Characterization of indeterminate soft tissue masses referred for biopsy: What is the added value of contrast imaging at 3.0 tesla?

Abstract

3 J. Magn. Reson. Imaging 2017;45:390-400.

Magnetic resonance imaging biomarkers in musculoskeletal soft tissue tumors: Review of conventional features and focus on nonmorphologic imaging

“…Delayed, static contrast‐enhanced MR images are helpful to detect central necrosis, perilesional enhancement, and local anatomic extent; however, vital information regarding tumor biology and its neovascularity may only be obtained with DCE MRI . DCE MRI can be performed either with the rapid acquisition and low anatomic resolution or with gradient echo volume acquisition using higher anatomic resolution and lower temporal resolution …”

“…The ADC value represents the slope of the linear regression of signal loss on DWI using each b‐value . The ADC value is a quantitative marker assigned to the degree of motion in tissue and is increasingly used as a quantitative biomarker for cellularity in soft tissue imaging …”

“…Because of the variability in study design and the inclusion of varied soft tissue tumor types in investigations of DWI thus far, a robust ADC cutoff to distinguish benign from malignant soft tissue masses is not available. However, several studies have shown that the minimum ADC value is the most useful metric . A minimum ADC value of less than 1.0 × 10 ‐3 mm 2 /s has been suggested as a clinically useful threshold value to characterize malignancy, as the mean ADC value can be diluted by intralesional cystic regions and necrosis .…”

Review of dynamic contrast‐enhanced MRI: Technical aspects and applications in the musculoskeletal system

“…DCE‐MRI has been suggested as a method to help differentiate benign from malignant processes, as the temporal pattern of enhancement contains important information, including perfusion, vascularity, and the volume of the interstitial space . As a result, the addition of DCE‐MRI to routine anatomic and static postcontrast sequences has been shown to improve characterization of musculoskeletal lesions for malignancy …”

“…Also, the detection volume of 3–5 mm 3 was considered as the lower threshold volume for detection of abnormal enhancement . Other authors have used a temporal resolution of greater than 6 s with success in differentiating benign and malignant entities …”