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Added-value of advanced magnetic resonance imaging to conventional morphologic analysis for the differentiation between benign and malignant non-fatty soft-tissue tumors

  • Musculoskeletal
  • Published:
European Radiology Aims and scope Submit manuscript

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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Abbreviations

CHAID:

Chi-squared automatic interaction detector

DCE-P:

Dynamic contrast-enhanced perfusion

DWI:

Diffusion-weighted imaging

H-MRS:

Magnetic resonance spectroscopy

NFSTT:

Non-fatty soft tissue tumor

R1/2/3/4:

Reader 1/2/3/4

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Service d’imagerie Guilloz, Hôpital Central, Centre Hospitalier Régional Universitaire de Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035, Nancy cedex, France

    Gauthier Dodin, Salma Jendoubi, Waled Abou Arab, Alain Blum & Pedro Augusto Gondim Teixeira

  2. Département de Biostatistique, Institut de Cancérologie de Lorraine, 6 avenue de Bourgogne, F-54519, Vandœuvre-lès-Nancy cedex, France

    Julia Salleron

  3. Centre Chirurgical Emile-Gallé, Centre Hospitalier Régional Universitaire de Nancy, 49, rue Hermite, 54000, Nancy cedex, France

    François Sirveaux

Authors
  1. Gauthier Dodin
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  2. Julia Salleron
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  3. Salma Jendoubi
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  4. Waled Abou Arab
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  7. Pedro Augusto Gondim Teixeira
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Correspondence to Gauthier Dodin.

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Guarantor

The scientific guarantor of this publication is Pr Pedro Augusto GONDIM TEIXEIRA.

Conflict of interest

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.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects have been previously reported in prior studies in our institution.

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• performed at one institution

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Dodin, G., Salleron, J., Jendoubi, S. et al. 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 31, 1536–1547 (2021). https://doi.org/10.1007/s00330-020-07190-0

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  • DOI: https://doi.org/10.1007/s00330-020-07190-0

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