Diffusional kurtosis imaging in the differentiation of benign and malignant bone tumors
Ying Li1, Cuiping Ren1, Jingliang Cheng1, and Zhizheng Zhuo2

1First affiliated hospital of Zhengzhou university, Zhengzhou, China, 2Clinical Science, Philips Healthcare, Beijing, China


This work investigated and evaluated the role of magnetic resonance (MR) diffusion kurtosis imaging(DKI) in characterizing the bone tumors, and furtherly evaluate the ability of DKI parameters to differentiate benign and malignant tumors by using receiver operating characteristic curve(ROC), which might be helpful for clinical diagnosis and studies.


Recent studies have shown that DKI provides a new method to evaluate the non-gaussian diffusion behavior in complex biological tissues in various brain diseases1and breast tumors2, but it was rarely used in the study of bone tumors. The purpose of this study is to investigate the application of DKI on bone tumors and furtherly evaluate the ability of DKI parameters to differentiate benign and malignant tumors.


Thirty-five patients (20 males and 15 females aged 35.1±19.6 years old) with bone tumors (all have been diagnosed as bone tumor according to pathological biopsy)were included in this study. And based on the WHO Classification of Tumors of Soft Tissue and Bone(2012) criteria, 35 patients were divided into two groups:17 for benign tumors and 18 for malignancies. All the patients were scanned by MR DKI sequence based on a 3T MR scanner (Ingenia, Philips Healthcare, Best, the Netherlands). The DKI scanning was performed with 3 b-values of 0, 600, 1,200 s/mm2 and 15 motion-sensitive gradient directions. The DTI parameters (mean diffusivity (MD),fractional anisotropy(FA), axial diffusivity (AD), radial diffusivity (RD)) and DKI parameters (mean kurtosis (MK), axial kurtosis(AK), radial kurtosis(RK)) were calculated by using DKE software (Version 2.6.0, website:www.musc.edu/cbi). All the above parameters were measured by drawing ROIs (Region of Interest) within the periphery and center of the lesions. And the measured parameters in benign and malignant lesions were compared by using Mann-Whitney U test with SPSS software (version 16.0). A P value of less than 0.05 was considered statistically significant. And receiver operating characteristic (ROC) analysis was performed to assess the sensitivity and specificity of every parameter in the diagnosis of benign and malignant bone lesions.


The statistical results of the parameters with significant difference between benign and malignant lesions were summarized in Table 1. The results revealed that FA and RK values of the periphery in the lesions are significantly different (P <0.05).All the parameters of the center in the lesions are not significantly different (P >0.05). The ROC analysis results were shown in Figure 2, which showed the ability of FA and RK values of the lesion periphery to differentiate benign and malignant lesions, and the area under the ROC curve are 0.82 and 0.775 respectively.


DKI is a non-invasive functional imaging based on diffusion MRI technique, which provide useful information of tumor cytoarchitectonic complexityon the water diffusion properties3.Our study results show that the DTI and DKI related parameters is able to differentiate benign from malignant bone tumors. Meanwhile, according to our analysis, FA values which belong to DTI related parameters and RK which belong to DKI related parameters have the ability of characterizing bone tumors, which reflect microstructure differences between benign and malignant tumors. In the future, more patients will be included in our study and furtherly to evaluate the clinical application of texture analysis and classifiers in clinical bone diseases.


DKI technique is helpful to evaluate the pathological behavior and provide useful information on the diffusion properties related to bone tumors microenvironment.


No acknowledgement found.


[1]. Peter Raab, Elke Hattingen, Kea Franz, et al. Cerebral Gliomas: Diffusional Kurtosis Imaging Analysis of Microstructural Differences[J].Radiology,2010,254(3):876-881.

[2]. LuísaNogueira, Sofia Brandão, Eduarda Matos, et al. Application of the diffusion kurtosis model for the study of breast lesions[J].Eur Radiol,2014,24:1197-1203.

[3].Dongmei Wu, Guanwu Li, Junxiang Zhang, et al. Characterization of Breast Tumors Using Diffusion Kurtosis Imaging (DKI)[J].PLOS ONE,2014,9(11):e113240.


Figure 1.The DTI and DKI related parameters of a malignant bone lesion (red arrow) (male, 18 years old, right distal femur).

Table 1. The summary of the parameters showed a statistically significant difference between benign and malignant tumors (Mann-Whitney U test, P<0.05 indicated a significant difference)

Figure 2. The ROC analysis result for the parameters in Table 1. The AUCs (Area under the curve) are 0.82 and 0.775 for periphery FA and periphery RK, respectively.

Proc. Intl. Soc. Mag. Reson. Med. 27 (2019)