TY - JOUR
T1 - Diffusion weighted imaging of extremity bone tumors— inter-reader analysis and incremental value over conventional MR imaging
AU - Guirguis, Mina
AU - Gupta, Anurag
AU - Thakur, Uma J
AU - Pezeshk, Parham
AU - Weatherall, Paul T
AU - Sharan, Gaurav
AU - Xi, Yin
AU - Chhabra, Avneesh
N1 - Publisher Copyright:
© 2023, British Institute of Radiology. All rights reserved.
PY - 2023/11/1
Y1 - 2023/11/1
N2 - Objective: To determine whether the addition of diffusion-weighted imaging (DWI) to conventional MRI improves diagnostic accuracy of bone tumor characterization with the hypothesis that the DWI has incremental value in the diagnosis of osseous tumors. Methods: In this multireader cross-sectional validation study, four musculoskeletal radiologists evalu-ated osseous tumors blinded to final diagnosis in two rounds—first without DWI or apparent diffusion coeffi-cient (ADC) maps, then months later with these avail-able. Each reader recorded a binary result as to whether the lesion is benign or malignant. Intraclass correlation (ICC) and Conger’s κ were used. Diagnostic performance measures including area under the receiver operating curve (AUC) were reported. Results: 133 osseous tumors of the extremities (76 benign, 57 malignant) were tested. Blinded to DWI, average reader sensitivity, specificity, positive-predictive value, and negative-predictive value were 0.83, 0.92, 0.94, and 0.82, respectively. With DWI, the values were 0.85, 0.92, 0.94, and 0.83, respectively. Interreader agreement was good for both rounds (0.67 and 0.71, respectively, p-value > 0.05). Average reader confidence was 4.1 and 4.4, respectively (p-value < 0.001). ADC values and DWI/ADC ratios showed significant differ-ences between benign and malignant tumors. Conclusion: DWI and ADC show statistically significantly different values of benign from malignant osseous tumors and mildly increased radiologist confidence with similar interreader reliability. However, given similar diagnostic accuracy, conventional MR imaging is adequate for bone tumor characterization and incremental value of DWI is limited. Advances in knowledge: This paper is the first of its kind to report the use of DWI/ADC ratio for the diagnosis of bone tumors.
AB - Objective: To determine whether the addition of diffusion-weighted imaging (DWI) to conventional MRI improves diagnostic accuracy of bone tumor characterization with the hypothesis that the DWI has incremental value in the diagnosis of osseous tumors. Methods: In this multireader cross-sectional validation study, four musculoskeletal radiologists evalu-ated osseous tumors blinded to final diagnosis in two rounds—first without DWI or apparent diffusion coeffi-cient (ADC) maps, then months later with these avail-able. Each reader recorded a binary result as to whether the lesion is benign or malignant. Intraclass correlation (ICC) and Conger’s κ were used. Diagnostic performance measures including area under the receiver operating curve (AUC) were reported. Results: 133 osseous tumors of the extremities (76 benign, 57 malignant) were tested. Blinded to DWI, average reader sensitivity, specificity, positive-predictive value, and negative-predictive value were 0.83, 0.92, 0.94, and 0.82, respectively. With DWI, the values were 0.85, 0.92, 0.94, and 0.83, respectively. Interreader agreement was good for both rounds (0.67 and 0.71, respectively, p-value > 0.05). Average reader confidence was 4.1 and 4.4, respectively (p-value < 0.001). ADC values and DWI/ADC ratios showed significant differ-ences between benign and malignant tumors. Conclusion: DWI and ADC show statistically significantly different values of benign from malignant osseous tumors and mildly increased radiologist confidence with similar interreader reliability. However, given similar diagnostic accuracy, conventional MR imaging is adequate for bone tumor characterization and incremental value of DWI is limited. Advances in knowledge: This paper is the first of its kind to report the use of DWI/ADC ratio for the diagnosis of bone tumors.
UR - http://www.scopus.com/inward/record.url?scp=85175358180&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85175358180&partnerID=8YFLogxK
U2 - 10.1259/bjr.20230352
DO - 10.1259/bjr.20230352
M3 - Article
C2 - 37493234
AN - SCOPUS:85175358180
SN - 0007-1285
VL - 96
JO - British Journal of Radiology
JF - British Journal of Radiology
IS - 1151
ER -