Role of Conventional and Diffusion Weighted MRI in the Evaluation of Pediatric Musculoskeletal Tumors
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- Category: Vol. 85, June 2017
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Role of Conventional and Diffusion Weighted MRI in the Evaluation of Pediatric Musculoskeletal Tumors, ESSAM A. AL-SHEIKH, IMAN M. ZAKI, LOBNA M. SHALABY, YAHIA L. MAHMOUD and MARWA A. ABOU EL-HASSAN
Abstract
Background: Soft tissue masses usually represent a diag-nostic dilemma, since there is a large and heterogeneous group of lesions than can manifest as such in children, including both neoplastic and non neoplastic lesions.
Purpose: To evaluate the signal characteristics of conven-tional and diffusion weighted MRI sequences of musculosk-eletal tumors in pediatric patients and their corresponding ADC measurements and their ability to differentiate between benign and malignant lesions and their response to therapy.
Material and Methods: From July 2012 to March 2014 twenty three children with soft tissue tumors 15 malignant (8 denovo and 7 cases received treatment) and 8 benign were assessed by conventional and diffusion MR images. Diffusion was carried out by single shot SE-EPI sequence using 0, 500 and 1000. ADC was automatically generated on the operating console.
Results: The mean ADC of benign tumors was 1.4 X 10–3 mm2/s. While that of malignant tumors was 0.9 X 10–3mm2/s, p value < 0.001. However overlap still exists. ROC analysis produced a cut off value >1.1 X 10–3mm2/s has 100% speci-ficity and 87.5% sensitivity. The mean ADC of tumors that had received treatment was 1.8 X 10–3mm2/s which was proved to be significantly different from that of de novo malignant tumors.
Conclusion: DWI and ADC can assist in evaluation of musculoskeletal tumors in conjunction with conventional sequences but do not have high accuracy. They may be used as markers to assess tumor response. Further dedicated study of a bigger sample is recommended to confirm our results, especially concerning follow-up of tumors and the use of perfusion insensitive ADC.