Pilot study to differentiate lipoma from atypical lipomatous tumour/well-differentiated liposarcoma using MR radiomics-b
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SCIENTIFIC ARTICLE
Pilot study to differentiate lipoma from atypical lipomatous tumour/well-differentiated liposarcoma using MR radiomics-based texture analysis Ian Pressney 1,2 & Michael Khoo 1 & Raymond Endozo 3 & Balaji Ganeshan 3 & Paul O’Donnell 1,4 Received: 13 January 2020 / Revised: 19 April 2020 / Accepted: 22 April 2020 # ISS 2020
Abstract Aims This pilot study aims to determine if tumour heterogeneity assessed using magnetic resonance imaging (MRI) radiomicsbased texture analysis (TA) can differentiate between lipoma and atypical lipomatous tumour (ALT)/well-differentiated liposarcoma (WDL). Materials and methods Thirty consecutive ALT/WDLs and 30 lipomas were included in the study, cases diagnosed both histologically and with murine double minute 2 (MDM2) gene amplification by fluorescence in situ hybridisation (FISH) in excision specimens. Multiple patient, MRI and MRTA factors were assessed. Heterogeneity was evaluated using a filtrationhistogram technique-based textural analysis on single axial proton density (PD) and coronal T1-W images of the most homogenously fatty component of the lesion. Results Thirty-three percent of the diagnoses of ALT/WDL vs lipoma were confirmed using FISH MDM2 analysis. ALT/WDLs were statistically different from lipomas in location (site in the body and depth from skin surface) and fat content, with p values of 0.021, 0.001, and 0.021 respectively. Nine of 36 (25%) texture parameters had significant differences between ALT/WDLs and lipomas on axial PD MRTA, with the most significant results at medium and coarse texture scales particularly mean intensity (p = 0.003) at SSF = 6, and kurtosis (p = 0.012) at SSF = 5. A cut-off value of < 304 for coarse-filtered texture on axial PD MRI identified ALT from lipoma with a sensitivity and specificity of 70% (AUC = 0.73, p = 0.003). Conclusions Texture heterogeneity quantified at fine, medium, and coarse texture scales are significant differentiators of lipoma and ALT/WDL with the difference particularly marked in medium and coarse texture scales for two MR TA parameters: mean and kurtosis. Keywords Lipoma . Magnetic resonance imaging . Neoplasms . Adipose tissue . Murine double minute 2 (MDM2)
Introduction Fat-containing tumours are commonly encountered in clinical practice [1]. Lipomas are the most common soft tissue
* Ian Pressney [email protected] 1
Clinical Radiology, Royal National Orthopaedic Hospital, Stanmore, UK
2
Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK
3
Nuclear Medicine, University College Hospital, London, UK
4
Institute of Orthopaedics and Musculoskeletal Science, University College, London, London, UK
tumours and liposarcomas the most common soft tissue sarcoma [2]. Lipomas are benign and do not require surgical excision or formal surveillance. The World Health Organization (WHO) committee for Classification of Soft Tissue Tumours in 2013 [3] subdivided soft tissue liposarcoma into five categories, with atypical lipomatous tumour (ALT)/
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