Contrast-Enhanced 3-T Perfusion MRI With Quantitative Analysis for the Characterization of Musculoskeletal Tumors: Is It Worth the Trouble?

Abstract

The purpose of this study was to evaluate the diagnostic performance of quantitative perfusion parameters in 3-T MRI for benign-malignant differentiation in musculoskeletal tumors. Ninety-five patients with histologically proven musculoskeletal tumors were prospectively included in this study. All patients underwent 3-T contrast-enhanced perfusion MRI with T1 mapping. The extended Tofts pharmacokinetic model was used to obtain four semiquantitative and four quantitative perfusion parameters for each tumor. Two radiologists evaluated all images and manually placed the ROIs in consensus. The 95 patients had 57 (59%) benign and 38 (41%) malignant tumors. Thirty-seven (39%) were bone and 58 (61%) were soft-tissue tumors. No significant differences were found in the perfusion parameters of benign and malignant tumors (p = 0.105-0.609). The best performance for benign-malignant differentiation was found for fractional volume of the extravascular extracellular space, which yielded 79% and 38% sensitivity and specificity. When soft-tissue tumors were considered, the transfer constant from plasma to the extravascular extracellular space exhibited a significant difference (p = 0.028) and had 79% and 27% sensitivity and specificity. Quantitative perfusion MRI had fair sensitivity and poor specificity for benign-malignant differentiation, which was similar to that obtained with semiquantitative parameters.