Journal Article
. 2013 Aug;42(11).
doi: 10.1007/s00256-013-1703-7.

Characterization of soft tissue masses: can quantitative diffusion weighted imaging reliably distinguish cysts from solid masses?

Ty K Subhawong 1 Daniel J Durand  Gaurav K Thawait  Michael A Jacobs  Laura M Fayad  
  • PMID: 23974467
  •     39 References
  •     17 citations


Objective: To investigate the accuracy of quantitative diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) mapping for characterizing soft tissue masses (STMs) as cysts or solid masses.

Materials And Methods: This IRB-approved retrospective study included 36 subjects with 37 STMs imaged by conventional MRI (T1-weighted, T2-weighted, contrast-enhanced T1-weighted sequences) and DWI (b-values 50, 400, 800 s/mm(2)) with ADC mapping. STMs were defined as non-solid cysts by histology or clinical follow-up, and as solid by histology. For each STM, ADC values (range, mean) were recorded by two observers. Differences between ADC values in cysts and solid STMs were compared using Wilcoxon rank-sum and receiver-operating characteristic (ROC) analysis.

Results: There were higher minimum (1.65 vs 0.68, p = 0.003) and mean (2.31 vs 1.45, p = 0.005) ADC values in cysts than solid STMs respectively. Areas under the ROC for minimum and mean ADC values were 0.82 and 0.81 respectively. Using threshold ADC values of 1.8 (minimum) or 2.5 (mean) yielded a sensitivity of 60 % and 80 % respectively, and a specificity of 100 % for classifying a STM as a cyst; for tumors with high fluid-signal intensity, the performance of these threshold values was maintained.

Conclusion: Diffusion-weighted imaging with ADC mapping provides a non-contrast MRI alternative for the characterization of STMs as cysts or solid masses. Threshold ADC values exist that provide 100 % specificity for differentiating cysts and solid STMs, even for tumors of high fluid-signal intensity on T2-weighted images.

