The diagnostic accuracy of intravoxel incoherent motion and diffusion kurtosis imaging in the differentiation of malignant and benign soft-tissue masses: which is better?
Restricted accessResearch articleFirst published online June, 2022
The diagnostic accuracy of intravoxel incoherent motion and diffusion kurtosis imaging in the differentiation of malignant and benign soft-tissue masses: which is better?
It is difficult for conventional magnetic resonance imaging (MRI) to distinguish benign soft-tissue masses (STMs) from malignant masses.
Purpose
To quantitatively compare the diagnostic value of intravoxel incoherent motion (IVIM) and diffusion kurtosis imaging (DKI) in STMs.
Material and Methods
The data from 58 patients with STMs were retrospectively analyzed. The GE Discovery 3.0-T MRI scanner was used to acquire conventional MRI sequences, IVIM, and DKI images. The chi-square test, independent sample t-test, and Mann–Whitney U tests were used to compare the differences between conventional MRI features, IVIM, and DKI parameters (Dslow, Dfast, f, mean kurtosis [MK], and mean diffusivity [MD]) between the benign and malignant groups. Receiver-operating characteristic (ROC) curve analysis was also performed.
Results
Tumor size and depth are statistically different in STTs. Dslow, MK, and MD values in the malignant groups are significantly lower than the benign groups (P < 0.05). However, Dfast and f values are not statistically different between the two groups. The area under the curve (AUC) of Dslow value (0.859) is higher than MD (0.765) and MK (0.676) values for identifying benign and malignant STMs. The Dslow value showed the best specificity (82.93%). The sensitivity and specificity of IVIM and DKI parameters are higher than that of conventional MRI sequences.
Conclusion
IVIM and DKI can be used to distinguish between benign and malignant STMs, with Dslow as the most meaningful parameter.
BrunoFArrigoniFMarianiS, et al.
Advanced magnetic resonance imaging (MRI) of soft tissue tumors: techniques and applications. Radiol Med2019;
124:243–252.
BeamanFDJelinekJSPriebatDA.Current imaging and therapy of malignant soft tissue tumors and tumor-like lesions. Semin Musculoskelet Radiol 2013;
17:168–176.
4.
De La Hoz PoloMDickEBhumbraR, et al.
Surgical considerations when reporting MRI studies of soft tissue sarcoma of the limbs. Skeletal Radiol2017;
46:1667–1678.
5.
FenzlLBubelKMehrmannM, et al.
Imaging and biopsy of soft tissue tumors. Der Radiologe2018;
58:79–92.
6.
MoriiTKishinoTShimamoriN, et al.
Differential diagnosis between benign and malignant soft tissue tumors utilizing ultrasound parameters. J Med Ultrason2018;
45:113–119.
7.
AhmedAAAbedalthagafiM.Cancer diagnostics: The journey from histomorphology to molecular profiling. Oncotarget2016;
7:58696–58708.
8.
SennerstamRBFranzénBSHWiksellHOT, et al.
Core-needle biopsy of breast cancer is associated with a higher rate of distant metastases 5 to 15 years after diagnosis than FNA biopsy. Cancer Cytopathol2017;
125:748–756.
9.
SchwaigerBJGersingASBaumT, et al.
Distinguishing benign and malignant vertebral fractures using CT and MRI. Semin Musculoskelet Radiol2016;
20:345–352.
10.
LiuXChengDWangW.MRI in differentiation of benign and malignant tongue tumors. Front Biosci (Landmark Ed)2015;
20:614–620.
11.
ManasterBJ.Soft-tissue masses: optimal imaging protocol and reporting. AJR Am J Roentgenol2013;
201:505–514.
12.
ParkSYChungHWChaeSY, et al.
Comparison of MRI and PET-CT in detecting the loco-regional recurrence of soft tissue sarcomas during surveillance. Skeletal Radiol2016;
45:1375–1384.
13.
GielenJLMADe SchepperAMVanhoenackerF, et al.
Accuracy of MRI in characterization of soft tissue tumors and tumor-like lesions. A prospective study in 548 patients. Eur Radiol2004;
14:2320–2330.
14.
ParkJWYooHJKimHS, et al.
MRI surveillance for local recurrence in extremity soft tissue sarcoma. Eur J Surg Oncol2019;
45:268–274.
15.
SongYYoonYCChongY, et al.
Diagnostic performance of conventional MRI parameters and apparent diffusion coefficient values in differentiating between benign and malignant soft-tissue tumours. Clin Radiol2017;
72:691.e1–691.e10.
16.
WuHZhangSLiangC, et al.
Intravoxel incoherent motion MRI for the differentiation of benign, intermediate, and malignant solid soft-tissue tumors. J Magn Reson Imaging2017;
46:1611–1618.
17.
CallejaMDimigenMSaifuddinA.MRI of superficial soft tissue masses: analysis of features useful in distinguishing between benign and malignant lesions. Skeletal Radiol2012;
41:1517–1524.
18.
