title: Characterization of soft tissue masses: can quantitative diffusion weighted imaging reliably distinguish cysts from solid masses?
abstract: OBJECTIVE
  To investigate the accuracy of quantitative diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) mapping for characterizing soft tissue masses (STMs) as cysts or solid masses.
  
  
  METHODS
  This IRB-approved retrospective study included 36 subjects with 37 STMs imaged by conventional MRI (T1-weighted, T2-weighted, contrast-enhanced T1-weighted sequences) and DWI (b-values 50, 400, 800 s/mm(2)) with ADC mapping. STMs were defined as non-solid cysts by histology or clinical follow-up, and as solid by histology. For each STM, ADC values (range, mean) were recorded by two observers. Differences between ADC values in cysts and solid STMs were compared using Wilcoxon rank-sum and receiver-operating characteristic (ROC) analysis.
  
  
  RESULTS
  There were higher minimum (1.65 vs 0.68, p = 0.003) and mean (2.31 vs 1.45, p = 0.005) ADC values in cysts than solid STMs respectively. Areas under the ROC for minimum and mean ADC values were 0.82 and 0.81 respectively. Using threshold ADC values of 1.8 (minimum) or 2.5 (mean) yielded a sensitivity of 60 % and 80 % respectively, and a specificity of 100 % for classifying a STM as a cyst; for tumors with high fluid-signal intensity, the performance of these threshold values was maintained.
  
  
  CONCLUSIONS
  Diffusion-weighted imaging with ADC mapping provides a non-contrast MRI alternative for the characterization of STMs as cysts or solid masses. Threshold ADC values exist that provide 100 % specificity for differentiating cysts and solid STMs, even for tumors of high fluid-signal intensity on T2-weighted images.
authors: Department of Radiology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, 1611 NW 12th Ave, JMH WW 279, Miami, FL, 33136, USA, tsubhawong@med.miami.edu.
authors: Ty K
authors: TK
authors: Subhawong
authors: Daniel J
authors: DJ
authors: Durand
authors: Gaurav K
authors: GK
authors: Thawait
authors: Michael A
authors: MA
authors: Jacobs
authors: Laura M
authors: LM
authors: Fayad
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003560:Cysts / Q000473:pathology*; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012983:Soft Tissue Neoplasms / Q000473:pathology*; D055815:Young Adult
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