Do contrast-enhanced and advanced MRI sequences improve diagnostic accuracy for indeterminate lipomatous tumors?

Brett A Shannon; Shivani Ahlawat; Carol D Morris; Adam S Levin; Laura M Fayad

doi:10.1007/s11547-021-01420-1

Do contrast-enhanced and advanced MRI sequences improve diagnostic accuracy for indeterminate lipomatous tumors?

Radiol Med. 2022 Jan;127(1):90-99. doi: 10.1007/s11547-021-01420-1. Epub 2021 Oct 25.

Authors

Brett A Shannon¹, Shivani Ahlawat², Carol D Morris^{1

3}, Adam S Levin¹, Laura M Fayad^{4

5

6}

Affiliations

¹ Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
² Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD, 21287, USA.
³ Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁴ Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. [email protected].
⁵ Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD, 21287, USA. [email protected].
⁶ Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. [email protected].

PMID: 34697728
DOI: 10.1007/s11547-021-01420-1

Abstract

Purpose: Benign, intermediate-grade and malignant tumors sometimes have overlapping imaging and clinical characteristics. The purpose of this study was to evaluate the added value of contrast-enhanced sequences (dynamic contrast enhancement (DCE)), diffusion-weighted imaging (DWI), and chemical shift imaging (CSI) to noncontrast MRI sequences for the characterization of indeterminate lipomatous tumors.

Materials and methods: Thirty-two consecutive patients with histologically proven peripheral lipomatous tumors were retrospectively evaluated. Two musculoskeletal radiologists recorded the MRI features in three sessions: (1) with noncontrast T1-weighted and fluid-sensitive sequences; (2) with addition of static pre- and post-contrast 3D volumetric T1-weighted sequences; and (3) with addition of DCE, DWI, and CSI. After each session, readers recorded a diagnosis (benign, intermediate/atypical lipomatous tumor (ALT), or malignant/dedifferentiated liposarcoma (DDL)). Categorical imaging features (presence of septations, nodules, contrast enhancement) and quantitative metrics (apparent diffusion coefficient values, CSI signal loss) were recorded.

Results: For 32 tumors, the diagnostic accuracy of both readers did not improve with the addition of contrast-enhanced sequences, DWI, or CSI (53% (17/32) session 1; 50% (16/30) session 2; 53% (17/32) session 3). Noncontrast features, including thick septations (p = 0.025) and nodules ≥ 1 cm (p < 0.001), were useful for differentiating benign tumors from ALTs and DDLs, as were DWI (p = 0.01) and CSI (p = 0.009) metrics.

Conclusion: The addition of contrast-enhanced sequences (static, DCE), DWI, and CSI to a conventional, noncontrast MRI protocol did not improve diagnostic accuracy for differentiating benign, intermediate-grade, and malignant lipomatous tumors. However, we identified potentially useful imaging features by DCE, DWI, and CSI that may help distinguish these entities.

Keywords: Atypical lipomatous tumor; Lipoma; Liposarcoma; MRI; Neoplasm.

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
Child
Contrast Media*
Diagnosis, Differential
Diffusion Magnetic Resonance Imaging
Female
Humans
Image Enhancement / methods*
Lipoma / diagnostic imaging*
Liposarcoma / diagnostic imaging*
Magnetic Resonance Imaging / methods*
Male
Middle Aged
Muscle Neoplasms / diagnostic imaging*
Reproducibility of Results
Retrospective Studies
Sensitivity and Specificity
Young Adult

Substances

Contrast Media