Benign and malignant skull-involved lesions: discriminative value of conventional CT and MRI combined with diffusion-weighted MRI

Abstract

Background

Little is known about the value of computed tomography (CT) and magnetic resonance imaging (MRI) combined with diffusion-weighted imaging (DWI) in distinguishing malignant from benign skull-involved lesions.

Purpose

To evaluate the discriminative value of DWI combined with conventional CT and MRI for differentiating between benign and malignant skull-involved lesions.

Material and Methods

CT and MRI findings of 58 patients with pathologically proven skull-involved lesions (43 benign and 15 malignant) were retrospectively reviewed. Conventional CT and MRI characteristics and apparent diffusion coefficient (ADC) value of the two groups were evaluated and compared. Multivariate logistic regression and receiver operating characteristic (ROC) curve analyses were performed to assess the differential performance of each parameter separately and together.

Results

The presence of cortical defects or break-through and ill-defined margins were associated with malignant skull-involved lesions (both P < 0.05). Malignant skull-involved lesions demonstrated a significantly lower ADC (P = 0.016) than benign lesions. ROC curve analyses indicated that a combination of CT, MRI, and DWI with an ADC ≤ 0.703 × 10^–3 mm²/s showed optimal sensitivity, while DWI along showed optimal specificity of 88.4% in differentiating between benign and malignant skull-involved lesions.

Conclusion

The combination of CT, MRI, and DWI can help to differentiate malignant from benign skull-involved lesions. CT + MRI + DWI offers optimal sensitivity, while DWI offers optimal specificity.

Keywords

Skull-involved lesion neoplasm magnetic resonance imaging diffusion-weighted imaging computed tomography

Get full access to this article

View all access options for this article.

References

Amaral

Chiurciu

Almeida

et al.

MR imaging for evaluation of lesions of the cranial vault: a pictorial essay. Arq Neuropsiquiatr 2003; 61: 521–532.

Colas

Caron

Cotten

. Skull vault lesions: a review. Am J Roentgenol 2015; 205: 840–847.

Yalcin

Yildirim

Kizilkilic

et al.

CT and MRI findings in calvarial non-infectious lesions. Diagn Interv Radiol 2007; 13: 68–74.

Garfinkle

Melancon

Cortes

et al.

Imaging pattern of calvarial lesions in adults. Skeletal Radiol 2011; 40: 1261–1273.

Thomas

Baker

Jr . Assessment of roentgenographic lucencies of the skull: a systematic approach. Neurology 1975; 25: 99–106.

Ginat

Mangla

Yeaney

et al.

Diffusion-weighted imaging of skull lesions. J Neurol Surg B Skull Base 2014; 75: 204–213.

Ginat

Mangla

Yeaney

et al.

Diffusion-weighted imaging for differentiating benign from malignant skull lesions and correlation with cell density. Am J Roentgenol 2012; 198: W597–601.

Cao

Liang

Gen

et al.

Role of diffusion-weighted imaging for detecting bone marrow infiltration in skull in children with acute lymphoblastic leukemia. Diagn Interv Radiol 2016; 22: 580–586.

Nemeth

Henson

Mullins

et al.

Improved detection of skull metastasis with diffusion-weighted MR imaging. Am J Neuroradiol 2007; 28: 1088–1092.

10.

Abdel Razek

Mossad

Ghonim

. Role of diffusion-weighted MR imaging in assessing malignant versus benign skull-base lesions. Radiol Med 2011; 116: 125–132.

11.

Schaefer

Grant

Gonzalez

. Diffusion-weighted MR imaging of the brain. Radiology 2000; 217: 331–345.

12.

Curnes

. MR imaging of peripheral intracranial neoplasms: extraaxial vs intraaxial masses. J Comput Assist Tomogr 1987; 11: 932–937.

13.

Beltran

Aparisi

Bonmati

et al.

Eosinophilic granuloma: MRI manifestations. Skeletal Radiol 1993; 22: 157–161.

14.

Okamoto

Ito

Furusawa

et al.

Imaging of calvarial eosinophil granuloma. Neuroradiology 1999; 41: 723–728.

15.

De Schepper

Ramon

Van Marck

. MR imaging of eosinophilic granuloma: report of 11 cases. Skeletal Radiol 1993; 22: 163–166.

16.

Ginsberg

. Radiology of meningiomas. J Neurooncol 1996; 29: 229–238.

17.

Daffner

Yakulis

Maroon

. Intraosseous meningioma. Skeletal Radiol 1998; 27: 108–111.

18.

Avrahami

Even

. Osteoma of the inner table of the skull–CT diagnosis. Clin Radiol 2000; 55: 435–438.

19.

White

Zhang

Robinson

. Evaluating tumors and tumorlike lesions of the nasal cavity, the paranasal sinuses, and the adjacent skull base with diffusion-weighted MRI. J Comput Assist Tomogr 2006; 30: 490–495.

20.

Thoeny

De Keyzer

King

. Diffusion-weighted MR imaging in the head and neck. Radiology 2012; 263: 19–32.

21.

Yeom

Holdsworth

Van

et al.

Comparison of readout-segmented echo-planar imaging (EPI) and single-shot EPI in clinical application of diffusion-weighted imaging of the pediatric brain. Am J Roentgenol 2013; 200: W437–443.

22.

Holdsworth

Skare

Newbould

et al.

Readout-segmented EPI for rapid high resolution diffusion imaging at 3 T. Eur J Radiol 2008; 65: 36–46.

23.

Holdsworth

Yeom

Skare

et al.

Clinical application of readout-segmented- echo-planar imaging for diffusion-weighted imaging in pediatric brain. Am J Neuroradiol 2011; 32: 1274–1279.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.15 MB