Diagnostic Accuracy of Diffusion-Weighted MRI and Apparent Diffusion Coefficient Values in Differentiating Benign and Malignant Soft-Tissue Tumours: A Prospective Histopathology-Correlated Study
DOI:
https://doi.org/10.48047/nhprjd10Keywords:
Soft-tissue tumours, diffusion-weighted imaging, apparent diffusion coefficient, magnetic resonance imagingAbstract
Background: Accurate differentiation between benign and malignant soft-tissue tumours is essential for appropriate clinical management, biopsy planning, and treatment selection. Conventional magnetic resonance imaging (MRI) provides excellent anatomical information but has limited specificity for distinguishing tumour nature. Diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) measurements offer quantitative assessment of tissue cellularity and may improve diagnostic characterization. Objective: To evaluate the diagnostic performance of diffusion-weighted imaging-derived ADC values in differentiating benign from malignant soft-tissue tumours using histopathology as the reference standard. Methods: This prospective diagnostic accuracy study included 110 patients with soft-tissue masses who underwent MRI with diffusion-weighted imaging prior to biopsy or surgical excision. ADC maps were generated from DWI sequences acquired at b-values of 0, 500, and 1000 s/mm². Mean ADC values were measured from the solid tumour components while avoiding necrotic and haemorrhagic areas. Histopathological diagnosis served as the reference standard. Mean ADC values between benign and malignant lesions were compared, and receiver operating characteristic (ROC) analysis was performed to determine diagnostic accuracy and the optimal ADC threshold. Results: Among the 110 lesions evaluated, 50 (45%) were malignant and 60 (55%) were benign on histopathology. Malignant tumours demonstrated significantly lower mean ADC values than benign lesions (0.95 ± 0.22 vs. 1.55 ± 0.30 × 10⁻³ mm²/s; p < 0.001). ROC analysis showed good diagnostic performance, with an area under the curve (AUC) of 0.88. The optimal ADC threshold for differentiating malignant from benign lesions was 1.20 × 10⁻³ mm²/s. At this threshold, sensitivity was 84%, specificity was 82%, positive predictive value was 80%, and negative predictive value was 86%. ADC values below the threshold were strongly associated with malignancy. Conclusion: Diffusion-weighted imaging-derived ADC values provide valuable quantitative information for the characterization of soft-tissue tumours. Malignant lesions exhibit significantly lower ADC values than benign lesions, and ADC demonstrates good diagnostic accuracy for distinguishing between the two groups. Incorporation of DWI into routine MRI protocols may improve non-invasive tumour characterization, assist biopsy planning, and support clinical decision-making. Nevertheless, ADC should be interpreted alongside conventional MRI findings and histopathological confirmation remains essential.
Downloads
References
Reichrath, J., Lehmann, B., Carlberg, C., Varani, J., & Zouboulis, C. C. (2007). Vitamins as hormones. Hormone and Metabolic Research, 39(2), 71–84. https://doi.org/10.1055/s-2007-958715
Mease, P. J. (2011). Measures of psoriatic arthritis: Tender and swollen joint assessment, PASI, NAPSI, mNAPSI, MEI, LEI, SPARCC, MASES, LDI, patient global, DLQI, PsAQOL, FACIT-F, PsARC, PsAJAI, DAPSA, and CPDAI. Arthritis Care & Research, 63(Suppl 11), S64–S85. https://doi.org/10.1002/acr.20577
Cutolo, M., Plebani, M., Shoenfeld, Y., Adorini, L., & Tincani, A. (2011). Vitamin D endocrine system and the immune response in rheumatic diseases. Vitamins & Hormones, 86, 327–351. https://doi.org/10.1016/B978-0-12-386960-9.00014-9
Karthaus, N., van Spriel, A. B., Looman, M. W. G., Chen, S., Spilgies, L. M., Lieben, L., et al. (2014). Vitamin D controls murine and human plasmacytoid dendritic cell function. Journal of Investigative Dermatology, 134(5), 1255–1264. https://doi.org/10.1038/jid.2013.501
George, J. A., Norris, S. A., van Deventer, H. E., Pettifor, J. M., & Crowther, N. J. (2014). Effect of adiposity, season, diet and calcium or vitamin D supplementation on the vitamin D status of healthy urban African and Asian-Indian adults. British Journal of Nutrition, 112(4), 590–599. https://doi.org/10.1017/S0007114514001202
