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Dynamic MRI and fine needle aspiration cytology in the evaluation of soft tissue lesions
Hildur Einarsdóttir1, Veli Söderlund, Lambert Skoog
1Department of Radiology, Karolinska Hospital, Stockholm, Sweden. hildur.einarsdottir@ks.se
Objective:
To assess the usefulness of dynamic magnetic resonance imaging (DMRI) in the diagnosis of soft tissue tumors.
Design And Patients:
A DMRI series of 33 patients with soft tissue lesions was evaluated with regard to start, pattern, and progression of enhancement. Early enhancement, predominantly peripheral, and a time-signal intensity (TSI) curve characterized by a steep rise to an early peak followed by a plateau or washout, were considered signs of malignancy. The results were compared with the initial fine needle aspiration cytology (FNAC) diagnosis and the final diagnosis.
Results:
Twenty of 23 malignant lesions and three of 10 benign lesions exhibited at least two of the three enhancement characteristics attributed to malignancy. Using two or more DMRI features of malignancy to dichotomize the series, the sensitivity and positive predictive value of the DMRI series were 87% and, the specificity and negative predictive value were 70%. FNAC was conclusive except in two cases.
Conclusion:
In tumor centers that rely on FNAC for preoperative diagnosis DMRI can be reserved for cytologically inconclusive cases. In centers that rely on open biopsy, DMRI may be useful as a coarse discriminator between benign and malignant lesions. However, larger series of soft tissue tumors need to be evaluated to conclusively identify the clinical role of DMRI.
