with meningiomas with chordoid histology diagnosis. CONCLUSIONS ADC values are higher in chordoid compared with nonchordoid meningiomas and may be used to discriminate the degree of chordoid histology in meningiomas. While qualitative MR imaging features do not strongly discriminate chordoid from nonchordoid meningiomas, DWI may allow preoperative identification of chordoid meningiomas.
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Affiliation(s)
- J D Baal
- From the Departments of Radiology and Biomedical Imaging (J.D.B., J.E.V.-M.)
| | - W C Chen
- Radiation Oncology (W.C.C., J.S.P., J.H.H., D.R.R.)
| | | | - J S Pai
- Radiation Oncology (W.C.C., J.S.P., J.H.H., D.R.R.)
| | | | - J H Hara
- Radiation Oncology (W.C.C., J.S.P., J.H.H., D.R.R.)
| | - N A Oberheim Bush
- Neurological Surgery (N.A.O.B., M.W.M.), University of California San Francisco, San Francisco, California
| | - M W McDermott
- Neurological Surgery (N.A.O.B., M.W.M.), University of California San Francisco, San Francisco, California
| | - D R Raleigh
- Radiation Oncology (W.C.C., J.S.P., J.H.H., D.R.R.)
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Differentiation between malignant and benign musculoskeletal tumors using diffusion kurtosis imaging. Skeletal Radiol 2019; 48:285-292. [PMID: 29740660 DOI: 10.1007/s00256-018-2946-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 03/20/2018] [Accepted: 04/03/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate differences in parameters of diffusion kurtosis imaging (DKI) and minimum apparent diffusion coefficient (ADCmin) between benign and malignant musculoskeletal tumors. MATERIALS AND METHODS In this prospective study, 43 patients were scanned using a DKI protocol on a 3-T MR scanner. Eligibility criteria were: non-fatty, non-cystic soft tissue or osteolytic tumors; > 2 cm; location in the retroperitoneum, pelvis, leg, or neck; and no prior treatment. They were clinically or histologically diagnosed as benign (n = 27) or malignant (n = 16). In the DKI protocol, diffusion-weighted imaging was performed using four b values (0-2000 s/mm2) and 21 diffusion directions. Mean kurtosis (MK) values were calculated on the MR console. A recently developed software application enabling reliable calculation was used for DKI analysis. RESULTS MK showed a strong correction with ADCmin (Spearman's rs = 0.95). Both MK and ADCmin values differed between benign and malignant tumors (p < 0.01). For benign and malignant tumors, the mean MK values (± SD) were 0.49 ± 0.17 and 1.14 ± 0.30, respectively, and ADCmin values were 1.54 ± 0.47 and 0.49 ± 0.17 × 10-3 mm2/s, respectively. At cutoffs of MK = 0.81 and ADCmin = 0.77 × 10-3 mm2/s, the specificity and sensitivity for diagnosis of malignant tumors were 96.3 and 93.8% for MK and 96.3 and 93.8% for ADCmin, respectively. The areas under the curve were 0.97 and 0.99 for MK and ADCmin, respectively (p = 0.31). CONCLUSIONS MK and ADCmin showed high diagnostic accuracy and strong correlation, reflecting the accuracy of MK. However, no clear added value of DKI could be demonstrated in differentiating musculoskeletal tumors.
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Choi YJ, Lee IS, Song YS, Kim JI, Choi KU, Song JW. Diagnostic performance of diffusion-weighted (DWI) and dynamic contrast-enhanced (DCE) MRI for the differentiation of benign from malignant soft-tissue tumors. J Magn Reson Imaging 2019; 50:798-809. [PMID: 30663160 DOI: 10.1002/jmri.26607] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 11/20/2018] [Accepted: 11/21/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND A wide range of specificity values for the differentiation of benign and malignant soft-tissue tumors show the limitations of conventional MRI features. The data obtained by quantitative analysis of diffusion-weighted image (DWI) and dynamic contrast-enhanced (DCE) MRIs would provide more objective results, especially in terms of cellularity and perfusion. PURPOSE To evaluate the diagnostic efficacies of DWI and DCE MRI for the differentiation of malignant and benign soft-tissue tumors. STUDY TYPE Retrospective. SUBJECTS In all, 136 patients (68 females, 68 males; age range 18-86 years, mean age 57.2 years) with soft-tissue tumors. FIELD STRENGTH/SEQUENCE 3 T, DWI, DCE. ASSESSMENT Tumor sizes, margins, locations, the presence of involvement in bone or neurovascular bundle, peritumoral edema, heterogeneity, and tumor necrosis were investigated on conventional MR images. On DWIs, visual signal drops were assessed and ADC (apparent diffusion coefficient) values were measured. Ktrans , Kep , Ve , and iAUC values, and time-concentration curve (TCC) types were determined using DCE images. STATISTICAL TESTS The data were statistically analyzed to determine the abilities to differentiate benign and malignant tumors using the chi-square test, two-sample t-test, and receiver operating characteristic (ROC) analysis. RESULTS Seventy-three cases were malignant and 63 benign. Age (mean ages of benign/malignant tumors, 51.75/61.86 years; P = 0.0002) and gender (F:M = 40:23 [benign], F:M = 28:45 [malignant], P = 0.003) influenced the distinction between benign and malignant. Sizes, margins, neurovascular bundle involvement, peritumoral edema, and heterogeneity of the tumors on conventional MR images and DCE parameters (Ktrans , Kep , Ve , and iAUC, and TCC plots) obtained from focal region of interest within a narrow volume of interest significantly differentiated benign and malignant lesions (all P < 0.0001, except Ve [P = 0.0004]). For DWI with ADC mapping, all ADC values and visually signal drops were also significant (P < 0.0001). DATA CONCLUSION DWI and DCE-MRI and derived variables were significantly helpful in discriminating benign and malignant soft-tissue tumors complementary to conventional MRI. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:798-809.