Comparison of biexponential and monoexponential model of diffusion weighted imaging in evaluation of renal lesions: preliminary experience.
Hersh Chandarana, Vivian S Lee, +2 authors, Eric E Sigmund.
Invest Radiol, 2010 Nov 26; 46(5). PMID: 21102345
Musculoskeletal ultrasound and MRI: which do I choose?
Jon A Jacobson.
Semin Musculoskelet Radiol, 2005 Jul 27; 9(2). PMID: 16044382
Diffusion-weighted MR imaging of the liver.
Bachir Taouli, Dow-Mu Koh.
Radiology, 2009 Dec 25; 254(1). PMID: 20032142
Highly Cited. Review.
Diffusion-weighted imaging of tumor recurrencies and posttherapeutical soft-tissue changes in humans.
A Baur, A Huber, +5 authors, M Reiser.
Eur Radiol, 2001 May 25; 11(5). PMID: 11372617
Role of ultrasound in the diagnosis of common soft tissue lesions of the limbs.
Size Wu, Rong Tu, Guangqing Liu, Yusen Shi.
Ultrasound Q, 2013 Feb 02; 29(1). PMID: 23370782
Differentiation of hepatic tumors by use of image contrast with T2-weighted MRI.
Akio Ogura, Katsumi Hayakawa, +4 authors, Takaharu Murata.
Radiol Phys Technol, 2009 Jan 01; 2(1). PMID: 20821129
Diffusion-weighted imaging of soft tissue tumors: usefulness of the apparent diffusion coefficient for differential diagnosis.
Shuji Nagata, Hiroshi Nishimura, +7 authors, Naofumi Hayabuchi.
Radiat Med, 2008 Jul 29; 26(5). PMID: 18661213
Usefulness of diffusion-weighted MRI with echo-planar technique in the evaluation of cellularity in gliomas.
T Sugahara, Y Korogi, +9 authors, M Takahashi.
J Magn Reson Imaging, 1999 Feb 25; 9(1). PMID: 10030650
Highly Cited.
Diffusion-weighted MR for differentiation of breast lesions at 3.0 T: how does selection of diffusion protocols affect diagnosis?
Wolfgang Bogner, Stephan Gruber, +6 authors, Siegfried Trattnig.
Radiology, 2009 Aug 26; 253(2). PMID: 19703869
Diffusion-weighted MRI in the body: applications and challenges in oncology.
Dow-Mu Koh, David J Collins.
AJR Am J Roentgenol, 2007 May 23; 188(6). PMID: 17515386
Highly Cited. Review.
Diffusion-weighted imaging improves the diagnostic accuracy of conventional 3.0-T breast MR imaging.
Riham H Ei Khouli, Michael A Jacobs, +4 authors, David A Bluemke.
Radiology, 2010 Jun 25; 256(1). PMID: 20574085    Free PMC article.
Highly Cited.
The role of MR imaging in soft tissue tumor evaluation: perspective of the orthopedic oncologist and musculoskeletal pathologist.
F J Frassica, J A Khanna, E F McCarthy.
Magn Reson Imaging Clin N Am, 2001 Jan 10; 8(4). PMID: 11149686
Sonographic detection of Baker's cysts: comparison with MR imaging.
E E Ward, J A Jacobson, +2 authors, M van Holsbeeck.
AJR Am J Roentgenol, 2001 Feb 13; 176(2). PMID: 11159077
Magnetic resonance imaging of musculoskeletal soft tissue masses.
M J Siegel.
Radiol Clin North Am, 2001 Sep 11; 39(4). PMID: 11549166
Breast MRI: Are T2 IR sequences useful in the evaluation of breast lesions?
Laura Ballesio, Sara Savelli, +8 authors, Lucia Manganaro.
Eur J Radiol, 2008 May 16; 71(1). PMID: 18479866
Soft-tissue masses: diagnosis using MR imaging.
M J Kransdorf, J S Jelinek, +4 authors, B H Berrey.
AJR Am J Roentgenol, 1989 Sep 01; 153(3). PMID: 2763953
The role of parallel diffusion-weighted imaging and apparent diffusion coefficient (ADC) map values for evaluating breast lesions: preliminary results.
Guangwei Jin, Ningyu An, Michael A Jacobs, Kuncheng Li.
Acad Radiol, 2010 Mar 09; 17(4). PMID: 20207316    Free PMC article.
Assessment of soft tissue tumours of the extremities with diffusion echoplanar MR imaging.
A Razek, N Nada, M Ghaniem, S Elkhamary.
Radiol Med, 2011 Jul 12; 117(1). PMID: 21744251
Relationship between apparent diffusion coefficient and signal intensity in endometrial and other pelvic cysts.
Takao Moteki, Hiroyuki Horikoshi, Keigo Endo.
Magn Reson Imaging, 2002 Oct 04; 20(6). PMID: 12361793
Soft-tissue tumors and tumorlike lesions: a systematic imaging approach.
Jim S Wu, Mary G Hochman.
Radiology, 2009 Oct 30; 253(2). PMID: 19864525
