Skip to main content
Log in

Is there a role for diffusion-weighted MRI (DWI) in the diagnosis of central cartilage tumors?

  • Scientific Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript



To assess if diffusion-weighted MRI (DWI) can differentiate between central enchondromas and chondrosarcomas (CS) and if DWI can distinguish low-grade chondroid lesions from high-grade CS.

Materials and methods

Fifty-two patients with central cartilage tumors were included. Patients underwent conventional MRI and DWI with ADC mapping. The slice on MRI with the most aggressive imaging feature was identified. The corresponding mean and minimum ADC maps of the tumor at this position were measured.


There were 24 enchondromas, five atypical cartilaginous lesions, 15 grade 1, three grade 2, two grade 3, and three dedifferentiated CS. Mean ADC values (×10−6 mm2/s) for enchondromas, atypical cartilaginous tumors, grade 1 CS, grade 2, CS, grade 3 CS and dedifferentiated CS were 1,896, 2,048, 2,152, 2,170, 2,076, and 1,261, respectively. Minimum ADC values (×10−6 mm2/s) for enchondromas, atypical cartilaginous tumors, grade 1 CS, grade 2, CS, grade 3 CS and dedifferentiated CS were 1,820, 1,752, 2,010, 1,829, 1,752, and 767, respectively. ANOVA test demonstrated a statistically significant difference in mean and minimum ADC values in all groups. Post hoc analysis revealed this was due to difference in mean and minimum ADC values in dedifferentiated CS. The mean ADC value in low-grade chondroid lesions was 2,001, while the ADC value for high-grade CS were 2,132. The minimum ADC value for low-grade chondroid lesions was 1,896, while the minimum ADC for high-grade CS was 1,837. The difference in minimum and mean ADC values was not statistically significant.


DWI cannot differentiate between enchondromas and CS and DWI does not aid in the distinction of low-grade chondroid tumors from high-grade CS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others


  1. Hogendoorn PCW, Bovee JVMG, Nielsen GP. Chondrosarcoma. In: Fletcher CDM, Bridge JA, Hogendoorn PCW, Mertens F, editors. World Health Organization classification of tumours of soft tissue and bone. Lyon: IARC Press; 2013. p. 264–8.

  2. Walden MJ, Murphey MD, Vidal JA. Incidental enchondromas of the knee. AJR Am J Roentgenol. 2008;190:1611–5.

    Article  PubMed  Google Scholar 

  3. Hong ED, Carrino JA, Weber KL, Fayad LM. Prevalence of shoulder enchondromas on routine MR imaging. Clin Imaging. 2011;35:378–84.

    Article  PubMed  Google Scholar 

  4. Douis H, Saifuddin A. The imaging of cartilaginous bone tumours. II. Chondrosarcoma. Skeletal Radiol. 2013;42:611–26.

    Article  CAS  PubMed  Google Scholar 

  5. Reliability of histopathologic and radiologic grading of cartilaginous neoplasms in long bones. Skeletal Lesions Interobserver Correlation among Expert Diagnosticians (SLICED) Study Group. J Bone Joint Surg Am 2007; 89: 2113–2123.

  6. Koh DM, Collins DJ. Diffusion-weighted MRI in the body: applications and challenges in oncology. AJR Am J Roentgenol. 2007;188:1622–35.

    Article  PubMed  Google Scholar 

  7. Khoo MM, Tyler PA, Saifuddin A, Padhani AR. Diffusion-weighted imaging (DWI) in musculoskeletal MRI: a critical review. Skeletal Radiol. 2011;40:665–81.

    Article  PubMed  Google Scholar 

  8. Hayashida Y, Hirai T, Yakushiji T, Katahira K, Shimomura O, Imuta M, et al. Evaluation of diffusion-weighted imaging for the differential diagnosis of poorly contrast-enhanced and T2-prolonged bone masses: initial experience. J Magn Reson Imaging. 2006;23:377–82.

