European Radiology

, Volume 26, Issue 3, pp 743–754 | Cite as

Differentiation of malignant from benign soft tissue tumours: use of additive qualitative and quantitative diffusion-weighted MR imaging to standard MR imaging at 3.0 T

  • So-Yeon Lee
  • Won-Hee JeeEmail author
  • Joon-Yong Jung
  • Michael Y. Park
  • Sun-Ki Kim
  • Chan-Kwon Jung
  • Yang-Guk Chung



To determine the added value of diffusion-weighted imaging (DWI) to standard magnetic resonance imaging (MRI) to differentiate malignant from benign soft tissue tumours at 3.0 T.


3.0 T MR images including DWI in 63 patients who underwent surgery for soft tissue tumours were retrospectively analyzed. Two readers independently interpreted MRI for the presence of malignancy in two steps: standard MRI alone, standard MRI and DWI with qualitative and quantitative analysis combined.


There were 34 malignant and 29 non-malignant soft tissue tumours. In qualitative analysis, hyperintensity relative to skeletal muscle was more frequent in malignant than benign tumours on DWI (P=0.003). In quantitative analysis, ADCs of malignant tumours were significantly lower than those of non-malignant tumours (P≤0.002): 759±385 vs. 1188±423 μm2/sec minimum ADC value, 941±440 vs. 1310±440 μm2/sec average ADC value. The mean sensitivity, specificity and accuracy of both readers were 96 %, 72 %, and 85 % on standard MRI alone and 97 %, 90 %, and 94 % on standard MRI with DWI.


The addition of DWI to standard MRI improves the diagnostic accuracy for differentiation of malignant from benign soft tissue tumours at 3.0 T.

Key Points

DWI has added value for differentiating malignant from benign soft tissue tumours.

Addition of DWI to standard MRI at 3.0 T improves the diagnostic accuracy.

Measurements of both ADC min within solid portion and ADC av are helpful.


MRI Diffusion magnetic resonance imaging Sarcoma Soft tissue neoplasms Differential diagnosis 



diffusion-weighted imaging


apparent diffusion coefficient


minimum value of ADC


average value of ADC



The scientific guarantor of this publication is Won-Hee Jee. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. Mi Yeon Lee kindly provided statistical advice for this manuscript. One of the authors has significant statistical expertise. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology:

Retrospective, diagnostic or prognostic study, performed at one institution.


