Whole-lesion ADC histogram analysis versus single-slice ADC measurement for the differentiation of benign and malignant soft tissue tumors

Purpose To evaluate and compare the diagnostic performances of whole-lesion apparent diffusion coefficient (ADC) histogram analysis and single-slice ADC measurement in the differentiation of benign and malignant soft tissue tumors. Methods Fifty-three patients (mean age: 48.5 ± 21.4) with soft tissue tumors (27 benign and 26 malignant) were evaluated with diffusion-weighted MRI. Whole-lesion ADC histogram parameters (mean, median, 10th percentile, 90th percentile, minimum, maximum, range, mean absolute deviation, interquartile range, kurtosis, skewness, root mean squared, variance and inhomogeneity) of the lesions were measured using the whole solid tumor volume region of interest (ROI). In other sessions, five ROIs were manually drawn on the tumor slices, and mean ADC and minimum ADC of the measurements were calculated. Diagnostic accuracies of the two methods were assessed and compared. Results Mean, median, minimum, 10th percentile, 90th percentile, range, root mean squared and inhomogeneity of ADC histogram analysis, and mean ADC and minimum ADC of single-slice ADC measurement were significantly different between malignant and benign lesions (p < 0.001 – p = 0.002). Among the ADC histogram parameters, 10th percentile had the highest diagnostic performance (AUC = 0.825) followed by mean (AUC = 0.792) and median (AUC = 0.789). For the single-slice ADC measurement, the AUC of mean ADC and minimum ADC were 0.842 and 0.786, respectively. Mean ADC of single-slice measurement had a similar diagnostic performance with the 10th percentile, mean, and median of ADC histogram analysis (p = 0.070–1.000). Conclusions Both whole-lesion ADC histogram analysis and single-slice ADC measurement can differentiate benign and malignant soft tissue tumors with similar diagnostic performances.