Utility of absolute apparent diffusion coefficient and chemical‐shift imaging versus CT attenuation for predicting malignancy from percutaneous bone biopsies

INTRODUCTION: Bone lesions are sometimes detected on computed tomography studies, and biopsies are performed to evaluate whether these are malignant. The aim of the study is to evaluate whether chemical‐shift imaging (CSI) and diffusion‐weighted imaging (DWI) magnetic resonance imaging (MRI) are more informative than the CT attenuation for predicting malignancy. METHODS: Retrospective analysis of 86 patients who underwent both diagnostic CT, CSI MRI and DWI MRI within 6 weeks prior to bone biopsy at a tertiary care academic institution between 01/01/2010 and 03/01/2020. The CT attenuation, signal intensity on in‐phase sequences (SIIP), signal intensity on out‐of‐phase sequences (SIOP), signal intensity ratio (SIR = SIOP/SIIP) and the apparent diffusion coefficient (ADC) of the lesions over the region of the biopsy tract were measured. RESULTS: A threshold CT attenuation of 157 Hounsfield Units (HU) had a sensitivity of 47.7%, specificity of 83.3% and area under the curve (AUC) of 0.59. A threshold ADC of 793 × 10(−6) mm(2)/s had a sensitivity of 75.8%, specificity of 85.7% and AUC of 0.83 to predict whether a bone biopsy would detect malignancy. A threshold SIR of 0.949 had a sensitivity of 77.8%, specificity of 77.8% and AUC of 0.81 to predict whether a bone biopsy would detect malignancy. ADC (P = 0.029) and SIR (P = 0.009) were significantly better than CT attenuation. There was no predictive difference between SIR and ADC (P = 0.742). CONCLUSIONS: The CT attenuation of a lesion is a poor predictor of malignancy in bone lesions. CSI and DWI are significantly better for predicting malignancy.