Diffusion-weighted imaging (DWI) in musculoskeletal MRI: a critical review.
Michael M Y Khoo, Philippa A Tyler, Asif Saifuddin, Anwar R Padhani.
Skeletal Radiol, 2011 Feb 12; 40(6). PMID: 21311884
Magnetic resonance imaging of soft tissue tumors.
A M De Schepper, L De Beuckeleer, J Vandevenne, J Somville.
Eur Radiol, 2000 Feb 09; 10(2). PMID: 10663750
Accuracy of MRI in characterization of soft tissue tumors and tumor-like lesions. A prospective study in 548 patients.
Jan L M A Gielen, Arthur M De Schepper, +4 authors, Joost Weyler.
Eur Radiol, 2004 Aug 04; 14(12). PMID: 15290067
MR imaging of intravoxel incoherent motions: application to diffusion and perfusion in neurologic disorders.
D Le Bihan, E Breton, +3 authors, M Laval-Jeantet.
Radiology, 1986 Nov 01; 161(2). PMID: 3763909
Highly Cited.
Analysis of cystic intracranial lesions performed with fluid-attenuated inversion recovery MR imaging.
I Aprile, F Iaiza, +5 authors, G Fabris.
AJNR Am J Neuroradiol, 1999 Sep 03; 20(7). PMID: 10472983    Free PMC article.
Ability of diffusion-weighted imaging for the differential diagnosis between chronic expanding hematomas and malignant soft tissue tumors.
Kiyoshi Oka, Toshitake Yakushiji, +4 authors, Hiroshi Mizuta.
J Magn Reson Imaging, 2008 Oct 31; 28(5). PMID: 18972359
Diffusion-weighted MRI of soft tissue tumours.
Hildur Einarsdóttir, Magnus Karlsson, Johan Wejde, Henrik C F Bauer.
Eur Radiol, 2004 Feb 10; 14(6). PMID: 14767604
Diffusion measurements in intracranial hematomas: implications for MR imaging of acute stroke.
S W Atlas, P DuBois, M B Singer, D Lu.
AJNR Am J Neuroradiol, 2000 Aug 23; 21(7). PMID: 10954267
The diagnostic value of diffusion-weighted magnetic resonance imaging in soft tissue abscesses.
Ozkan Unal, Halil Ibrahim Koparan, +2 authors, Erol Kisli.
Eur J Radiol, 2009 Sep 15; 77(3). PMID: 19748752
MR imaging of skeletal soft tissue infection: utility of diffusion-weighted imaging in detecting abscess formation.
Srinivasan Harish, Mary M Chiavaras, Nikhil Kotnis, Ryan Rebello.
Skeletal Radiol, 2010 Jun 17; 40(3). PMID: 20552358
Proton, diffusion-weighted imaging, and sodium (23Na) MRI of uterine leiomyomata after MR-guided high-intensity focused ultrasound: a preliminary study.
Michael A Jacobs, Ronald Ouwerkerk, +3 authors, Hyun S Kim.
J Magn Reson Imaging, 2009 Feb 27; 29(3). PMID: 19243047    Free PMC article.
Diffusion-weighted magnetic resonance imaging as a cancer biomarker: consensus and recommendations.
Anwar R Padhani, Guoying Liu, +11 authors, Peter L Choyke.
Neoplasia, 2009 Feb 04; 11(2). PMID: 19186405    Free PMC article.
Highly Cited.
Diffusion-weighted magnetic resonance imaging for the evaluation of musculoskeletal tumors.
Flávia Martins Costa, Elisa Carvalho Ferreira, Evandro Miguelote Vianna.
Magn Reson Imaging Clin N Am, 2010 Dec 07; 19(1). PMID: 21129640
MR imaging differentiation of soft-tissue hemangiomas from malignant soft-tissue masses.
E L Teo, P J Strouse, R J Hernandez.
AJR Am J Roentgenol, 2000 Jun 14; 174(6). PMID: 10845496
Principles and applications of diffusion-weighted imaging in cancer detection, staging, and treatment follow-up.
Ashkan A Malayeri, Riham H El Khouli, +4 authors, Katarzyna J Macura.
Radiographics, 2011 Oct 15; 31(6). PMID: 21997994
Soft-tissue tumors evaluated by line-scan diffusion-weighted imaging: influence of myxoid matrix on the apparent diffusion coefficient.
Masayuki Maeda, Akihiko Matsumine, +4 authors, Kan Takeda.
J Magn Reson Imaging, 2007 May 24; 25(6). PMID: 17520732
From the archives of the AFIP: Imaging of synovial sarcoma with radiologic-pathologic correlation.
Mark D Murphey, Michael S Gibson, +3 authors, Donald A Gajewski.
Radiographics, 2006 Sep 16; 26(5). PMID: 16973781
Diffusion-weighted MRI in the characterization of soft-tissue tumors.
Catherina S P van Rijswijk, Patrik Kunz, +3 authors, Johan L Bloem.
J Magn Reson Imaging, 2002 Mar 14; 15(3). PMID: 11891975