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Affiliation(s)
- Young Jin Choi
- Division of Hematology/Oncology, Department of Internal Medicine, Pusan National University Hospital, Biomedical Research Institute, Busan, Korea.,Pusan National University School of Medicine, Busan, Korea
| | - In Sook Lee
- Pusan National University School of Medicine, Busan, Korea.,Department of Radiology, Pusan National University Hospital, Biomedical Research Institute, Busan, Korea
| | - You Seon Song
- Pusan National University School of Medicine, Busan, Korea.,Department of Radiology, Pusan National University Hospital, Biomedical Research Institute, Busan, Korea
| | - Jeung Il Kim
- Pusan National University School of Medicine, Busan, Korea.,Department of Orthopaedic Surgery, Pusan National University Hospital, Biomedical Research Institute, Busan, Korea
| | - Kyung-Un Choi
- Pusan National University School of Medicine, Busan, Korea.,Department of Pathology, Pusan National University Hospital, Biomedical Research Institute, Busan, Korea
| | - Jong Woon Song
- Department of Radiology, Inje University Haeundae Paik Hospital, Busan, Korea
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Pollock RE, Payne JE, Rogers AD, Smith SM, Iwenofu OH, Valerio IL, Zomerlei TA, Howard JH, Dornbos D, Galgano MA, Goulart C, Mendel E, Miller ED, Xu-Welliver M, Martin DD, Haglund KE, Bupathi M, Chen JL, Yeager ND. Multidisciplinary sarcoma care. Curr Probl Surg 2018; 55:517-580. [PMID: 30526918 DOI: 10.1067/j.cpsurg.2018.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Raphael E Pollock
- The Ohio State University Comprehensive Cancer Center, Columbus, OH.
| | - Jason E Payne
- The Ohio State University Wexner Medical Center, Columbus, OH
| | - Alan D Rogers
- The Ohio State University Wexner Medical Center, Columbus, OH
| | - Stephen M Smith
- The Ohio State University Wexner Medical Center, Columbus, OH
| | - O Hans Iwenofu
- Department of Pathology & Laboratory Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Ian L Valerio
- The Ohio State University Wexner Medical Center, Columbus, OH
| | | | | | - David Dornbos
- The Ohio State University Wexner Medical Center, Columbus, OH
| | | | | | - Ehud Mendel
- The Ohio State University Wexner Medical Center, Columbus, OH
| | - Eric D Miller
- The Ohio State University Wexner Medical Center, Columbus, OH
| | | | | | - Karl E Haglund
- The Ohio State University Wexner Medical Center, Columbus, OH
| | | | - James L Chen
- The Ohio State University Wexner Medical Center, Columbus, OH
| | - Nicholas D Yeager
- Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH
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Reinert CP, Schuhmann MU, Bender B, Gugel I, la Fougère C, Schäfer J, Gatidis S. Comprehensive anatomical and functional imaging in patients with type I neurofibromatosis using simultaneous FDG-PET/MRI. Eur J Nucl Med Mol Imaging 2018; 46:776-787. [DOI: 10.1007/s00259-018-4227-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 11/25/2018] [Indexed: 12/31/2022]
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41
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Hong JH, Jee WH, Jung CK, Jung JY, Shin SH, Chung YG. Soft tissue sarcoma: adding diffusion-weighted imaging improves MR imaging evaluation of tumor margin infiltration. Eur Radiol 2018; 29:2589-2597. [PMID: 30413958 DOI: 10.1007/s00330-018-5817-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 09/11/2018] [Accepted: 10/01/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE To determine the added value of diffusion-weighted imaging (DWI) to conventional magnetic resonance (MR) imaging in assessment of tumor margin infiltration in soft tissue sarcoma (STS) at 3T. MATERIALS AND METHODS The institutional review board approved this retrospective study. Forty-five patients who underwent 3T MR imaging including DWI and were pathologically confirmed were included in this study. Two readers retrospectively scored conventional MR imaging alone. Then, they assessed a combination of conventional MR imaging and DWI. At pathology, margin infiltration was retrospectively reviewed by one pathologist blinded to MR findings. Areas under the curve (AUCs) of the receiver-operating characteristic curve were obtained for