title: Diffusion-weighted MRI and in-phase/opposed-phase sequences in the assessment of bone tumors.
abstract: To evaluate the role of diffusion-weighted apparent diffusion coefficient (ADC) and in-phase/opposed-phase sequences in the differentiation of benign and malignant osseous tumors.
  
  
  
  At 1.5T, routine sequences were compared to diffusion-weighted and in-phase/opposed-phase in 63 patients. Routine sequence magnetic resonance imaging (MRI) scoring, mean ADC value, and in-phase/opposed-phase signal intensity ratio (SIR) was obtained. Statistical analysis included significance, receiver operating characteristic (ROC), and linear correlation between the three parameters.
  
  
  
  In all, 38 patients had malignant tumors and 25 patients had benign tumors. Benign and malignant tumors showed different routine sequence scores (P < 0.001). Mean ADC of the benign lesions ranged 0.9-3.2 × 10(-3) mm(2) /sec of mean ± SD (1.9 ± 0.6). In malignant tumors, the mean ADC ranged 0.6-1.9 × 10(-3) mm(2) /sec of mean ± SD (1.1 ± 0.4) (P < 0.0001). There was a possible differentiation between malignant and benign tumors at a threshold of 1.1 × 10(-3) mm(2) /sec of sensitivity and specificity of 94.1% and 70.3%, respectively. SIR for benign tumors ranged 0.2-1.0 of mean ± SD (0.6 ± 0.3). For malignant lesions SIR ranged 0.4-1.2 of mean ± SD (0.8 ± 0.3). Benign and malignant tumors show statistically significant SIR at P < 0.022 with possible differentiation at a threshold of 0.75 of sensitivity and specificity of 70.3% and 76.5%, respectively. Simple linear correlation between both ADC and SIR was significant at P < 0.01 with correlation coefficient (r) = 0.45.
  
  
  
  Diffusion-weighted and in-phase/opposed-phase imaging might be used in addition to conventional MRI as a routine tool for differentiation of benign and malignant tumors. J. Magn. Reson. Imaging 2016;44:565-572.
authors.affiliation: Radiology Department, Alexandria University, Alexandria, Egypt.
authors.forename: Wessam M
authors.initials: WM
authors.lastname: Amin
authors.affiliation: Radiology Department, Alexandria University, Alexandria, Egypt.
authors.forename: Hesham T
authors.initials: HT
authors.lastname: Kotb
authors.affiliation: Radiology Department, Alexandria University, Alexandria, Egypt.
authors.forename: Ali A
authors.initials: AA
authors.lastname: Abdel-Kerim
authors.affiliation: Radiology Department, Alexandria University, Alexandria, Egypt.
authors.forename: Mohamed S
authors.initials: MS
authors.lastname: Barakat
authors.affiliation: Orthopedic surgery Department, Alexandria University, Alexandria, Egypt.
authors.forename: Awad A
authors.initials: AA
authors.lastname: El-Malky
authors.affiliation: Oncology Department, Alexandria University, Alexandria, Egypt.
authors.forename: Shady H
authors.initials: SH
authors.lastname: Fadel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001859:Bone Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012815:Signal Processing, Computer-Assisted; D055815:Young Adult
keywords: bone-osseous tumors; chemical shift imaging; diffusion; in-phase/opposed-phase