title: Characterization of indeterminate soft tissue masses referred for biopsy: What is the added value of contrast imaging at 3.0 tesla?
abstract: To assess the added value of contrast-enhanced (CE) MR sequences (static CE-MR sequences, dynamic CE-MR sequences) to noncontrast enhanced MR sequences (non-CE-MR sequences) including T1, fluid-sensitive, and diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) mapping for characterizing "indeterminate" soft tissue masses (STMs) as benign or malignant.
  
  
  
  Thirty-nine patients with indeterminate STMs (27 benign, 12 malignant) underwent 3 Tesla MRI with conventional non-CE-MR sequences (T1-weighted, fluid-sensitive), DWI (b-values 50, 400, 800, ADC mapping), dynamic CE-MR sequences (7-s time resolution), and static CE-MR sequences. Two readers independently reviewed imaging in four sessions (conventional non-CE-MR sequences alone, conventional+DWI/ADC, conventional+DWI/ADC+static CE-MR sequences, conventional+DWI/ADC+static CE-MR sequences dynamic CE-MR sequences). Readers recorded the potential of malignancy at each session; reader diagnostic performance (receiver operating characteristics analysis) and inter-observer variability (weighted kappa [k]) were determined.
  
  
  
  Diagnostic performance for distinguishing benign and malignant STMs was highest with the addition of dynamic CE-MR sequences (reader 1, area under the curve [AUC] 0.91; reader 2, AUC 0.88). The diagnostic performance of static CE-MR sequences (reader 1, AUC 0.86; reader 2, AUC 0.84) was not superior to non-CE-MR sequences with DWI (reader 1, AUC 0.88; reader 2, AUC 0.8). Interobserver agreement was: k = 0.82 (static CE-MRI), k = 0.79 (dynamic CE-MRI), k = 0.53 (non-CE-MR sequences without DWI), and k = 0.63 (with DWI).
  
  
  
  Non-CE-MR sequences offer similar diagnostic performance to imaging with the addition of static CE-MR sequences, but their interobserver reliability is lower. The addition of dynamic CE-MR sequences offers the higher diagnostic performance for distinguishing benign and malignant indeterminate STMs.
  
  
  
  3 J. Magn. Reson. Imaging 2017;45:390-400.
authors.affiliation: Johns Hopkins University School of Medicine, The Russell H Morgan Department of Radiology and Radiological Sciences, Baltimore, Maryland, USA.|Ospedale Regionale di Lugano, Servizio di Radiologia. Lugano, Ticino, Switzerland.
authors.forename: Filippo
authors.initials: F
authors.lastname: Del Grande
authors.affiliation: Johns Hopkins University School of Medicine, The Russell H Morgan Department of Radiology and Radiological Sciences, Baltimore, Maryland, USA.
authors.forename: Shivani
authors.initials: S
authors.lastname: Ahlawat
authors.affiliation: Department of Radiology (R-109), University of Miami, Miami, Florida, USA.
authors.forename: Ty
authors.initials: T
authors.lastname: Subhawong
authors.affiliation: Johns Hopkins University School of Medicine, The Russell H Morgan Department of Radiology and Radiological Sciences, Baltimore, Maryland, USA.
authors.forename: L M
authors.initials: LM
authors.lastname: Fayad
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media; D005260:Female; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008875:Middle Aged; D015588:Observer Variation; D015995:Prevalence; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012983:Soft Tissue Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology*; D014600:Utilization Review; D055815:Young Adult
chemical_list: D003287:Contrast Media
keywords: DWI; MRI-contrast enhanced imaging; soft tissue tumors