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Qualitative evaluation of MRI features of lipoma and atypical lipomatous tumor: results from a multicenter study

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Abstract

Objectives

The objectives of the study are (1) to distinguish lipoma (L) from atypical lipomatous tumor (ALT) using MRI qualitative features, (2) to assess the value of contrast enhancement, and (3) to evaluate the reproducibility and confidence level of radiological readings.

Materials and methods

Patients with pathologically proven L or ALT, who underwent MRI within 3 months from surgical excision were included in this retrospective multicenter international study. Two radiologists independently reviewed MRI centrally. Impressions were recorded as L or ALT. A third radiologist was consulted for discordant readings. The two radiologists re-read all non-contrast sequences; impression was recorded; then post-contrast images were reviewed and any changes were recorded.

Results

A total of 246 patients (135 females; median age, 59 years) were included. ALT was histopathologically confirmed in 70/246 patients. In multivariable analysis, in addition to the lesion size, deep location, proximal lower limb lesions, demonstrating incomplete fat suppression, or increased architectural complexity were the independent predictive features of ALT; but not the contrast enhancement. Post-contrast MRI changed the impression in a total of 5 studies (3 for R1 and 4 for R2; 2 studies are common); all of them were incorrectly changed from Ls to ALTs. Overall, inter-reader kappa agreement was 0.42 (95% CI 0.39–0.56). Discordance between the two readers was statistically significant for both pathologically proven L (p < 0.001) and ALT (p = 0.003).

Conclusion

Most qualitative MR imaging features can help distinguish ALTs from BLs. However, contrast enhancement may be limited and occasionally misleading. Substantial discordance on MRI readings exists between radiologists with a relatively high false positive and negative rates.

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Funding

This study is supported in part by the UC Davis Paul Calabresi Career Development Award for Clinical Oncology as funded by the National Cancer Institute/National Institutes of Health through grant no. 5K12-CA138464.

Author information

Authors and Affiliations

  1. Department of Radiology, University of California Davis, 4860 Y Street, Suite 3100, Sacramento, CA, 95817, USA

    Lorenzo Nardo, Yasser G Abdelhafez, Andrew L. Wong, Dani Sarohia & Ramsey D. Badawi

  2. Radiologia Pediatrica - Ospedale dei Bambini, ASST Spedali Civili , Brescia, Italy

    Francesco Acquafredda

  3. Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA

    Silvia Schirò & Thomas M. Link

  4. Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy

    Silvia Schirò

  5. Scienze Radiologiche, Università degli Studi di Brescia, Brescia, Italy

    Roberto Maroldi

  6. Pathology and Laboratory Medicine, University of California Davis, Sacramento, CA, USA

    Morgan A. Darrow

  7. Department of Statistics, University of California, Irvine, CA, USA

    Michele Guindani

  8. Department of Radiological Sciences, University of California, Irvine, CA, USA

    Sonia Lee

  9. Department of Diagnostic Radiology, McGill University Health Center, Montreal, Canada

    Michelle Zhang

  10. Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Ahmed W. Moawad

  11. Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Khaled M. Elsayes

Authors
  1. Lorenzo Nardo
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  2. Yasser G Abdelhafez
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  3. Francesco Acquafredda
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  4. Silvia Schirò
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  5. Andrew L. Wong
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  8. Morgan A. Darrow
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  9. Michele Guindani
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  10. Sonia Lee
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  11. Michelle Zhang
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  12. Ahmed W. Moawad
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  13. Khaled M. Elsayes
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  14. Ramsey D. Badawi
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  15. Thomas M. Link
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Corresponding author

Correspondence to Lorenzo Nardo.

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Conflict of interest

Ramsey D Badawi received research/grant support from United Imaging Healthcare.

The authors declare that they have no conflict of interest.

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Nardo, L., Abdelhafez, Y.G., Acquafredda, F. et al. Qualitative evaluation of MRI features of lipoma and atypical lipomatous tumor: results from a multicenter study. Skeletal Radiol 49, 1005–1014 (2020). https://doi.org/10.1007/s00256-020-03372-5

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  • DOI: https://doi.org/10.1007/s00256-020-03372-5

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