Orbital Indeterminate Lesions in Adults: Combined Magnetic Resonance Morphometry and Histogram Analysis of Apparent Diffusion Coefficient Maps for Predicting Malignancy

Xiao-Quan Xu; Hao Hu; Guo-Yi Su; Ling Zhang; Hu Liu; Xun-Ning Hong; Hai-Bin Shi; Fei-Yun Wu

doi:10.1016/j.acra.2015.10.015

Orbital Indeterminate Lesions in Adults: Combined Magnetic Resonance Morphometry and Histogram Analysis of Apparent Diffusion Coefficient Maps for Predicting Malignancy

Acad Radiol. 2016 Feb;23(2):200-8. doi: 10.1016/j.acra.2015.10.015. Epub 2015 Nov 28.

Authors

Xiao-Quan Xu¹, Hao Hu¹, Guo-Yi Su¹, Ling Zhang¹, Hu Liu², Xun-Ning Hong¹, Hai-Bin Shi¹, Fei-Yun Wu³

Affiliations

¹ Department of Radiology, First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing 210000, China.
² Department of Ophthalmology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
³ Department of Radiology, First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing 210000, China. Electronic address: wfy_njmu@163.com.

PMID: 26625705
DOI: 10.1016/j.acra.2015.10.015

Abstract

Rationale and objectives: The aim of this study was to evaluate the added value of histogram analysis of apparent diffusion coefficient (ADC) maps in differentiating indeterminate orbital malignant tumors from benign tumors, compared to using magnetic resonance (MR) morphological features alone.

Materials and methods: We retrospectively evaluated 54 patients with orbital tumors from March 2013 to February 2015. All the patients were assessed by both routine MR and diffusion-weighted imaging, and divided into benign group and malignant group. Routine MR imaging features and histogram parameters derived from ADC maps, including mean ADC (ADCmean), median ADC (ADCmedian), standard deviation, skewness, kurtosis, and 10th and 90th percentiles of ADC (ADC10 and ADC90), were compared between two groups. Univariate and multivariate logistic regression analyses were used to identify the most valuable variables in predicting malignancy. Receiver operating characteristic (ROC) curve analysis was used to determine the diagnostic value of significant variables.

Results: Multivariate logistic regression analysis indicated that two or more quadrants involved, iso-intense on T2-weighted imaging (T2WI), and ADC10 were significant predictors for orbital malignancy. By using model 2 (iso-intense on T2WI + two or more quadrants involved + ADC10 < 0.990) as the criterion, higher AUC and specificity could be achieved than by using model 1 (iso-intense on T2WI + two or more quadrants involved) alone, (model 2 vs model 1; area under curve (AUC), 0.827 vs 0.793; sensitivity, 65.4% vs 69.2%; specificity, 100% vs 89.3%).

Conclusions: Iso-intense on T2WI, two or more quadrants involved, and ADC10 are risk factors for orbital malignancy. Histogram analysis of ADC map might provide added value in predicting orbital malignancy.

Keywords: Differential diagnosis; Diffusion-weighted imaging; Histogram analysis; Magnetic resonance imaging; Orbital tumor.

Publication types

Comparative Study

MeSH terms

Adenoma, Pleomorphic / diagnostic imaging
Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Area Under Curve
Cohort Studies
Diagnosis, Differential
Diffusion Magnetic Resonance Imaging / statistics & numerical data*
Female
Forecasting
Humans
Image Processing, Computer-Assisted / statistics & numerical data
Lymphoma / diagnostic imaging
Magnetic Resonance Imaging / statistics & numerical data*
Male
Middle Aged
Neurilemmoma / diagnostic imaging
Orbital Neoplasms / diagnostic imaging*
Orbital Pseudotumor / diagnostic imaging
ROC Curve
Retrospective Studies
Risk Factors
Sensitivity and Specificity
Young Adult