diagnostic performance. Interobserver agreement for the scoring of margin infiltration of STS was assessed with kappa statistics. RESULTS Among 45 cases of STS, 33 had infiltrative tumor margin at pathology. Sensitivity, specificity, and accuracy of each reader were 100%, 17%, and 78%; 97%, 25%, and 78% on conventional MR imaging alone and 94%, 67%, and 87%; 94%, 42%, and 80% on conventional MR imaging combined with DWI. AUCs of conventional MR imaging combined with DWI were significantly higher than those of conventional MR imaging alone: 0.890 vs 0.678 (p = .0123) and 0.846 vs 0.640 (p = .0305) for each reader. Interobserver agreements of conventional MR imaging alone and conventional MR imaging combined with DWI were moderate to substantial (κ = 0.646, κ = 0.496). CONCLUSION The addition of DWI to conventional MR imaging may improve specificity for assessing tumor margin infiltration in STS at 3T. KEY POINTS • DWI has added value for assessment of tumor margin infiltration in soft tissue sarcoma. • Addition of DWI to conventional MRI at 3T may improve specificity. • Addition of DWI to conventional MRI may help orthopedic surgeon determine the extent of the resection margin.
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Affiliation(s)
- Ji Hyun Hong
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, South Korea
- Department of Radiology, Kangdong Seong-Sim Hospital, College of Medicine, Hallym University, 150 Seongan-ro, Gangdong-gu, Seoul, 05355, South Korea
| | - Won-Hee Jee
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, South Korea.
| | - Chan-Kwon Jung
- Department of Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, South Korea
| | - Joon-Yong Jung
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, South Korea
| | - Seung Han Shin
- Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, South Korea
| | - Yang-Guk Chung
- Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, South Korea
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42
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Multiparametric MR Imaging of Soft Tissue Tumors and Pseudotumors. Magn Reson Imaging Clin N Am 2018; 26:543-558. [DOI: 10.1016/j.mric.2018.06.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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43
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Estimation of microvascular capillary physical parameters using MRI assuming a pseudo liquid drop as model of fluid exchange on the cellular level. Rep Pract Oncol Radiother 2018; 24:3-11. [PMID: 30337842 DOI: 10.1016/j.rpor.2018.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 04/30/2018] [Accepted: 09/06/2018] [Indexed: 11/20/2022] Open
Abstract
Aim One of the most important microvasculatures' geometrical variables is number of pores per capillary length that can be evaluated using MRI. The transportation of blood from inner to outer parts of the capillary is studied by the pores and the relationship among capillary wall thickness, size and the number of pores is examined. Background Characterization of capillary space may obtain much valuable information on the performance of tissues as well as the angiogenesis. Methods To estimate the number of pores, a new pseudo-liquid drop model along with appropriate quantitative physiological purposes has been investigated toward indicating a package of data on the capillary space. This model has utilized the MRI perfusion, diffusion and relaxivity parameters such as cerebral blood volume (CBV), apparent diffusion coefficient (ADC), ΔR 2 and Δ R 2 * values. To verify the model, a special protocol was designed and tested on various regions of eight male Wistar rats. Results The maximum number of pores per capillary length in the various conditions such as recovery, core, normal-recovery, and normal-core were found to be 183 ± 146, 176 ± 160, 275 ± 166, and 283 ± 143, respectively. This ratio in the normal regions was more than that of the damaged ones. The number of pores increased with increasing mean radius of the capillary and decreasing the thickness of the wall in the capillary space. Conclusion Determination of the number of capillary pore may most likely help to evaluate angiogenesis in the tissues and treatment planning of abnormal ones.
