Diffusion weighted MRI of mediastinal masses: Can measurement of ADC value help in the differentiation between benign and malignant lesions

Nasr, Amin M.; Elshahat, Hazem Mohamed; Safwat, Hadeer; Alsaif, Rand F; Alshehab, D.; Shebl, Mohamed

doi:10.1016/j.ejrnm.2015.12.002

Cited by 9 publications

(15 citation statements)

References 15 publications

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“…In agreement with Nasr et al, there was no statistically significant difference between the ADC mean values of lymphoma and the ADC mean values of the rest of the histopathological groups conjointly. Tondo et al, 2011 reported similar results to ours where no significant difference was found between bronchogenic carcinoma (adenocarcinomas) and malignant mediastinal lesions in their study [11,16].…”

Section: Discussionsupporting

confidence: 83%

“…Moreover, the 32 malignant mediastinal lesions studied by Nasr et al, 2016 included lymphoma, bronchogenic carcinoma, invasive thymoma, and metastases. No significant difference between their ADCmean values was found as well [11].…”

Section: Discussionmentioning

confidence: 77%

“…One lesion, namely a malignant teratoma had an ADC mean evidently higher than these cut-off ADC values (ADCmean = 2.44 × 10− 3 mm 2 /s) and was hence mistaken for a benign lesion. This may be explained by the fact that when the mass was surgically excised, it proved malignant only by the presence of microscopic foci of immature neuroepithelial component [11,13,14,16,17].…”

Section: Discussionmentioning

confidence: 99%

“…Quantitative assessment of a tumor is possible by calculating its apparent diffusion coefficient (ADC) value which is inversely correlated with tissue cellularity. Hence, DWI has been proposed as a cancer biomarker with the diagnostic potential to distinguish benign from malignant tumors because of the tendency of the latter to show more restricted diffusion, i.e., lower ADC values (Table 2) [9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

“…Studies, conducted over the past few years, showed that the ADC values of malignant mediastinal lesions are significantly lower than those of benign lesions and determined cut-off ADC values to differentiate the two; concluding that ADC value is a promising noninvasive, imaging parameter that helps assess and characterize mediastinal tumors. Further studies were recommended [11,[13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

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Role of diffusion weighted MR-imaging in the evaluation of malignant mediastinal lesions

Sabri

Nossair

Assal

et al. 2020

Egypt J Radiol Nucl Med

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Background: Conducted studies showed that the ADC (apparent diffusion coefficient) values of malignant mediastinal lesions are significantly lower than those of benign lesions. Investigators determined cut-off ADC values to differentiate the two; concluding that ADC value is a promising noninvasive, imaging parameter that helps assess and characterize mediastinal tumors. Taking this a step forward, the primary objective of our prospective study was to investigate the potential of DW-MRI (diffusion-weighted magnetic resonance imaging) to characterize malignant mediastinal lesions using their ADC values. Thirty-three patients that underwent MRI of the chest with DWI and latter pathologically diagnosed with a malignant mediastinal lesion were included in this study. Lesions' ADC values were measured and correlated with the histopathological results. The statistical significance of differences between measurements was tested using the one-way ANOVA (analysis of variance) test; p values equal to or less than 0.05 were considered significant. Results: There was no statistically significant difference between the ADC mean values of the histopathological groups of lesions assessed with the overlap of their ADC mean values. The average ADC mean value of NHL (non-Hodgkin lymphoma) was evidently lower than that of HD (Hodgkin disease) with no overlap between their ADC mean values. DWI failed at characterizing one lesion in this study as a malignant tumor, namely an immature teratoma (germ-cell tumor). Again DWI could not be used to evaluate a mass, latter pathologically diagnosed as an angiosarcoma, because of its overall hemorrhagic nature showing no definite non-hemorrhagic soft tissue components. The aforementioned results did not differ considerably when minimum ADC was used instead of mean ADC. Conclusion: There was no statistically significant difference between the ADC values of the malignant mediastinal lesions evaluated. However, regarding lymphoma subtypes, our limited sample study of lymphoma suggested a considerable difference between the ADC values of Hodgkin disease and non-Hodgkin lymphoma.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Role of diffusion weighted MR-imaging in the evaluation of malignant mediastinal lesions

Sabri

Nossair

Assal

et al. 2020

Egypt J Radiol Nucl Med

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MR diffusion imaging and ADC measurement in solid and cystic mediastinal masses for differentiating benign from malignant lesions

El-Nahas

Sadek

Gwely

et al. 2018

The Egyptian Journal of Radiology and Nuclear Medicine

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Role of diffusion-weighted MRI in characterization of mediastinal masses

Raafat

Ahmed

Seif

et al. 2020

Egypt J Radiol Nucl Med

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Background Diffusion MR imaging (DWI) is a widely available non-invasive non-contrast functional MR imaging technique with short acquisition time. It helps in the analysis of tissue characteristics based on the diffusion of water protons within the tissue. Quantitative assessment of a mass is possible by calculating its apparent diffusion coefficient (ADC) value which is inversely correlated with tissue cellularity. So, DWI has diagnostic potential to distinguish benign from malignant tumors because of the tendency of the latter to show lower ADC values and more restricted diffusion. The aim of our work is to evaluate the use of DWI and ADC value measurement in differentiation between benign and malignant mediastinal tumors. Results This study included 44 cases of mediastinal masses: 27 males and 17 females. The mean ADC value of malignant mediastinal lesions was significantly lower than the mean ADC value of benign mediastinal lesions, with mean ADC 1.39 ± 0.26 in benign mediastinal lesions and mean ADC 0.86 ± 0.35 in malignant mediastinal lesions. This study also revealed that the cut-off threshold of ADC value for the differentiation between malignant and benign lesions was 1.11 × 10-3 mm2/s, with an area under ROC curve of 0.93. The sensitivity and specificity of our cutoff ADC values were 90.9% and 100%, with 100% positive predictive value and 76.9% negative predictive value. Conclusion DWI with calculation of ADC value is functional MR imaging technique used in the analysis of tissue characteristics and quantitative assessment of a mediastinal mass. So, it can distinguish benign from malignant tumors because of the tendency of the malignant lesions to show more restricted diffusion and lower ADC values.

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Diffusion weighted MRI of mediastinal masses: Can measurement of ADC value help in the differentiation between benign and malignant lesions

Cited by 9 publications

References 15 publications

Role of diffusion weighted MR-imaging in the evaluation of malignant mediastinal lesions

Role of diffusion weighted MR-imaging in the evaluation of malignant mediastinal lesions

MR diffusion imaging and ADC measurement in solid and cystic mediastinal masses for differentiating benign from malignant lesions

Role of diffusion-weighted MRI in characterization of mediastinal masses

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