Takahashi, H., Tsuji, H., Ishida-Yamamoto, A., & Iizuka, H. (2013). Comparison of clinical effects of psoriasis treatment regimens among calcipotriol alone, narrowband ultraviolet B phototherapy alone, and their combinations. Journal of Dermatology, 40(6), 424–427. https://doi.org/10.1111/1346-8138.12102
Finamor, D. C., Sinigaglia-Coimbra, R., Neves, L. C. M., Gutierrez, M., Silva, J. J., Torres, L. D., et al. (2013). A pilot study assessing the effect of prolonged administration of high daily doses of vitamin D on the clinical course of vitiligo and psoriasis. Dermato-Endocrinology, 5(1), 222–234. https://doi.org/10.4161/derm.24808
Chandrashekar, L., Kumari, G. R. K., Rajappa, M., Revathy, G., Munisamy, M., & Thappa, D. M. (2015). 25-hydroxy vitamin D and ischaemia-modified albumin levels in psoriasis and their association with disease severity. British Journal of Biomedical Science, 72(2), 56–60. https://doi.org/10.1080/09674845.2015.11666797
Atwa, M. A., Balata, M. G., Hussein, A. M., Abdelrahman, N. I., & Elminshawy, H. H. (2013). Serum 25-hydroxyvitamin D concentration in patients with psoriasis and rheumatoid arthritis and its association with disease activity and serum tumor necrosis factor-alpha. Saudi Medical Journal, 34(8), 806–813. PMID: 23974451
Maleki, M., Nahidi, Y., Azizahari, S., Meibodi, N. T., & Hadianfar, A. (2015). Serum 25-OH vitamin D level in psoriatic patients and comparison with control subjects. Journal of Cutaneous Medicine and Surgery, 20(3), 207–210. https://doi.org/10.1177/1203475415622207
Oh, Y. J., Lim, H. K., Choi, J. H., Lee, J. W., & Kim, N. I. (2014). Serum leptin and adiponectin levels in Korean patients with psoriasis. Journal of Korean Medical Science, 29(5), 729–734. https://doi.org/10.3346/jkms.2014.29.5.729
Mazzotti, E., Barbaranelli, C., Picardi, A., Abeni, D., & Pasquini, P. (2005). Psychometric properties of the Dermatology Life Quality Index (DLQI) in 900 Italian patients with psoriasis. Acta Dermato-Venereologica, 85(5), 409–413. https://doi.org/10.1080/00015550510032832
Jain, V., Gupta, N., Kalaivani, M., Jain, A., Sinha, A., & Agarwal, R. (2011). Vitamin D deficiency in healthy breastfed term infants at 3 months and their mothers in India: Seasonal variation and determinants. Indian Journal of Medical Research, 133(3), 267–273. PMID: 21441679
Kim, G. E., Seidler, E., & Kimball, A. B. (2015). A measure of chronic quality of life predicts socioeconomic and medical outcomes in psoriasis patients. Journal of the European Academy of Dermatology and Venereology, 29(2), 249–254. https://doi.org/10.1111/jdv.12503
Osmancevic, A., Landin-Wilhelmsen, K., Larkö, O., & Krogstad, A. L. (2010). Vitamin D status in psoriasis patients during different treatments with phototherapy. Journal of Photochemistry and Photobiology B: Biology, 101(2), 117–123. https://doi.org/10.1016/j.jphotobiol.2010.05.008
Romaní, J., Caixàs, A., Carrascosa, J. M., Ribera, M., Rigla, M., & Luelmo, J. (2012). Effect of narrowband ultraviolet B therapy on inflammatory markers and body fat composition in moderate to severe psoriasis. British Journal of Dermatology, 166(6), 1237–1244. https://doi.org/10.1111/j.1365-2133.2012.10883.x
Downloads
Published
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format for any purpose, even commercially.
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
- The licensor cannot revoke these freedoms as long as you follow the license terms.
Under the following terms:
- Attribution — You must give appropriate credit , provide a link to the license, and indicate if changes were made . You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
Notices:
You do not have to comply with the license for elements of the material in the public domain or where your use is permitted by an applicable exception or limitation .
No warranties are given. The license may not give you all of the permissions necessary for your intended use. For example, other rights such as publicity, privacy, or moral rights may limit how you use the material.
