title: Radiological indeterminate vestibular schwannoma and meningioma in cerebellopontine angle area: differentiating using whole-tumor histogram analysis of apparent diffusion coefficient.
abstract: OBJECTIVE
  To assess the role of whole-tumor histogram analysis of apparent diffusion coefficient (ADC) maps in differentiating radiological indeterminate vestibular schwannoma (VS) from meningioma in cerebellopontine angle (CPA).
  
  
  METHODS
  Diffusion-weighted (DW) images (b = 0 and 1000 s/mm2) of pathologically confirmed and radiological indeterminate CPA meningioma (CPAM) (n = 27) and VS (n = 12) were retrospectively collected and processed with mono-exponential model. Whole-tumor regions of interest were drawn on all slices of the ADC maps to obtain histogram parameters, including the mean ADC (ADCmean), median ADC (ADCmedian), 10th/25th/75th/90th percentile ADC (ADC10, ADC25, ADC75and ADC90), skewness and kurtosis. The differences of ADC histogram parameters between CPAM and VS were compared using unpaired t-test. Multiple receiver operating characteristic (ROC) curves analysis was used to determine and compare the diagnostic value of each significant parameter.
  
  
  RESULTS
  Significant differences were found on the ADCmean, ADCmedian, ADC10, ADC25, ADC75and ADC90between CPAM and VS (all p values < 0.001), while no significant difference was found on kurtosis (p = 0.562) and skewness (p = 0.047). ROC curves analysis revealed, a cut-off value of 1.126 × 10-3mm2/s for the ADC90value generated highest area under curves (AUC) for differentiating CPAM from VS (AUC, 0.975; sensitivity, 100%; specificity, 88.9%).
  
  
  CONCLUSIONS
  Histogram analysis of ADC maps based on whole tumor can be a useful tool for differentiating radiological indeterminate CPAM from VS. The ADC90value was the most promising parameter for differentiating these two entities.
authors.affiliation: a Department of Radiology , The First Affiliated Hospital of Nanjing Medical University , Nanjing , China.
authors.forename: Xiao-Quan
authors.initials: XQ
authors.lastname: Xu
authors.affiliation: a Department of Radiology , The First Affiliated Hospital of Nanjing Medical University , Nanjing , China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Li
authors.affiliation: a Department of Radiology , The First Affiliated Hospital of Nanjing Medical University , Nanjing , China.
authors.forename: Xun-Ning
authors.initials: XN
authors.lastname: Hong
authors.affiliation: a Department of Radiology , The First Affiliated Hospital of Nanjing Medical University , Nanjing , China.
authors.forename: Fei-Yun
authors.initials: FY
authors.lastname: Wu
authors.affiliation: a Department of Radiology , The First Affiliated Hospital of Nanjing Medical University , Nanjing , China.
authors.forename: Hai-Bin
authors.initials: HB
authors.lastname: Shi
mesh_terms: D000328:Adult; D002530:Cerebellopontine Angle / Q000000981:diagnostic imaging*; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008577:Meningeal Neoplasms / Q000000981:diagnostic imaging*; D008579:Meningioma / Q000000981:diagnostic imaging*; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000000981:diagnostic imaging*; D012372:ROC Curve; D012189:Retrospective Studies
keywords: cerebellopontine angle; diffusion-weighted imaging; histogram analysis; meningioma; vestibular schwannoma