Investig Magn Reson Imaging.  2017 Sep;21(3):162-170. 10.13104/imri.2017.21.3.162.

The Imaging Features of Desmoid Tumors: the Usefulness of Diffusion Weighted Imaging to Differentiate between Desmoid and Malignant Soft Tissue Tumors

• Lee SB
• Oh SN
• Choi MH
• Rha SE
• Jung SE
• Byun JY

• KMID: 2392687
• DOI: http://doi.org/10.13104/imri.2017.21.3.162

Abstract

PURPOSE
To evaluate the imaging findings of desmoid tumors using various imaging modalities and to evaluate whether diffusion-weighted imaging (DWI) can help differentiate between desmoid and malignant tumors.
MATERIALS AND METHODS
The study included 27 patients with pathologically confirmed desmoid tumors. Two radiologists reviewed 23 computed tomography (CT), 12 magnetic resonance imaging (MRI) and 8 positron emission tomography-computed tomography (PET-CT) scans of desmoid tumors and recorded data regarding the shape, multiplicity, size, location, degree of enhancement, and presence or absence of calcification or hemorrhage. The signal intensity of masses on T1- and T2-weighted imaging and the presence or absence of whirling or band-like low signal intensity on T2-weighted imaging were recorded. The apparent diffusion coefficient (ADC) values of the desmoid tumors in nine patients with DWIs were compared with the ADC values of 32 malignant tumors. The maximum standardized uptake value (SUV(max)) on PET-CT images was measured in 8 patients who underwent a PET-CT.
RESULTS
The mean size of the 27 tumors was 6.77 cm (range, 2.5-26 cm) and four tumors exhibited multiplicity. The desmoid tumors were classified by shape as either mass forming (n = 18), infiltrative (n = 4), or combined (n = 5). The location of the tumors was either intra-abdominal (n = 15), within the abdominal wall (n = 8) or extra-abdominal (n = 4). Among the 27 tumors, 21 showed moderate to marked enhancement and 22 showed homogeneous enhancement. Two tumors showed calcifications and one displayed hemorrhage. Eleven of the 12 MR T2-weighted images showed whirling or band-like low signal intensity areas in the mass. The mean ADC value of the desmoid tumors (1493 × 10⁻⁶ mm²/s) was significantly higher than the mean of the malignant soft tissue tumors (873 × 10⁻⁶ mm²/s, P < 0.001). On the PET-CT images, all tumors exhibited an intermediate SUV(max) (mean, 3.7; range, 2.3-4.5).
CONCLUSION
Desmoids tumors showed homogenous, moderate to marked enhancement on CT and MRI scans and a characteristic whirling or band-like pattern on T2-weighted images. DWI can be useful for the differentiation of desmoid tumors from malignant soft tissue tumors.

Keyword

CT; MRI; Desmoid Tumor; Fibromatosis; DWI

MeSH Terms

Abdominal Wall
Diffusion*
Electrons
Fibroma
Fibromatosis, Aggressive*
Hemorrhage
Humans
Magnetic Resonance Imaging

Figure

• 

  Fig. 1 MR T2-weighted image of a 34-year-old female patient with an abdominal wall desmoid tumor (white arrows) shows internal whirling or band-like low signal intensities (long white arrows).

• 

  Fig. 2 ADC maps of desmoid tumors (a, b), and malignant soft tissue tumors (c, d). (a) Intra-abdominal desmoid tumor in a 31-year-old male patient and (b) intra-abdominal desmoid tumor in a 32-year-old male patient. (c) Intra-abdominal malignant soft tissue tumor (primitive neuroectodermal tumor) in a 32-year-old female patient and (d) intra-abdominal malignant soft tissue tumor (retroperitoneal malignant solitary fibrous tumor) in a 69-year-old male patient. Three white squares (approximately 1.0 cm × 1.0 cm) in each ADC map represent the regions of interest within the tumors.

• 

  Fig. 3 Box plot distribution of the mean ADC values of the desmoid and malignant soft tissue tumors. Box = 25th-75th percentile; horizontal line = median. The mean ADC value of desmoid tumors (mean: 1493 × 10−6 mm2/s, min: 1204 × 10−6 mm2/s, max: 1828 × 10−6 mm2/s, SD: 221 × 10−6 mm2/ s) was significantly higher than that of the malignant soft tissue tumors (mean: 873 × 10−6 mm2/s, min: 370 × 10-6 mm2/s, max: 1503 × 10−6 mm2/s, SD: 273 × 10−6 mm2/s; P < 0.001). The Y-axis represents apparent diffusion coefficient (ADC) values. Unit of ADC value: 10−6 mm2/s.

• 

  Fig. 4 A 64-year-old male patient with an intra-abdominal desmoid tumor. The contrast enhanced CT axial image (a) shows homogeneous enhancing soft tissue mass (arrow) in the peritoneal cavity. The PET-CT image (b) shows moderate increased uptake of the mass (arrows) (SUVmax=2.3).

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