Differentiation of peripheral nerve sheath tumors in patients with neurofibromatosis type 1 using diffusion-weighted magnetic resonance imaging.

Differentiation of peripheral nerve sheath tumors in patients with neurofibromatosis type 1 using diffusion-weighted magnetic resonance imaging.

Neuro Oncol. 2018 Nov 28;:

Authors: Well L, Salamon JM, Kaul MG, Farschtschi S, Herrmann J, Geier KI, Hagel C, Bockhorn M, Bannas P, Adam G, Mautner VF, Derlin T

Abstract
Background: To determine the value of diffusion-weighted (DW) magnetic resonance imaging (MRI) for characterization of benign and malignant peripheral nerve sheath tumors (PNSTs) in patients with neurofibromatosis type 1 (NF1).
Methods: Twenty-six patients with NF1 and suspicion of malignant transformation of PNSTs were prospectively enrolled, and underwent DW MRI at 3T. For a set of benign (n=55) and malignant (n=12) PNSTs, functional MRI parameters were derived from both biexponential intravoxel incoherent motion (diffusion coefficient D and perfusion fraction f) and monoexponential data analysis (apparent diffusion coefficients (ADCs)). A panel of morphological MRI features was evaluated using T1- and T2-weighted imaging. Mann-Whitney-U test, Fisher's exact test, and ROC analyses were applied to assess the diagnostic accuracy of quantitative and qualitative MRI. Cohen's kappa was used to determine inter-rater reliability.
Results: Malignant PNSTs demonstrated significantly lower diffusivity (P<0.0001) compared to benign PNSTs. The perfusion fraction f was significantly higher in malignant PNSTs (P<0.001). In ROC analysis, functional MRI parameters showed high diagnostic accuracy for differentiation of PNSTs (e.g., ADCmean, 92% sensitivity with 98% specificity, AUC 0.98; Dmean, 92% sensitivity with 98% specificity, AUC 0.98). By contrast, morphological imaging features had only limited sensitivity (18-94%) and specificity (18-82%) for identification of malignancy. Inter-rater reliability was higher for monoexponential data analysis.
Conclusion: DW imaging shows better diagnostic performance than morphological features and allows accurate differentiation of benign and malignant peripheral nerve sheath tumors in NF1.

PMID: 30496452 [PubMed - as supplied by publisher]

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