Water diffusion compartmentation and anisotropy at high b values in the human brain.
C A Clark, D Le Bihan.
Magn Reson Med, 2000 Dec 07; 44(6). PMID: 11108621
Highly Cited.
Diffusion-weighted imaging of skeletal muscle lymphoma.
Alexey Surov, Curd Behrmann.
Skeletal Radiol, 2014 Mar 19; 43(7). PMID: 24638123
Diffusion-weighted MR imaging for characterizing musculoskeletal lesions.
Ty K Subhawong, Michael A Jacobs, Laura M Fayad.
Radiographics, 2014 Sep 11; 34(5). PMID: 25208274    Free PMC article.
Comparison of ADC values in different malignancies of the skeletal musculature: a multicentric analysis.
Alexey Surov, Shuji Nagata, +3 authors, Thomas Kahn.
Skeletal Radiol, 2015 Apr 29; 44(7). PMID: 25916616
Case of pseudoaneurysm mimicking a soft tissue sarcoma: a diagnostic pitfall.
Sandeep Albert, Sanju Daniel, Mohamad Gouse, Vinu Mathew Cherian.
Malays J Med Sci, 2015 May 30; 22(2). PMID: 26023297    Free PMC article.
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 Jee, +4 authors, Yang-Guk Chung.
Eur Radiol, 2015 Jun 18; 26(3). PMID: 26080796
Diffusion-weighted imaging in musculoskeletal radiology-clinical applications and future directions.
Nicholas Bhojwani, Peter Szpakowski, +8 authors, Mark R Robbin.
Quant Imaging Med Surg, 2015 Dec 19; 5(5). PMID: 26682143    Free PMC article.
Diffusion-Weighted Imaging in Meningioma: Prediction of Tumor Grade and Association with Histopathological Parameters.
Alexey Surov, Sebastian Gottschling, +4 authors, Eckhard Fiedler.
Transl Oncol, 2015 Dec 23; 8(6). PMID: 26692534    Free PMC article.
Translational research in diagnosis and management of soft tissue tumours.
Eugenio Rimondi, Maria Serena Benassi, +5 authors, Daniel Vanel.
Cancer Imaging, 2016 Jun 09; 16(1). PMID: 27266712    Free PMC article.
Current whole-body MRI applications in the neurofibromatoses: NF1, NF2, and schwannomatosis.
Shivani Ahlawat, Laura M Fayad, +15 authors, REiNS International Collaboration Members 2016.
Neurology, 2016 Aug 17; 87(7 Suppl 1). PMID: 27527647    Free PMC article.
Correlations between intravoxel incoherent motion (IVIM) parameters and histological findings in rectal cancer: preliminary results.
Alexey Surov, Hans Jonas Meyer, +4 authors, Nikita Garnov.
Oncotarget, 2017 Apr 21; 8(13). PMID: 28423540    Free PMC article.
Diffusion weighted imaging demystified: the technique and potential clinical applications for soft tissue imaging.
Shivani Ahlawat, Laura M Fayad.
Skeletal Radiol, 2017 Nov 22; 47(3). PMID: 29159675
Can MRI diffusion-weighted imaging identify postoperative residual/recurrent soft-tissue sarcomas?
Mai Maher ElDaly, Amr Farouk Ibrahim Moustafa, +2 authors, Nagui Abd El Wahab.
Indian J Radiol Imaging, 2018 Apr 26; 28(1). PMID: 29692531    Free PMC article.
Is MRI diffusion-weighted imaging a reliable tool for the diagnosis and post-therapeutic follow-up of extremity soft tissue neoplasms?
Amr Farouk Ibrahim Moustafa, Mai Maher Eldaly, Rania Zeitoun, Ahmed Shokry.
Indian J Radiol Imaging, 2020 Jan 18; 29(4). PMID: 31949339    Free PMC article.
Conventional MR and diffusion-weighted imaging of musculoskeletal soft tissue malignancy: correlation with histologic grading.
Avneesh Chhabra, Oganes Ashikyan, +5 authors, Yin Xi.
Eur Radiol, 2018 Dec 05; 29(8). PMID: 30511176
Use of ultrasound combined with magnetic resonance imaging for diagnosis of breast masses and fibroids.
Wei Xiang, Zihui Huang, +4 authors, Fanrong Meng.
J Int Med Res, 2019 Jun 04; 47(7). PMID: 31155996    Free PMC article.
Integrated Multiparametric Radiomics and Informatics System for Characterizing Breast Tumor Characteristics with the OncotypeDX Gene Assay.
Michael A Jacobs, Christopher B Umbricht, +5 authors, Antonio C Wolff.
Cancers (Basel), 2020 Oct 01; 12(10). PMID: 32992569    Free PMC article.
Advances in Diffusion and Perfusion MRI for Quantitative Cancer Imaging.
Mehran Baboli, Jin Zhang, Sungheon Gene Kim.
Curr Pathobiol Rep, 2020 Dec 22; 7(4). PMID: 33344067    Free PMC article.