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Evaluation of Classic and Quantitative Imaging Features in the Differentiation of Benign and Atypical Lipomatous Soft Tissue Tumors Using a Standardized Multiparametric MRI Protocol: A Prospective Single-Centre Study in 45 Patients

Background: Discrimination between benign and atypical lipomatous tumors (ALT) is important due to potential local complications and recurrence of ALT but can be difficult due to the often-similar imaging appearance. Using a standardized MRI protocol, this study aimed to rank established and quantit...

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Autores principales: Gruber, Leonhard, Kremser, Christian, Zelger, Bettina, Schwabegger, Anton, Josip, Ena, Dammerer, Dietmar, Thaler, Martin, Henninger, Benjamin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10047222/
https://www.ncbi.nlm.nih.gov/pubmed/36975465
http://dx.doi.org/10.3390/curroncol30030252
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author Gruber, Leonhard
Kremser, Christian
Zelger, Bettina
Schwabegger, Anton
Josip, Ena
Dammerer, Dietmar
Thaler, Martin
Henninger, Benjamin
author_facet Gruber, Leonhard
Kremser, Christian
Zelger, Bettina
Schwabegger, Anton
Josip, Ena
Dammerer, Dietmar
Thaler, Martin
Henninger, Benjamin
author_sort Gruber, Leonhard
collection PubMed
description Background: Discrimination between benign and atypical lipomatous tumors (ALT) is important due to potential local complications and recurrence of ALT but can be difficult due to the often-similar imaging appearance. Using a standardized MRI protocol, this study aimed to rank established and quantitative MRI features by diagnostic value in the differentiation of benign and atypical lipomatous tumors and to develop a robust scoring system. Methods: Patients with clinical or sonographic suspicion of a lipomatous tumor were prospectively and consecutively enrolled from 2015 to 2019 after ethic review board approval. Histology was confirmed for all ALT and 85% of the benign cases. Twenty-one demographic and morphologic and twenty-three quantitative features were extracted from a standardized MRI protocol (T1/T2-proton-density-weighting, turbo-inversion recovery magnitude, T2* multi-echo gradient-echo imaging, qDIXON-Vibe fat-quantification, T1 relaxometry, T1 mapping, diffusion-weighted and post-contrast sequences). A ranking of these features was generated through a Bayes network analysis with gain-ratio feature evaluation. Results: Forty-five patients were included in the analysis (mean age, 61.2 ± 14.2 years, 27 women [60.0%]). The highest-ranked ALT predictors were septation thickness (gain ratio merit [GRM] 0.623 ± 0.025, p = 0.0055), intra- and peritumoral STIR signal discrepancy (GRM 0.458 ± 0.046, p < 0.0001), orthogonal diameter (GRM 0.554 ± 0.188, p = 0.0013), contrast enhancement (GRM 0.235 ± 0.015, p = 0.0010) and maximum diameter (GRM 0.221 ± 0.075, p = 0.0009). The quantitative features did not provide a significant discriminatory value. The highest-ranked predictors were used to generate a five-tiered score for the identification of ALTs (correct classification rate 95.7% at a cut-off of three positive items, sensitivity 100.0%, specificity 94.9%, likelihood ratio 19.5). Conclusions: Several single MRI features have a substantial diagnostic value in the identification of ALT, yet a multiparametric approach by a simple combination algorithm may support radiologists in the identification of lipomatous tumors in need for further histological assessment.