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Key Words
- 2DFT, two-dimensional Fourier transform
- ADC, apparent diffusion coefficient
- CBF, cerebral blood flow
- CBV, cerebral blood volume
- DWI, diffusion weighted imaging
- Diameter
- Diffusion MRI
- FLASH, fast low angle shot
- FOV, field of view
- MCA, middle cerebral artery
- MTT, mean transit time
- Microvasculature
- PWI, perfusion weighted imaging
- Pores
- Pseudo-liquid drop model
- RF, radio frequency
- ROI, region of interest
- TCL, total capillary length
- VSI, vessel size index
- Wistar rats
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Diffusion weighted MRI of soft tissue masses: Can measurement of ADC value help in the differentiation between benign and malignant lesions? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2018.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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45
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Hybrid quantitative MRI using chemical shift displacement and recovery-based simultaneous water and lipid imaging: A preliminary study. Magn Reson Imaging 2018; 50:61-67. [DOI: 10.1016/j.mri.2018.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 03/08/2018] [Accepted: 03/10/2018] [Indexed: 01/03/2023]
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46
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Romeih M, Raafat T, Khalaf M, Sallam K. The diagnostic value of diffusion-weighted magnetic resonance imaging in characterization of musculoskeletal soft tissue tumors. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2018.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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47
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ElDaly MM, Moustafa AFI, Abdel-Meguid SMS, Shokry AM, El Wahab NA. Can MRI diffusion-weighted imaging identify postoperative residual/recurrent soft-tissue sarcomas? Indian J Radiol Imaging 2018; 28:70-77. [PMID: 29692531 PMCID: PMC5894324 DOI: 10.4103/ijri.ijri_251_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Purpose The aim of this study was to evaluate contrast-enhanced magnetic resonance imaging (CE-MRI) and quantitative diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) mapping in the detection of recurrent/residual postoperative soft tissue sarcomas. Materials and Methods This study included 36 patients; 27 patients had postoperative recurrent/residual soft tissue sarcomas and 9 patients had postoperative and treatment-related changes (inflammation/fibrosis). The DWI was obtained with 3 b values including 0, 400, and 800 s/mm2. Calculation of the ADC value of the lesion was done via placing the region of interest (ROI) to include the largest area of the lesion. ADC values were compared to histopathology. Results Our results showed that including CE-MRI improved the diagnostic accuracy and sensitivity in recurrence detection compared to conventional non-enhanced sequences. However, it showed low specificity (55.56%) with a high false-positive rate that may lead to an unnecessary biopsy of a mass such as region of postoperative scar tissue. Conclusion The joint use of gadolinium-enhanced MRI and quantitative DWI with ADC mapping offer added value in the detection of recurrent/residual postoperative soft tissue sarcoma. This combined use increased both the diagnostic sensitivity and specificity with a cut-off average ADC value for detecting nonmyxoid recurrent/residual lesions ≤1.3 × 10-3 mm2/s (100% specificity and 90.48% sensitivity). Our results showed limited value of DWI with ADC mapping in assessing myxoid sarcomatous tumor recurrences.
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Affiliation(s)
- Mai Maher ElDaly
- Department of Diagnostic and Intervention Radiology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Amr Farouk Ibrahim Moustafa
- Department of Diagnostic and Intervention Radiology, National Cancer Institute, Cairo University, Cairo, Egypt
| | | | - Ahmed Mohamed Shokry
- Department of Diagnostic and Intervention Radiology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Nagui Abd El Wahab
- Department of Diagnostic and Intervention Radiology, Faculty of Medicine, Cairo University, Cairo, Egypt
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Ahlawat S, Fayad LM. Diffusion weighted imaging demystified: the technique and potential clinical applications for soft tissue imaging. Skeletal Radiol 2018; 47:313-328. [PMID: 29159675 DOI: 10.1007/s00256-017-2822-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 10/26/2017] [Accepted: 11/07/2017] [Indexed: 02/02/2023]
Abstract
Diffusion-weighted imaging (DWI) is a fast, non-contrast technique that is readily available and easy to integrate into an existing imaging protocol. DWI with apparent diffusion coefficient (ADC) mapping offers a quantitative metric for soft tissue evaluation and provides information regarding the cellularity of a region of interest. There are several available methods of performing DWI, and artifacts and pitfalls must be considered when interpreting DWI studies. This review article will review the various techniques of DWI acquisition and utility of qualitative as well as quantitative methods of image interpretation, with emphasis on optimal methods for ADC measurement. The current clinical applications for DWI are primarily related to oncologic evaluation: For the assessment of de novo soft tissue masses, ADC mapping can serve as a useful adjunct technique to routine anatomic sequences for lesion characterization as cyst or solid and, if solid, benign or malignant. For treated soft tissue masses, the role of DWI/ADC mapping in the assessment of treatment response as well as recurrent or residual neoplasm in the setting of operative management is discussed, especially when intravenous contrast medium cannot be given. Emerging DWI applications for non-neoplastic clinical indications are also reviewed.
