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Soft-Tissue Tumors: Value of Static and Dynamic Gadopentetate Dimeglumine–enhanced MR Imaging in Prediction of Malignancy¹

¹ From the Departments of Radiology (C.S.P.v.R., J.L.B.), Pathology (P.C.W.H.), Orthopaedic Surgery (A.H.M.T.), and Medical Statistics (A.H.Z.), Leiden University Medical Center, Bldg C3-Q, 2300 RC Leiden, the Netherlands; Departments of Radiology (M.J.A.G.) and Surgery (F.v.C.), Netherlands Cancer Institute, Antonie van Leeuwenhoek Hospital, Amsterdam, the Netherlands; and Department of Radiology, Medical University of South Carolina, Charleston, SC (T.L.P.). From the 2002 RSNA scientific assembly. Received July 15, 2003; revision requested September 26; final revision received February 23, 2004; accepted March 16. Address correspondence to C.S.P.v.R. (e-mail: C.S.P.van_Rijswijk@lumc.nl).

PURPOSE: To prospectively evaluate static and dynamic gadopentetate dimeglumine–enhanced magnetic resonance (MR) imaging relative to nonenhanced MR imaging in differentiation of benign from malignant soft-tissue lesions and to evaluate which MR imaging parameters are most predictive of malignancy, with associated interobserver variability.

MATERIALS AND METHODS: One hundred forty consecutive patients (78 male patients [median age, 51 years], 62 female patients [median age, 53 years]) with a soft-tissue mass underwent nonenhanced static and dynamic contrast material–enhanced MR imaging. Diagnosis was based on histologic findings in surgical specimens (86 of 140), findings at core-needle biopsy (43 of 140), or results of all imaging procedures with clinical follow-up (11 of 140). Multivariate logistic regression analysis was used to identify the best combination of MR imaging parameters that might be predictive of malignancy. Subjective overall performance of two observers was evaluated with receiver operating characteristic analysis.

RESULTS: For subjective overall diagnosis, area under the receiver operating characteristic curve, a measure for diagnostic accuracy, was significantly larger for combined nonenhanced and contrast-enhanced MR imaging than it was for nonenhanced MR imaging alone, with no significant difference between observers. Multivariate analysis of all lesions revealed that combined nonenhanced static and dynamic contrast-enhanced MR imaging parameters were significantly superior to nonenhanced MR imaging parameters alone and to nonenhanced MR imaging parameters combined with static contrast-enhanced MR imaging parameters in prediction of malignancy. The most discriminating parameters were presence of liquefaction, start of dynamic enhancement (time interval between start of arterial and tumor enhancement), and lesion size (diameter). Results for extremity lesions were the same, with one exception: With dynamic contrast-enhanced MR imaging parameters, diagnostic performance of one observer did not improve.

CONCLUSION: Static and dynamic contrast-enhanced MR imaging, when added to nonenhanced MR imaging, improved differentiation between benign and malignant soft-tissue lesions.

© RSNA, 2004

Index terms: Magnetic resonance (MR), contrast enhancement • Neoplasms, MR, 40.1214, 40.121415, 40.12143 • Sarcoma, 40.37 • Soft tissues, neoplasms, 40.36, 40.37

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