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Utility of apparent diffusion coefficient (ADC) values in differentiating benign and malignant skull lesions with
Aishwarya K Mahendrakar1, Sunitha Palasamudram Kumaran1, Bhavana Nagabhushan Reddy1
1Department of Radiology, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore 560066, India.
Aim:
Assess role of ADC in differentiating benign and malignant skull lesions and to evaluate the added value of ADC over conventional MRI in facilitating the differentiation.
Materials And Methods:
53 patients (24 males, 29 females; age 3-75 years) were subjected to both conventional and Diffusion weighted (DWI) MR imaging. DWI was performed using a single-shot SE EPI sequence with b-values of 0& 1000 s/mm2 on 1.5 T MR scanner. Margins of the lesion, number, soft-tissue component, local extension, periosteal reaction and enhancement pattern were the parameters used for differentiating benign & malignant lesions by conventional MRI. ADC values (mean of 3 ROIs over solid component) were calculated. Conventional MRI characteristics and ADC value of lesions were evaluated & compared using statistical analysis. These findings were compared and correlated with histopathology of the skull lesions.
Results:
24 malignant and 29 benign lesions were identified on HPE (Histopathological examination) in 53 patients. ADC cut-off value of 0.96 × 10-3 mm2/s obtained from ROC curve was found to have 75.47% accuracy, 87.5% sensitivity, 65.52% specificity, 67.74% PPV and 86.36% NPV for differentiating malignant from benign lesions. Statistically significant differences (p < 0.05) were seen in the mean ADC values of malignant (0.64 ± 0.42 × 10-3 mm2/s) and benign lesions (1.14 ± 0.56 × 10-3 mm2/s). The sensitivity, specificity, PPV and NPV in differentiating benign & malignant skull lesions were found to be 58.33%, 62.07%, 56% and 64.29% respectively, with diagnostic accuracy of 60.38% on using conventional MRI alone and 75%, 72.41%, 69.23% and 77.78% respectively, with diagnostic accuracy of 73.58% on using conventional MRI with ADC.
Conclusion:
ADC is a promising non-invasive parameter that facilitates differentiation between benign and malignant skull lesions. It is a robust biomarker to narrow differentials when conventional imaging features are indeterminate.