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Affiliation(s)
- Shivani Ahlawat
- The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins Medical Institutions, 600 North Wolfe Street, Baltimore, MD, 21287, USA.
| | - Laura M Fayad
- The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins Medical Institutions, 600 North Wolfe Street, Baltimore, MD, 21287, USA.,Department of Oncology, The Johns Hopkins Medical Institutions, 600 North Wolfe Street, Baltimore, MD, 21287, USA.,Department of Orthopaedic Surgery, The Johns Hopkins Medical Institutions, 600 North Wolfe Street, Baltimore, MD, 21287, USA
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Nakajo M, Fukukura Y, Hakamada H, Yoneyama T, Kamimura K, Nagano S, Nakajo M, Yoshiura T. Whole-tumor apparent diffusion coefficient (ADC) histogram analysis to differentiate benign peripheral neurogenic tumors from soft tissue sarcomas. J Magn Reson Imaging 2018; 48:680-686. [PMID: 29469942 DOI: 10.1002/jmri.25987] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 02/03/2018] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Apparent diffusion coefficient (ADC) histogram analyses have been used to differentiate tumor grades and predict therapeutic responses in various anatomic sites with moderate success. PURPOSE To determine the ability of diffusion-weighted imaging (DWI) with a whole-tumor ADC histogram analysis to differentiate benign peripheral neurogenic tumors (BPNTs) from soft tissue sarcomas (STSs). STUDY TYPE Retrospective study, single institution. SUBJECTS In all, 25 BPNTs and 31 STSs. FIELD STRENGTH/SEQUENCE Two-b value DWI (b-values = 0, 1000s/mm2 ) was at 3.0T. ASSESSMENT The histogram parameters of whole-tumor for ADC were calculated by two radiologists and compared between BPNTs and STSs. STATISTICAL TESTS Nonparametric tests were performed for comparisons between BPNTs and STSs. P < 0.05 was considered statistically significant. The ability of each parameter to differentiate STSs from BPNTs was evaluated using area under the curve (AUC) values derived from a receiver operating characteristic curve analysis. RESULTS The mean ADC and all percentile parameters were significantly lower in STSs than in BPNTs (P < 0.001-0.009), with AUCs of 0.703-0.773. However, the coefficient of variation (P = 0.020 and AUC = 0.682) and skewness (P = 0.012 and AUC = 0.697) were significantly higher in STSs than in BPNTs. Kurtosis (P = 0.295) and entropy (P = 0.604) did not differ significantly between BPNTs and STSs. DATA CONCLUSION Whole-tumor ADC histogram parameters except kurtosis and entropy differed significantly between BPNTs and STSs. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018.
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Affiliation(s)
- Masanori Nakajo
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Yoshihiko Fukukura
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Hiroto Hakamada
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Tomohide Yoneyama
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Kiyohisa Kamimura
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Satoshi Nagano
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | | | - Takashi Yoshiura
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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Abstract
Soft tissue tumors represent a special challenge in interdisciplinary cooperation. Malignant tumors require a multimodal therapy concept so that patient treatment in a specialized tumor center is recommended. The task of the surgeon in close cooperation with the radiologist is the resection of the tumor in sano with the required safety margin. The aim of diagnostic imaging is to describe the primary expansion of the tumor size and a possible tumor infiltration of adjacent compartments. The most important diagnostic imaging for this purpose is magnetic resonance imaging (MRI), especially T1-weighted fat-suppressed gadolinium-enhanced sequences. Together with T2-weighted sequences a reliable differentiation between necrosis and vital tumor tissue is possible, which enables a targeted biopsy of vital tumor tissue. For the differentiation between benign and malignant soft tissue tumors and for determination of histological differentation a core needle biopsy, either computer tomography-guided or under sonographic control and increasingly more by MRI guidance, is currently the gold standard in most tumor centers. A representative biopsy from vital tumor tissue leads to the diagnosis with a very high degree of certainty.
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Affiliation(s)
- L Fenzl
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum des Saarlandes, Kirrbergerstraße, 66424, Homburg/Saar, Deutschland.
| | - K Bubel
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum des Saarlandes, Kirrbergerstraße, 66424, Homburg/Saar, Deutschland
| | - M Mehrmann
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum des Saarlandes, Kirrbergerstraße, 66424, Homburg/Saar, Deutschland
| | - G Schneider
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum des Saarlandes, Kirrbergerstraße, 66424, Homburg/Saar, Deutschland
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