FayadLMJacobsMAWangX, et al.
Musculoskeletal tumors: how to use anatomic, functional, and metabolic MR techniques. Radiology2012;
265:340–356.
19.
ShanYChenXLiuK, et al.
Prostate cancer aggressive prediction: preponderant diagnostic performances of intravoxel incoherent motion (IVIM) imaging and diffusion kurtosis imaging (DKI) beyond ADC at 3.0 T scanner with Gleason score at final pathology.Abdom Radiol (NY)2019;
44:3441–3452.
20.
MaeharaM.Development of voxel-based optimization diffusion kurtosis imaging (DKI) and comparison with conventional DKI. Radiol Phys Technol2019;
12:290–298.
21.
Le BihanDBretonELallemandD, et al.
Separation of diffusion and perfusion in intravoxel incoherent motion MR imaging. Radiology1988;
168:497–505.
22.
WanQDengYSLeiQ, et al.
Differentiating between malignant and benign solid solitary pulmonary lesions: are intravoxel incoherent motion and diffusion kurtosis imaging superior to conventional diffusion-weighted imaging?Eur Radiol2019;
29:1607–1615.
23.
RosenkrantzABPadhaniARChenevertTL, et al.
Body diffusion kurtosis imaging: Basic principles, applications, and considerations for clinical practice. J Magn Reson Imaging2015;
42:1190–1202.
24.
BennettKMHydeJSSchmaindaKM.Water diffusion heterogeneity index in the human brain is insensitive to the orientation of applied magnetic field gradients. Magn Reson Med2006;
56:235–239.
25.
WuGLiuXXiongY, et al.
Intravoxel incoherent motion and diffusion kurtosis imaging for discriminating soft tissue sarcoma from vascular anomalies. Medicine (Baltimore)2018;
97:e13641.
26.
JensenJHHelpernJARamaniA, et al.
Diffusional kurtosis imaging: the quantification of non-gaussian water diffusion by means of magnetic resonance imaging. Magn Reson Med2005;
53:1432–1440.
27.
DingYTanQMaoW, et al.
Differentiating between malignant and benign renal tumors: do IVIM and diffusion kurtosis imaging perform better than DWI?Eur Radiol2019;
29:6930–6939.
28.
WuGXieRLiuX, et al.
Intravoxel incoherent motion diffusion MR and diffusion kurtosis imaging for discriminating atypical bone metastasis from benign bone lesion. Br J Radiol 2019;
92:20190119.
29.
LimHKJeeW-HJungJ-Y, et al.
Intravoxel incoherent motion diffusion-weighted MR imaging for differentiation of benign and malignant musculoskeletal tumours at 3 T. Br J Radiol2018;
91:20170636.
30.
GruberLGruberHLugerAK, et al.
Diagnostic hierarchy of radiological features in soft tissue tumours and proposition of a simple diagnostic algorithm to estimate malignant potential of an unknown mass. Eur J Radiol2017;
95:102–110.
31.
DatirAJamesSAliK, et al.
MRI of soft-tissue masses: the relationship between lesion size, depth, and diagnosis. Clin Radiol2008;
63:373–378; discussion 379–380.
32.
ChhabraAAshikyanOSlepickaC, et al.
Conventional MR and diffusion-weighted imaging of musculoskeletal soft tissue malignancy: correlation with histologic grading. Eur Radiol2019;
29:4485–4494.
33.
SumiMVan CauterenMSumiT, et al.
Salivary gland tumors: use of intravoxel incoherent motion MR imaging for assessment of diffusion and perfusion for the differentiation of benign from malignant tumors. Radiology2012;
263:770–777.
34.
XuX-QHuHSuG-Y, et al.
Differentiation between orbital malignant and benign tumors using intravoxel incoherent motion diffusion-weighted imaging: Correlation with dynamic contrast-enhanced magnetic resonance imaging. Medicine (Baltimore) 2019;
98:e14897.
35.
MaoXZouXYuN, et al.
Quantitative evaluation of intravoxel incoherent motion diffusion-weighted imaging (IVIM) for differential diagnosis and grading prediction of benign and malignant breast lesions. Medicine (Baltimore)2018;
97:e11109.
36.
OgawaMKanHAraiN, et al.
Differentiation between malignant and benign musculoskeletal tumors using diffusion kurtosis imaging. Skeletal Radiol2019;
48:285–292.
37.
MinosseSMarziSPiluduF, et al.
Correlation study between DKI and conventional DWI in brain and head and neck tumors. Magn Reson Imaging2017;
42:114–122.
38.
LiHMZhaoSHQiangJW, et al. Diffusion kurtosis imaging for differentiating borderline from malignant epithelial ovarian tumors: A correlation with Ki-67 expression. J Magn Reson Imaging2017;
46:1499–1506.
39.
DasSKYangDJWangJL, et al.
Non-Gaussian diffusion imaging for malignant and benign pulmonary nodule differentiation: a preliminary study. Acta Radiol2017;
58:19–26.
