Differentiation of Skull Base Chondrosarcomas, Chordomas, and Metastases: Utility of DWI and Dynamic Contrast-Enhanced Perfusion MR Imaging

Y. Ota; E. Liao; A.A. Capizzano; A. Baba; R. Kurokawa; M. Kurokawa; A. Srinivasan

doi:10.3174/ajnr.A7607

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FIG 1.
Box-and-whisker plots of DWI and DCE-MR imaging parameters with the Kruskal-Wallis H test and post hoc test with the Bonferroni correction are shown. The boundaries of boxes represent 25th and 75th percentiles, and the lines in boxes indicate medians.
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FIG 2.
Receiver operating characteristic curves of chondrosarcoma versus chordoma (A), chondrosarcoma versus metastasis (B), and chordoma versus metastasis (C) are shown.
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FIG 3.
A 56-year-old man with a chondrosarcoma in the left petrous apex. A, Axial fat-saturated postcontrast T1-weighted image shows a heterogeneously enhancing mass in the left petrous apex. B, An ROI was placed on the ADC map, and the nADCmean was calculated. Mean ADC and ADC values in the medulla were 2.05, and 0.80 × 10⁻³ mm²/s, respectively. The nADCmean was 2.56. C, An ROI was placed on the permeability map, and Vp, K^trans, and Ve were calculated. D, Vp is 0.01.
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FIG 4.
A 16-year-old boy with a chordoma in the clivus. A, Axial fat-saturated postcontrast T1-weighted image shows a heterogeneously enhancing mass in the clivus. B, An ROI was placed on the ADC map, and the nADCmean was 1.5. C, An ROI was placed on the permeability map, and Vp, K^trans, and Ve were calculated. D, Vp is 0.08.
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FIG 5.
A 39-year-old woman with a metastatic breast cancer lesion in the clivus. A, Axial fat-saturated postcontrast T1-weighted image shows a heterogeneously enhancing mass in the clivus. B, An ROI was placed on the ADC map, and the nADCmean was 0.97. C, An ROI was placed on the permeability map, and Vp, K^trans, and Ve were calculated. D, Vp showed 0.23.

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Table 1:

Patient demographics^{^a}

	Chondrosarcoma	Chordoma	Metastasis
No. of patients	15	14	30
Sex (male/total)	9/15	6/14	11/30
Age (yr)	62 (46–70)	47 (32–58)	61 (47–70)
Maximum axial diameter (mm)	29.5 (24–36)	33 (24–40)	18.5 (15–23)
Primary cancer type	NA	NA	11 Breast, 6 lung, 6 malignant melanoma,4 head and neck, 2 sarcoma, 1 kidney

Note:—NA indicates not applicable.
↵a Values are presented as the median (IQR).

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Table 2:

Conventional imaging characteristics of chondrosarcomas, chordomas, and metastases

	Chondrosarcoma	Chordoma	Metastasis	P Value
Main location (petrous bone:clivus)	9:6	1:13	5:25	P^a = .08P^b = .14P^c = .65
Cystic/necrotic changes	8/15	7/14	10/30	P^a = 1.0P^b = .22P^c = .33
T2 hyperintensity or iso-/hypointensity relative to the brain parenchyma (T2 hyperintensity/total)	10/15	9/14	9/30	P^a = 1.0P^b = .027P^c = .049
Enhancement patterns (heterogeneous/total)	15/15	14/14	26/30	P^a = 1.0P^b = .29P^c = .29
Other metastatic lesions in the head and neck	NA	NA	5/30	NA

Note:—P^a is obtained from a comparison between chondrosarcoma and chordoma, P^b is from a comparison between chondrosarcoma and metastasis, and P^c is from a comparison between chordoma versus metastasis.

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Table 3:

DWI and DCE-MR imaging parameters of chondrosarcoma, chordoma, and metastasis using the Kruskal-Wallis H test and the post hoc test with Bonferroni correction^{^a}

	Chondrosarcoma	Chordoma	Metastasis	P Value^a	P Value^b
	Chondrosarcoma	Chordoma	Metastasis	P Value^a	Chondrosarcoma vs Chordoma	Chondrosarcoma vs Metastasis	Chordoma vs Metastasis
nADCmean	2.44 (2.27–2.71)	1.30 (1.07–1.73)	1.39 (1.21–1.70)	<.001	<.001	<.001	1.0
Vp	0.015 (0.01–0.028)	0.045 (0.04–0.068)	0.12 (0.09–0.14)	<.001	.003	<.001	<.001
Ve	0.25 (0.15–0.31)	0.35 (0.30–0.40)	0.48 (0.34–0.63)	.007	.14	.022	.17
K^trans (minute⁻¹)	0.08 (0.06–0.17)	0.16 (0.13–0.20)	0.39 (0.20–0.63)	<.001	.16	.002	.002

Note:—P^a is from Kruskal–Wallis H test. P^b is adjusted for pair-wise comparison by Bonferroni correction.
↵a Numbers in parentheses indicate interquartile range.

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Table 4:

Diagnostic performance of DCE-MR imaging parameters for each tumor comparison^{^a}

Parameters	Chondrosarcoma vs Chordoma		Chondrosarcoma vs Metastasis			Chordoma vs Metastasis
Parameters	nADCmean	Vp	nADCmean	Vp	K^trans (minute⁻¹)	Vp	K^trans (minute⁻¹)
Cutoff	1.99	0.03	2.09	0.06	0.12	0.09	0.30
Sensitivity	1.0 (0.68–1)	0.93 (0.66–0.99)	0.93 (0.76–0.99)	0.93 (0.78–0.99)	0.93 (0.78–0.99)	0.80 (0.61–0.92)	0.60 (0.41–0.77)
Specificity	0.86 (0.57–0.98)	0.71 (0.42–0.92)	0.87 (0.60–0.98)	0.93 (0.66–0.9)	0.71 (0.42–0.92)	0.93 (0.66–1)	1.0 (0.68–1)
PPV	0.88 (0.62–0.98)	0.77 (0.50–0.93)	0.93 (0.76–0.99)	0.97 (0.82–1)	0.88 (0.71–0.97)	0.96 (0.80–1)	1.0 (0.74–1)
NPV	1.0 (0.64–1)	0.91 (0.59–0.99)	0.87 (0.60–0.98)	0.87 (0.60–0.98)	0.83 (0.52–0.98)	0.68 (0.43–0.87)	0.54 (0.33–0.73)
Accuracy	0.93 (0.78–0.99)	0.82 (0.63–0.94)	0.91 (0.77–0.97)	0.93 (0.81–0.99)	0.86 (0.73–0.95)	0.84 (0.70–0.93)	0.73 (0.57–0.85)
AUC	0.96 (0.90–1)	0.86 (0.72–1)	0.95 (0.88–1)	0.99 (0.96–1)	0.82 (0.67–0.98)	0.92 (0.84– 1)	0.82 (0.70–0.95)