The Role of Dynamic Contrast Enhancement MR Imaging as A Modality to Differentiate between Benign and Malignant bone lesion

Abstract

The study was aimed to determine Time Intensity Curve (TIC) type and slope value on Dynamic Contrast Enhancement Magnetic Resonance Imaging (DCE-MRI) examination technique to differentiate between benign and malignant bone lesion. The study was done on December 2018 to July 2019 with retrospective cross sectional analytic study. The samples were bone lesion patients which was examined with Dynamic Contrast Enhancement on 3T MRI. The sample size were 15 subjects, consisted of 8 (53.3%) males and 7 (46.7%) females. The age range of subjects was 13 to 75 years old (38,20 ± 20.49 y.o). Patients with malignant bone lesion were 9 (60%) people and benign bone lesion were 6 (40%) people. DCE-MRI could assess tissue vascularization and perfusion based on TIC. In this study, benign bone lesion showed TIC type 2 and 3, while malignant bone lesion mostly showed TIC type 4, with mean slope value of malignant bone lesion was 83,66 ± 75,34 % and for benign bone lesion was 9,82 ± 5,94 % with cut-off value for malignancy of >26,70%/m. The mean slope value differential for malignant and benign bone lesion was statistically significant (p<0.05). TIC examination had sensitivity of 75% and specificity of 100% in differentiating malignant and benign bone lesion. The difference in pattern type and mean slope value of TIC between benign and malignant bone lesion showed that DCE-MRI has important role in differentiating between benign and malignant bone lesion.

Characteristic of Apparent Diffusion Coefficient and Time Intensity Curve Analysis of Dynamic Contrast Enhanced MRI in Osteosarcoma Histopathologic Subtypes

“…The highest quantitative of TIC results using %slope and ME representation covered its steepest slope value which accurately reflected tumor vascularization. These results were similar to previous studies conducted by Varidha and Setiawati in 2020, they reported that the mean slope of osteosarcoma was 68.59%/s 26 . Yong Park et al (2014) stated that the steepest slope and early relative elevation signal intensity have a potential role in differentiating benign and malignant soft tissue tumor 27 .…”

“…Tucbilek et al (2004) stated that the steepest lope value accurately reflects tumor vascularization, the malignant soft tissue tumor showed early elevation signal intensity and steepest slope e.g. liposarcoma 28 . Two cases of chondroblastic and osteoblastic OS with the presented of ADC value mapping and TIC on DCE were described on Figure 1 and Figure 2.…”

“…The strong relationship between the mean value of ADC and ME found in this study was in accordance with the principle of contrast enhancement in producing a TIC curve. It was the total volume of accumulated contrast agent in tumor vascular and interstitial space (EES), reflected in the maximum increase between changes in tumor signal intensity before and after enhancement 27,28,29 . The osteosarcoma subtypes exhibited the distinct radiologic features that may be mimicked by various benign and malignant bone tumor entities.…”

An imaging‑based diagnostic approach to vascular anomalies of the oral and maxillofacial region

“…In the present study, the majority of the CI curves of the VAs exhibited an early peak of enhancement before 200 sec (T-peak <200 sec), with this enhancement peak being weak (CI-peak <2.0), after which the contrast intensity remained constant for a period of 400–600 sec, in what is known as the ‘plateau phase’. Varidha et al ( 33 ) reported that a CI curve of rapid early enhancement followed by a plateau has limited specificity in terms of benign vascular lesion characterization. They also suggested that early enhancement is a result of high microvascularization and tissue perfusion, whereas a plateau phase results from the accumulation of contrast in the neovasculature and its surrounding interstitium due to a change in endothelial permeability.…”

“…Varidha et al (33) reported that a CI curve of rapid early enhancement followed by a plateau has limited specificity in terms of benign vascular lesion characterization. They also suggested that early enhancement is a result of high microvascularization and tissue perfusion, whereas a plateau phase results from the accumulation of contrast in the neovasculature and its surrounding interstitium due to a change in endothelial permeability.…”