Predicting pathological subtypes and stages of thymic epithelial tumors using DWI: value of combining ADC and texture parameters

Objectives To explore the value of combining apparent diffusion coefficients (ADC) and texture parameters from diffusion-weighted imaging (DWI) in predicting the pathological subtypes and stages of thymic epithelial tumors (TETs). Methods Fifty-seven patients with TETs confirmed by pathological analysis were retrospectively enrolled. ADC values and optimal texture feature parameters were compared for differences among low-risk thymoma (LRT), high-risk thymoma (HRT), and thymic carcinoma (TC) by one-way ANOVA, and between early and advanced stages of TETs were tested using the independent samples t test. Receiver operating characteristic (ROC) curve analysis was performed to determine the differentiating efficacy. Results The ADC values in LRT and HRT were significantly higher than the values in TC ( p = 0.004 and 0.001, respectively), also in early stage, values were significantly higher than ones in advanced stage of TETs ( p < 0.001). Among all texture parameters analyzed in order to differentiate LRT from HRT and TC, the V 312 achieved higher diagnostic efficacy with an AUC of 0.875, and combination of ADC and V 312 achieved the highest diagnostic efficacy with an AUC of 0.933, for differentiating the LRT from HRT and TC. Furthermore, combination of ADC and V 1030 achieved a relatively high differentiating ability with an AUC of 0.772, for differentiating early from advanced stages of TETs. Conclusions Combination of ADC and DWI texture parameters improved the differentiating ability of TET grades, which could potentially be useful in clinical practice regarding the TET evaluation before treatment. Key Points • DWI texture analysis is useful in differentiating TET subtypes and stages. • Combination of ADC and DWI texture parameters may improve the differentiating ability of TET grades. • DWI texture analysis could potentially be useful in clinical practice regarding the TET evaluation before treatment.