    Article  PubMed  Google Scholar 

  9. Yakushiji T, Oka K, Sato H, Yorimitsu S, Fujimoto T, Yamashita Y, et al. Characterization of chondroblastic osteosarcoma: gadolinium-enhanced versus diffusion-weighted MR imaging. J Magn Reson Imaging. 2009;29:895–900.

    Article  PubMed  Google Scholar 

  10. Stratta M, Robba T, Clementi V, Regis G, Gallo A, Piana R, et al. DWI in the differential diagnosis of enchondroma and central chondrosarcoma. Skeletal Radiol. 2012;41:1179–87.

    Article  Google Scholar 

  11. Grimer RJ, Carter SR, Tillman RM, Mangham DC, Abudu A, Fiorenza F. Chondrosarcoma of bone. J Bone Joint Surg Am. 2000;82-A:1203–4.

    CAS  PubMed  Google Scholar 

  12. Douis H, Singh L, Saifuddin A. MRI differentiation of low-grade from high-grade appendicular chondrosarcoma. Eur Radiol. 2014;24:232–40.

    Article  PubMed  Google Scholar 

  13. Inwards C, Hogendoorn PCW. Dedifferentiated chondrosarcoma. In: Fletcher CDM, Bridge JA, Hogendoorn PCW, Mertens F, editors. World Health Organization classification of tumours of soft tissue and bone. Lyon: IARCP; 2013. p. 269–70.

  14. Murphey MD, Flemming DJ, Boyea SR, Bojescul JA, Sweet DE, Temple HT. Enchondroma versus chondrosarcoma in the appendicular skeleton: differentiating features. Radiographics. 1998;18:1213–37. quiz 1244–1215.

    Article  CAS  PubMed  Google Scholar 

  15. Eefting D, Schrage YM, Geirnaerdt MJ, Le Cessie S, Taminiau AH, Bovee JV, et al. Assessment of interobserver variability and histologic parameters to improve reliability in classification and grading of central cartilaginous tumors. Am J Surg Pathol. 2009;33:50–7.

    Article  PubMed  Google Scholar 

  16. Verdegaal SH, Brouwers HF, van Zwet EW, Hogendoorn PC, Taminiau AH. Low-grade chondrosarcoma of long bones treated with intralesional curettage followed by application of phenol, ethanol, and bone-grafting. J Bone Joint Surg Am. 2012;94:1201–7.

    Article  PubMed  Google Scholar 

  17. Rizzo M, Ghert MA, Harrelson JM, Scully SP. Chondrosarcoma of bone: analysis of 108 cases and evaluation for predictors of outcome. Clin Orthop Relat Res. 2001;391:224–33.

    Article  PubMed  Google Scholar 

  18. Subhawong TK, Jacobs MA, Fayad LM. Diffusion-weighted MR, imaging for characterizing musculoskeletal lesions. Radiographics. 2014;34:1163–77.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Hanna SA, Whittingham-Jones P, Sewell MD, Pollock RC, Skinner JA, Saifuddin A, et al. Outcome of intralesional curettage for low-grade chondrosarcoma of long bones. Eur J Surg Oncol. 2009;35:1343–7.

    Article  CAS  PubMed  Google Scholar 

  20. Donati D, Colangeli S, Colangeli M, Di Bella C, Bertoni F. Surgical treatment of grade I central chondrosarcoma. Clin Orthop Relat Res. 2010;468:581–9.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Yoo HJ, Hong SH, Choi JY, Moon KC, Kim HS, Choi JA, et al. Differentiating high-grade from low-grade chondrosarcoma with MR imaging. Eur Radiol. 2009;19:3008–14.

    Article  PubMed  Google Scholar 

  22. Messiou C, Collins DJ, Morgan VA, Desouza NM. Optimising diffusion weighted MRI for imaging metastatic and myeloma bone disease and assessing reproducibility. Eur Radiol. 2011;21:1713–8.

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

There is no conflict of interest to declare.

Author information

Authors and Affiliations


Corresponding author

Correspondence to H. Douis.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Douis, H., Jeys, L., Grimer, R. et al. Is there a role for diffusion-weighted MRI (DWI) in the diagnosis of central cartilage tumors?. Skeletal Radiol 44, 963–969 (2015).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: