The Added Value of Diffusion Magnetic Resonance Imaging in the Diagnosis and Posttreatment Evaluation of Skull Base Chordomas

Abstract

Objectives To determine the use of diffusion-weighted imaging (DWI) in the pre- and posttreatment evaluation of skull base chordomas.

Design Retrospective study.

Setting Tertiary care university hospital.

Participants In total, 17 patients with histopathological diagnosis of chordoma who had magnetic resonance (MR) imaging and DWI were evaluated. Of them, 13 patients had posttreatment MR imaging including DWI.

Main Outcome Measures Three apparent diffusion coefficient (ADC) values were obtained from tumor, and an ADC value was measured from pons for the purpose of normalization. ADC values of the subtypes of chordomas (typical and chondroid chordomas) were compared.

Results Ten (59%) masses had increased signal on trace DWI at pretreatment evaluation. The mean ADC_{entire tumor}/ADC_pons was calculated as 1.55 ± 0.44. The mean ADC_{entire tumor} values of typical and chondroid chordomas were 1.26 ± 0.29 × 10⁻³ mm²/s and 0.99 ± 0.46 × 10⁻³ mm²/s, respectively. There was no statistically significant difference between ADC values of the subtypes (p > 0.05). For posttreatment evaluation, DWI enabled detection of residual tumor in the majority (85%) of cases.

Conclusions DWI is useful in diagnosis and posttreatment evaluation of skull base chordomas. However, ADC values in our series did not distinguish the subtypes of chordomas.

Keywords

diffusion-weighted imaging - magnetic resonance imaging - chordoma - skull base

• References

• 1 Heffelfinger MJ, Dahlin DC, MacCarty CS, Beabout JW. Chordomas and cartilaginous tumors at the skull base. Cancer 1973; 32 (02) 410-420
• 2 Soo MY. Chordoma: review of clinicoradiological features and factors affecting survival. Australas Radiol 2001; 45 (04) 427-434
• 3 Dahlin DC, MacCarty CS. Chordoma. Cancer 1952; 5 (06) 1170-1178
• 4 Kendall BE. Cranial chordomas. Br J Radiol 1977; 50 (598) 687-698
• 5 Ormerod R. A case of chordoma presenting in the nasopharynx. J Laryngol Otol 1960; 74: 245-254
• 6 Shugar JM, Som PM, Krespi YP, Arnold LM, Som ML. Primary chordoma of the maxillary sinus. Laryngoscope 1980; 90 (11 Pt 1): 1825-1830
• 7 Mapstone TB, Kaufman B, Ratcheson RA. Intradural chordoma without bone involvement: nuclear magnetic resonance (NMR) appearance. Case report. J Neurosurg 1983; 59 (03) 535-537
• 8 Mindell ER. Chordoma. J Bone Joint Surg Am 1981; 63 (03) 501-505
• 9 Mizerny BR, Kost KM. Chordoma of the cranial base: the McGill experience. J Otolaryngol 1995; 24 (01) 14-19
• 10 Clark WC, Robertson JH, Lara R. Chondroid chordoma. Case report. J Neurosurg 1982; 57 (06) 842-845
• 11 Tsutsumi S, Akiba C, Suzuki T. , et al. Skull base chondroid chordoma: atypical case manifesting as intratumoral hemorrhage and literature review. Clin Neuroradiol 2014; 24 (04) 313-320
• 12 Colli BO, Al-Mefty O. Chordomas of the skull base: follow-up review and prognostic factors. Neurosurg Focus 2001; 10 (03) E1
• 13 Jian BJ, Bloch OG, Yang I, Han SJ, Aranda D, Parsa AT. A comprehensive analysis of intracranial chordoma and survival: a systematic review. Br J Neurosurg 2011; 25 (04) 446-453
• 14 Erdem E, Angtuaco EC, Van Hemert R, Park JS, Al-Mefty O. Comprehensive review of intracranial chordoma. Radiographics 2003; 23 (04) 995-1009
• 15 Sze G, Uichanco III LS, Brant-Zawadzki MN. , et al. Chordomas: MR imaging. Radiology 1988; 166 (1 Pt 1): 187-191
• 16 Bammer R. Basic principles of diffusion-weighted imaging. Eur J Radiol 2003; 45 (03) 169-184
• 17 Nemeth AJ, Henson JW, Mullins ME, Gonzalez RG, Schaefer PW. Improved detection of skull metastasis with diffusion-weighted MR imaging. AJNR Am J Neuroradiol 2007; 28 (06) 1088-1092
• 18 Abdel Razek A, Mossad A, Ghonim M. Role of diffusion-weighted MR imaging in assessing malignant versus benign skull-base lesions. Radiol Med (Torino) 2011; 116 (01) 125-132
• 19 White ML, Zhang Y, Robinson RA. Evaluating tumors and tumorlike lesions of the nasal cavity, the paranasal sinuses, and the adjacent skull base with diffusion-weighted MRI. J Comput Assist Tomogr 2006; 30 (03) 490-495
• 20 Ginat DT, Mangla R, Yeaney G, Johnson M, Ekholm S. Diffusion-weighted imaging for differentiating benign from malignant skull lesions and correlation with cell density. AJR Am J Roentgenol 2012; 198 (06) W597-W601
• 21 Le Bihan D, Breton E, Lallemand D, Grenier P, Cabanis E, Laval-Jeantet M. MR imaging of intravoxel incoherent motions: application to diffusion and perfusion in neurologic disorders. Radiology 1986; 161 (02) 401-407
• 22 Sugahara T, Korogi Y, Kochi M. , et al. Usefulness of diffusion-weighted MRI with echo-planar technique in the evaluation of cellularity in gliomas. J Magn Reson Imaging 1999; 9 (01) 53-60
• 23 Yeom KW, Lober RM, Mobley BC. , et al. Diffusion-weighted MRI: distinction of skull base chordoma from chondrosarcoma. AJNR Am J Neuroradiol 2013; 34 (05) 1056-1061 , S1
• 24 Freeze BS, Glastonbury CM. Differentiation of skull base chordomas from chondrosarcomas by diffusion-weighted MRI. AJNR Am J Neuroradiol 2013; 34 (10) E113
• 25 Müller U, Kubik-Huch RA, Ares C. , et al. Is there a role for conventional MRI and MR diffusion-weighted imaging for distinction of skull base chordoma and chondrosarcoma?. Acta Radiol 2016; 57 (02) 225-232
• 26 Jian BJ, Bloch OG, Yang I. , et al. Adjuvant radiation therapy and chondroid chordoma subtype are associated with a lower tumor recurrence rate of cranial chordoma. J Neurooncol 2010; 98 (01) 101-108