  1. 1.
    Kransdorf MJ, Murphey MD (2014) Imaging of soft tissue masses. In: Kransdorf MJ, Murphey MD (eds) Imaging of soft tissue tumors, 3rd edn. Lippincott Williams & Williams, Philadelphia, pp 39–94Google Scholar
  2. 2.
    Fletcher CD, Bridge JA, Hogendorm PC, Mertens F (eds) (2013) WHO classification of tumours of soft tissue and bone, 4th ed. IARC, LyonGoogle Scholar
  3. 3.
    Crim JR, Seeger LL, Yao L, Chandnani V, Eckardt JJ (1992) Diagnosis of soft-tissue masses with MR imaging: can benign masses be differentiated from malignant ones? Radiology 185:581–586CrossRefPubMedGoogle Scholar
  4. 4.
    Knapp EL, Kransdorf MJ, Letson GD (2005) Diagnostic imaging update: soft tissue sarcomas. Cancer Control 12:22–26PubMedGoogle Scholar
  5. 5.
    Moulton JS, Blebea JS, Dunco DM, Braley SE, Bisset GS 3rd, Emery KH (1995) MR imaging of soft-tissue masses: diagnostic efficacy and value of distinguishing between benign and malignant lesions. AJR Am J Roentgenol 164:1191–1199CrossRefPubMedGoogle Scholar
  6. 6.
    Gielen JL, De Schepper AM, Vanhoenacker F et al (2004) Accuracy of MRI in characterization of soft tissue tumors. A prospective study in 548 patients. Eur Radiol 14:2320–2330CrossRefPubMedGoogle Scholar
  7. 7.
    Van Rijswijk CS, Geirnaerdt MJ, Hogendoorn PC et al (2004) Soft-tissue tumors: value of static and dynamic gadopentetate dimeglumine-enhanced MR imaging in prediction of malignancy. Radiology 233:493–502CrossRefPubMedGoogle Scholar
  8. 8.
    van Rijswijk CS, Kunz P, Hogendoorn PC, Taminiau AH, Doornbos J, Bloem JL (2002) Diffusion-weighted MR imaging in the characterization of soft-tissue tumors. J Magn Reson Imaging 15:302–307CrossRefPubMedGoogle Scholar
  9. 9.
    Einarsdottir H, Karlsson M, Wejde J, Bauer HC (2004) Diffusion-weighted MR imaging of soft tissue tumours. Eur Radiol 14:959–963CrossRefPubMedGoogle Scholar
  10. 10.
    Maeda M, Matsumine A, Kato H et al (2007) Soft-tissue tumors evaluated by line-scan diffusion-weighted imaging: influence of myxoid matrix on the apparent diffusion coefficient. J Magn Reson Imaging 25:1199–1204CrossRefPubMedGoogle Scholar
  11. 11.
    Nagata S, Nishimura H, Uchida M et al (2008) Diffusion-weighted imaging of soft tissue tumors: usefulness of the apparent diffusion coefficient for differential diagnosis. Radiat Med 26:287–295CrossRefPubMedGoogle Scholar
  12. 12.
    Razek A, Nada N, Ghaniem M, Elkhamary S (2012) Assessment of soft tissue tumours of the extremities with diffusion echoplanar MR imaging. Radiol Med 117:96–101CrossRefPubMedGoogle Scholar
  13. 13.
    Del Grande F, Subhawong T, Weber K et al (2014) Detection of soft-tissue sarcoma recurrence: added value of functional MR imaging techniques at 3.0 T. Radiology 271:499–511CrossRefPubMedGoogle Scholar
  14. 14.
    Kransdorf MJ, Bridges MD (2013) Current developments and recent advances in musculoskeletal tumor imaging. Semin Musculoskelet Radiol 17:145–155CrossRefPubMedGoogle Scholar
  15. 15.
    Suzuki C, Maeda M, Matsumine A et al (2007) Apparent diffusion coefficient of subcutaneous epidermal cysts in the head and neck comparison with intracranial epidermoid cysts. Acad Radiol 14:1020–1028CrossRefPubMedGoogle Scholar
  16. 16.
    Khoo MM, Tyler PA, Saifuddin A, Padhani AR (2011) Diffusion-weighted imaging (DWI) in musculoskeletal MRI: a critical review. Skelet Radiol 40:665–681CrossRefGoogle Scholar
  17. 17.
    El Kady RM, Choudhary AK, Tappouni R (2011) Accuracy of apparent diffusion coefficient value measurement on PACS workstation: a comparative analysis. AJR Am J Roentgenol 196:W280–W284CrossRefPubMedGoogle Scholar
  18. 18.
    Ginat DT, Mangla R, Yeaney G, Johnson M, Ekholm S (2012) Diffusion-weighted imaging for differentiating benign from malignant skull lesions and correlation with cell density. AJR Am J Roentgenol 198:W597–W601CrossRefPubMedGoogle Scholar
  19. 19.
    Subhawong TK, Durand DJ, Thawait GK, Jacobs MA, Fayad LM (2013) Characterization of soft tissue masses: can quantitative diffusion weighted imaging reliably distinguish cysts from solid masses? Skelet Radiol 42:1583–1592CrossRefGoogle Scholar
  20. 20.
    Bland JM, Altman DG (1999) Measuring agreement in method comparison studies. Stat Methods Med Res 8:135–160CrossRefPubMedGoogle Scholar
  21. 21.
    Altman DG (1991) Practical statistics for medical research. Chapman & Hall, LondonGoogle Scholar
  22. 22.
    Sasaki M, Yamada K, Watanabe Y et al (2008) Variability in absolute apparent diffusion coefficient values across different platforms may be substantial: a multivendor, multi-institutional comparison study. Radiology 249:624–630CrossRefPubMedGoogle Scholar
  23. 23.
    Giles SL, Messiou C, Collins DJ et al (2014) Whole-body diffusion-weighted MR imaging for assessment of treatment response in myeloma. Radiology 271:785–794CrossRefPubMedGoogle Scholar
  24. 24.
    Sung JK, Jee WH, Jung JY et al (2014) Differentiation of acute osteoporotic and malignant compression fractures of the spine: use of additive qualitative and quantitative axial diffusion-weighted MR imaging to conventional MR imaging at 3.0 T. Radiology 271:488–498CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Radiology 2015

Authors and Affiliations

  • So-Yeon Lee
    • 1
    • 2
  • Won-Hee Jee
    • 1
    Email author
  • Joon-Yong Jung
    • 1
  • Michael Y. Park
    • 1
  • Sun-Ki Kim
    • 1
    • 3
  • Chan-Kwon Jung
    • 4
  • Yang-Guk Chung
    • 5
  1. 1.Department of Radiology, Seoul St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaSeoulKorea
  2. 2.Department of Radiology, Kangbuk Samsung HospitalSungkyunkwan University School of MedicineSeoulKorea
  3. 3.Department of Radiology, Incheon St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaIncheonKorea
  4. 4.Department of Pathology, Seoul St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaSeoulKorea
  5. 5.Department of Orthopedic Surgery, Seoul St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaSeoulKorea

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