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spelling pubmed-100472222023-03-29 Evaluation of Classic and Quantitative Imaging Features in the Differentiation of Benign and Atypical Lipomatous Soft Tissue Tumors Using a Standardized Multiparametric MRI Protocol: A Prospective Single-Centre Study in 45 Patients Gruber, Leonhard Kremser, Christian Zelger, Bettina Schwabegger, Anton Josip, Ena Dammerer, Dietmar Thaler, Martin Henninger, Benjamin Curr Oncol Article Background: Discrimination between benign and atypical lipomatous tumors (ALT) is important due to potential local complications and recurrence of ALT but can be difficult due to the often-similar imaging appearance. Using a standardized MRI protocol, this study aimed to rank established and quantitative MRI features by diagnostic value in the differentiation of benign and atypical lipomatous tumors and to develop a robust scoring system. Methods: Patients with clinical or sonographic suspicion of a lipomatous tumor were prospectively and consecutively enrolled from 2015 to 2019 after ethic review board approval. Histology was confirmed for all ALT and 85% of the benign cases. Twenty-one demographic and morphologic and twenty-three quantitative features were extracted from a standardized MRI protocol (T1/T2-proton-density-weighting, turbo-inversion recovery magnitude, T2* multi-echo gradient-echo imaging, qDIXON-Vibe fat-quantification, T1 relaxometry, T1 mapping, diffusion-weighted and post-contrast sequences). A ranking of these features was generated through a Bayes network analysis with gain-ratio feature evaluation. Results: Forty-five patients were included in the analysis (mean age, 61.2 ± 14.2 years, 27 women [60.0%]). The highest-ranked ALT predictors were septation thickness (gain ratio merit [GRM] 0.623 ± 0.025, p = 0.0055), intra- and peritumoral STIR signal discrepancy (GRM 0.458 ± 0.046, p < 0.0001), orthogonal diameter (GRM 0.554 ± 0.188, p = 0.0013), contrast enhancement (GRM 0.235 ± 0.015, p = 0.0010) and maximum diameter (GRM 0.221 ± 0.075, p = 0.0009). The quantitative features did not provide a significant discriminatory value. The highest-ranked predictors were used to generate a five-tiered score for the identification of ALTs (correct classification rate 95.7% at a cut-off of three positive items, sensitivity 100.0%, specificity 94.9%, likelihood ratio 19.5). Conclusions: Several single MRI features have a substantial diagnostic value in the identification of ALT, yet a multiparametric approach by a simple combination algorithm may support radiologists in the identification of lipomatous tumors in need for further histological assessment. MDPI 2023-03-13 /pmc/articles/PMC10047222/ /pubmed/36975465 http://dx.doi.org/10.3390/curroncol30030252 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Gruber, Leonhard
Kremser, Christian
Zelger, Bettina
Schwabegger, Anton
Josip, Ena
Dammerer, Dietmar
Thaler, Martin
Henninger, Benjamin
Evaluation of Classic and Quantitative Imaging Features in the Differentiation of Benign and Atypical Lipomatous Soft Tissue Tumors Using a Standardized Multiparametric MRI Protocol: A Prospective Single-Centre Study in 45 Patients
title Evaluation of Classic and Quantitative Imaging Features in the Differentiation of Benign and Atypical Lipomatous Soft Tissue Tumors Using a Standardized Multiparametric MRI Protocol: A Prospective Single-Centre Study in 45 Patients
title_full Evaluation of Classic and Quantitative Imaging Features in the Differentiation of Benign and Atypical Lipomatous Soft Tissue Tumors Using a Standardized Multiparametric MRI Protocol: A Prospective Single-Centre Study in 45 Patients
title_fullStr Evaluation of Classic and Quantitative Imaging Features in the Differentiation of Benign and Atypical Lipomatous Soft Tissue Tumors Using a Standardized Multiparametric MRI Protocol: A Prospective Single-Centre Study in 45 Patients
title_full_unstemmed Evaluation of Classic and Quantitative Imaging Features in the Differentiation of Benign and Atypical Lipomatous Soft Tissue Tumors Using a Standardized Multiparametric MRI Protocol: A Prospective Single-Centre Study in 45 Patients
title_short Evaluation of Classic and Quantitative Imaging Features in the Differentiation of Benign and Atypical Lipomatous Soft Tissue Tumors Using a Standardized Multiparametric MRI Protocol: A Prospective Single-Centre Study in 45 Patients
title_sort evaluation of classic and quantitative imaging features in the differentiation of benign and atypical lipomatous soft tissue tumors using a standardized multiparametric mri protocol: a prospective single-centre study in 45 patients
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10047222/
https://www.ncbi.nlm.nih.gov/pubmed/36975465
http://dx.doi.org/10.3390/curroncol30030252
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