Int J Med Sci 2022; 19(11):1638-1647. doi:10.7150/ijms.76179 This issue

Research Paper

The value of diffusion-weighted and dynamic contrast-enhanced imaging in the diagnosis of thymic epithelial tumors

Tran-Thi Mai Thuy1,2*, Vo Tan Duc1,2, Tran Thanh Vy3,4, Nguyen Hoang Nam1, Nguyen Minh Duc5✉*

1. Department of Radiology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.
2. Department of Radiology, University Medical Center HCMC, Ho Chi Minh City, Vietnam.
3. Department of Cardiothoracic Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.
4. Department of Thoracic Surgery, University Medical Center HCMC, Ho Chi Minh City, Vietnam.
5. Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam.
*These authors contributed equally to this article as co-first authors.

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Citation:
Thuy TTM, Duc VT, Vy TT, Nam NH, Duc NM. The value of diffusion-weighted and dynamic contrast-enhanced imaging in the diagnosis of thymic epithelial tumors. Int J Med Sci 2022; 19(11):1638-1647. doi:10.7150/ijms.76179. Available from https://www.medsci.org/v19p1638.htm

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Abstract

Graphic abstract

Background: Thymic epithelial tumors (TETs) are clinically the most frequently encountered neoplasm of the prevascular mediastinum in adults. The role of chest magnetic resonance (MR) imaging has been increasingly stressed thanks to its excellent contrast resolution, freedom from ionizing radiation, and capability to provide additional information regarding tumors' cellular structure and vascularity.

Methods: This study aimed to establish the relationship between the MR findings and pathological classification of TETs, focusing on diffusion-weighted (DW) and dynamic contrast-enhanced (DCE) imaging. This retrospective cross-sectional study included 44 TET patients who underwent chest MR scanning. The tumors were classified into three groups according to the WHO classification: low-risk thymoma (LRT), high-risk thymoma (HRT), and non-thymoma (NT). Along with morphological characteristics, the apparent diffusion coefficient (ADC) value, time-intensity curve (TIC) pattern, and time to peak enhancement (TTP) of the tumors were recorded and compared between the three groups.

Results: A smooth contour and complete or almost complete capsule were suggestive of LRTs. The median ADC value of the 44 tumors was 0.95 × 10-3 mm2/sec. Among the three groups, LRTs had the highest ADC values, while NTs had the lowest. The differences between the ADC values of the three groups were statistically significant (p = 0.006). Using an ADC cutoff of 0.82 × 10-3 mm2/sec to differentiate between LRTs and tumors of the two remaining groups, the area under the curve was 0.775, sensitivity was 100%, specificity was 50%, and accuracy was 65.91%. The washout (type 3) TIC pattern was the most prevalent, accounting for 45.45% of the population; this pattern was also predominantly observed in LRTs (71.43%). Although the median TTP of LRTs was lower than that of HRTs or NTs, no statistically significant differences were found between the TTPs of the three groups (p = 0.170).

Conclusions: MR is a good imaging modality to preoperatively assess TETs. Morphological features, ADC value, TIC pattern, and TTP are helpful in preoperatively predicting TET pathology.

Keywords: Thymic epithelial tumor, Magnetic resonance imaging, Diffusion-weighted imaging, Dynamic contrast-enhanced imaging