Benign and malignant skull-involved lesions: discriminative value of conventional CT and MRI combined with diffusion-weighted MRI

Abstract

Background Little is known about the value of computed tomography (CT) and magnetic resonance imaging (MRI) combined with diffusion-weighted imaging (DWI) in distinguishing malignant from benign skull-involved lesions. Purpose To evaluate the discriminative value of DWI combined with conventional CT and MRI for differentiating between benign and malignant skull-involved lesions. Material and Methods CT and MRI findings of 58 patients with pathologically proven skull-involved lesions (43 benign and 15 malignant) were retrospectively reviewed. Conventional CT and MRI characteristics and apparent diffusion coefficient (ADC) value of the two groups were evaluated and compared. Multivariate logistic regression and receiver operating characteristic (ROC) curve analyses were performed to assess the differential performance of each parameter separately and together. Results The presence of cortical defects or break-through and ill-defined margins were associated with malignant skull-involved lesions (both P < 0.05). Malignant skull-involved lesions demonstrated a significantly lower ADC ( P = 0.016) than benign lesions. ROC curve analyses indicated that a combination of CT, MRI, and DWI with an ADC ≤ 0.703 × 10 mm/s showed optimal sensitivity, while DWI along showed optimal specificity of 88.4% in differentiating between benign and malignant skull-involved lesions. Conclusion The combination of CT, MRI, and DWI can help to differentiate malignant from benign skull-involved lesions. CT + MRI + DWI offers optimal sensitivity, while DWI offers optimal specificity.

Comparison of computed tomography and magnetic resonance imaging in evaluation of skull lesions

“…The nature of lesion can be lytic, sclerotic or mixed (lytic + sclerotic). The presence of lytic lesion represents aggressive nature of lesion and a sclerotic lesion may suggest a long standing lesion with remodelling [16]. In our study, CT detected lytic lesions in 15 cases, mixed lesions in 16 cases and sclerotic lesions in 5 cases whereas MRI detected lytic lesions in 17 cases, mixed lesions in 14 cases and sclerotic lesions in 6 cases.…”

“…2). Tu et al concluded that presence of cortical defects or break through or ill-defined lesion were important factors in differentiating benign and malignant lesions [16]. Another study conducted by Gomez et al, they concluded that benign lesions have well defined margins with a narrow zone of transition whereas malignant lesions have poorly defined margins with a wide zone of transition [17].…”

Sinonasal lymphoma: A primer for otolaryngologists

“…Biopsies are critical in establishing the diagnosis of SN‐NHL; however, magnetic resonance imaging (MRI), computed tomography (CT), and positron emission tomography (PET)/CT can determine the extent of the lesion as well as assist in early detection and ultimately establish disease staging 2,81 . Staging is used to determine pretreatment risk stratification and selection of therapy.…”

“…Biopsies are critical in establishing the diagnosis of SN‐NHL; however, magnetic resonance imaging (MRI), computed tomography (CT), and positron emission tomography (PET)/CT can determine the extent of the lesion as well as assist in early detection and ultimately establish disease staging. 2 , 81 Staging is used to determine pretreatment risk stratification and selection of therapy. CT best evaluates bony involvement and is typically the first imaging modality obtained; MRI aids in visualization of soft tissue; and PET/CT is recommended for extraprimary regional and distant spread.…”

“… 60 , 88 , 92 , 93 , 94 , 95 ADC values are typically lower in malignancies in comparison to benign skull base tumors and have been shown to be significantly lower in SN‐NHL than in sinonasal carcinomas (Figure 2D ). 81 , 88 , 96 , 97 Wang et al compared ADC values between DLBCL and ENKTL using a higher resolution DWI technique and found the mean ADC value of ENKTLs to be significantly higher than that of DLBCLs. This is consistent with the study of He et al who used a variation of the higher resolution DWI technique.…”