Role of apparent diffusion coefficients with diffusion-weighted magnetic resonance imaging in differentiating between benign and malignant bone tumors

Abstract

BackgroundBenign and malignant bone tumors can present similar imaging features. This study aims to evaluate the significance of apparent diffusion coefficients (ADC) in differentiating between benign and malignant bone tumors.MethodsA total of 187 patients with 198 bone masses underwent diffusion-weighted (DW) magnetic resonance (MR) imaging. The ADC values in the solid components of the bone masses were assessed. Statistical differences between the mean ADC values in the different tumor types were determined by Student’s t-test.ResultsHistological analysis showed that 84/198 (42.4%) of the bone masses were benign and 114/198 (57.6%) were malignant. There was a significant difference between the mean ADC values in the benign and malignant bone lesions (P <0.05). However, no significant difference was found in the mean ADC value between non-ossifying fibromas, osteofibrous dysplasia, and malignant bone tumors. When an ADC cutoff value ≥1.10 × 10−3 mm2/s was applied, malignant bone lesions were excluded with a sensitivity of 89.7%, a specificity of 84.5%, a positive predictive value of 82.6%, and a negative predictive value of 95.3%.ConclusionsThe combination of DW imaging with ADC quantification and T2-weighted signal characteristics of the solid components in lesions can facilitate differentiation between benign and malignant bone tumors.

A Giant Cell Granuloma of the Temporal Bone: A Case Report

“…The presented patient also had mixed density in both T1 and T2W images, and contrast enhancement was heterogenous after contrast media injection (Figure 2). DWI is a valuable method for differentiation of a bone lesion that it is benign or malign [9]. The low signal on DWI was detected on MRI in the presented case was thought the lesion was benign nature.…”

MRI biomarkers in osseous tumors

“…Simple bone cysts, and aneurysmal bone cysts, especially have been reported as having high minimum or mean ADC (around 2.0 × 10 −3 mm 2 /s) because of their higher water content . On the other hand, even if benign, several tumors such as nonossifying fibroma and intraosseous epidermoid are reported as having an ADC of less than 1.0 × 10 −3 mm 2 /s . Extracellular water movement might be restricted due to their dense network of collagen fibers in fibrotic tumors like nonossifying fibromas.…”

“…Extracellular water movement might be restricted due to their dense network of collagen fibers in fibrotic tumors like nonossifying fibromas. Hence, it has been suggested that ADC needs to be interpreted within the context of a tumor's signal intensity on T 2 ‐weighted images (T 2 WI) and DWI . Furthermore, biologically aggressive benign lesions, such as giant cell tumor (GCT), osteoblastoma, and Langerhans cell histiocytosis, have also been reported to have lower minimum and mean ADC, which considerably overlap with the value of malignant lesions …”

“…Variable low ADCs have been reported in osteosarcoma (OS), Ewing sarcoma, plasmacytoma, multiple myeloma (MM), lymphoma, and bone metastases . Among them, small round cell tumors like Ewing sarcoma, plasmacytoma, MM, and lymphoma tend to have somewhat consistently lower values around 0.9 × 10 −3 mm 2 /s, with some overlapping with the range of normal red marrow . In OS, variable ADC can be measured according to histological features (Fig.…”

“…[33][34][35] On the other hand, even if benign, several tumors such as nonossifying fibroma and intraosseous epidermoid are reported as having an ADC of less than 1.0 × 10 −3 mm 2 /s. 36 Extracellular water movement might be restricted due to their dense network of collagen fibers in fibrotic tumors like nonossifying fibromas. Hence, it has been suggested that ADC needs to be interpreted within the context of a tumor's signal intensity on T 2weighted images (T 2 WI) and DWI.…”