The study included 108 newly diagnosed soft tissue lesions.
Their histologic diagnoses were as follows:
Fibromatosis (n=42),dermatofibrosarcoma protuberans (n=4),
NF (n=3),
lipoma (n=9) ,
hemangioma (n=5) schwannoma(n=1),
paraganglioma (n=1),
GCT tendon sheath(n=1)/ synovial sarcoma (n=6)/ rhabdomyosarcoma (n=7),
myxoliposarcoma (n=6),
undifferentiated sarcoma (n=7)/ malignant melanoma (n=2),
squamous cell carcinoma (n=3)/ mucor fungoides (n=1),
leiyomyosarcoma (n=1),
high grade sarcoma (n=3),
myxofibrosarcoma (n=1),
low grade sarcoma (n=2),
malignant nerve sheath tumor (n=1),
liposarcoma (n=1),
MFH (n=1).
Our study results demonstrated that benign soft tissue masses had a mean ADC value 1.18+ 1.0191 x 10-3 mm2/s; with the lowest recorded value was 0.1 x 10-3 mm2/s in lipoma & the highest ADC value was 3.6 x 10-3 mm2/s in hemangiomas.
These benign soft tissue masses showed a mean minimum ADC value 0.9 +0.84 mm2/s; with the lowest value 0.05 & the highest minimum ADC value for benign tumors was 2.9 x 10-3 mm2/s.
For malignant soft-tissue masses,
the mean ADC value was 1.3+ 0.7 x 10-3 mm2/s with its lowest value 0.5 & highest value 3.4 meanwhile minimum ADC values was 0.85+0.84 x 10-3 mm2/s with the lowest value 0.3 & the highest value 3.1.).
Myxomatous malignant masses had an ADC value of 2.6+ 0.55 x 10-3 mm2/s while non-myxomatous malignant masses had an ADC value 1.1+0.8 x 10-3 mm2/s.
Regarding fibromatosis patient the newly diagnosed cases demonstrated a mean ADC value 1.31+ 0.245 x 10-3 mm2/sec & minimum ADC value 0.71+ 0.4 x 10-3 mm2/sec.
Detailed analysis of ADC (mm2/sec) values is shown in the table (1),
including the average ADC+ SD in newly diagnosed benign,
malignant and fibromatosis lesions included in our study.
Final clinical diagnosis
|
Mean ADC
|
Std.
deviation
|
Min ADC
|
Std.
deviation
|
Malignant masses
|
1.309
|
0.723
|
0.825
|
0.66
|
Benign masses
|
1.18
|
1.0191
|
0.9
|
0.84
|
Myxoid malignant masses
|
2.6
|
0.69
|
1.9
|
0.8
|
Nonmyxoid malignant masses
|
1.1
|
0.35
|
0.64
|
0.31
|
Fibromatosis
|
1.31
|
0.245
|
0.71
|
0.4
|
Table (1),
ADC (mm2/sec) values in showing different pathological entities included in our study.
Attempted propagation of ADC cut off value between benign & non benign (including malignant & locally aggressive masses) was 0.6 x 10-3 mm2/sec with a sensitivity 98.3% & specificity 50% (P=0.5123).
Also attempted propagation of statistical difference between malignant soft tissue masses (mean ADC 1.309+0.723x10-3 mm2/s) & fibromatosis masses (mean ADC value 1.31 +0.245 x 10-3 mm2/s ) using a comparative (T-test) showing a difference -0.0051,
standard error =0.17 & poor significance level 0.9757 (table 2).
Diagnosis
|
Mean ADC
|
Std.
deviation
|
Malignant masses
|
1.309
|
0.723
|
Fibromatosis
|
1.31
|
0.245
|
(T-test) Difference -0.0051 ,standard error=0.17,signifacnce level=0.9757
|
Table 2 shows comparative T-test for comparison of ADC values of fibromatosis & malignant masses.
Regarding post-chemo-radiotherapy for soft tissue sarcoma patients:-
Follow up MR examinations were available for 9 patients with soft tissue sarcoma who received chemo+/-radiotherapy showing regression in size with the corresponding increase of mean ADC values (table 3).
|
Mean ADC
|
Standard deviation
|
Pre therapy
|
1.8222
|
0.8758
|
Post therapy
|
2.1
|
0.8689
|
Mean difference using a paired sample t-test is 0.2778 with a standard deviation of 0.097 (P=<0.0001)
|
Regarding post-chemo-radiotherapy for fibromatosis patients:-
Follow up MR examinations were available for 9 patients with fibromatosis (12 lesions) who received chemo+/-radiotherapy. Eight lesions showed a favorable response with an overall reduction or stabilization of tumor size accompanied by a decrease in their T2 signal intensity and an increase in the percentage of the low signal bands/areas within the tumor (Table 4).
|
Mean ADC
|
Standard deviation
|
Minimum ADC Value
|
Standard deviation
|
Favourable response to treatment
|
1.4
|
0.19
|
0.79
|
0.43
|
Poor response to treatment.
|
1.5
|
0.3
|
0.8
|
0.25
|
Table 4 show ADC values of fibromatosis patients with a favorable & poor response.
Lesions that showed a favorable response to chemo- or radiotherapy exhibited lower ADC values than those showing a progressive disease course.
This difference was even more evident in the minimum than the mean ADC values.