Skip to main content Skip to main navigation menu Skip to site footer

Characteristics and Role of Apparent Diffusion Coefficient (ADC) Value in Musculoskeletal Soft Tissue Tumor


Introduction: Musculoskeletal soft tissue tumors (STTs) consist of a group of malignant and benign tumors that present challenges in diagnosis and therapy. Adding diffusion-weighted imaging and apparent diffusion coefficient (DWI/ADC) ​​provides tissue characteristics that are different from those obtained by conventional MR techniques. Quantitative examination of the diffusion of water molecules in tissue is expressed as ADC value, which is expected to be more helpful in differentiating malignant and benign soft tissue masses. This study was carried out to determine the characteristics and role of ADC values ​​in musculoskeletal STTs.

Methods: This research was conducted retrospectively. Analysis was performed using MRI results of patients with musculoskeletal STTs who met the inclusion and exclusion criteria. Three regions of interest (ROI) were assessed in the tumor area with the strongest contrast enhancement for DWI mapping, ADC, and ROI ADC value placement. An Independent T-test test was performed to determine the mean difference of ADC in each tumor category. Receiver Operating Characteristics (ROC) were generated to find the optimal cut-off value. Then, a diagnostic test was carried out to determine the sensitivity, specificity, PPV, and NPV of the ADC value.

Results: There were 41 research subjects with musculoskeletal STTs with male predominance, in which 75.61% of cases were malignant. DWI/ADC showed that 78.05% of patients with musculoskeletal soft tissue tumors had restricted diffusion areas. In this study, the ADC cutoff value to differentiate benign and malignant musculoskeletal STT is 0,84 x 10-3mm2/s with 77.4% sensitivity and 90% specificity, 96% positive predictive value and 56.3% negative predictive value.

Conclusion: In differentiating malignant and benign musculoskeletal STTs, the ADC value provides fair sensitivity, very good specificity, good positive predictive value, and low negative predictive value.



  1. Picci P. Epidemiology of Soft Tissue Lesions. In: Picci P, Manfrini M, Donati DM, Gambarotti M, Righi A, Vanel D, et al., editors. Diagnosis of Musculoskeletal Tumors and Tumor-like Conditions [Internet]. Cham: Springer International Publishing; 2020 [cited 2023 Nov 28]. p. 15–8. Available from:
  2. Yuceturk G. Prevalence of bone and soft tissue tumors. Acta Orthop Traumatol Turc. 2011;45(3):135–43.
  3. Hassanien OA, Younes RL, Dawoud RM. Diffusion weighted MRI of soft tissue masses: Can measurement of ADC value help in the differentiation between benign and malignant lesions? Egypt J Radiol Nucl Med. 2018 Sep;49(3):681–8.
  4. Wu JS, Hochman MG. Soft-Tissue Tumors and Tumorlike Lesions: A Systematic Imaging Approach. Radiology. 2009 Nov;253(2):297–316.
  5. Romeih M, Raafat T, Khalaf M, Sallam K. The diagnostic value of diffusion-weighted magnetic resonance imaging in characterization of musculoskeletal soft tissue tumors. Egypt J Radiol Nucl Med. 2018 Jun;49(2):400–7.
  6. Fouad D, Mohamed D. Qualitative and quantitative performance of diffusion-weighted imaging in differentiation between benign and malignant soft tissue lesions. J Curr Med Res Pract. 2021;6(2):192.
  7. Murphey MD, Kransdorf MJ. Staging and Classification of Primary Musculoskeletal Bone and Soft-Tissue Tumors According to the 2020 WHO Update, From the AJR Special Series on Cancer Staging. Am J Roentgenol. 2021 Nov;217(5):1038–52.
  8. Characteristics of Apparent Diffusion Coefficient and Time Intensity Curve in AdvancedMagnetic Resonance Imaging of Malignant Soft Tissue Tumors. Indian J Forensic Med Toxicol [Internet]. 2021 May 12 [cited 2023 Nov 28]; Available from:
  9. Zhang H, Pan J, Shen Y, Bai X, Wang Y, Wang H, et al. High signal renal tumors on DWI: the diagnostic value of morphological characteristics. Abdom Radiol. 2019 Jan;44(1):239–46.
  10. Weller A, Papoutsaki MV, Waterton JC, Chiti A, Stroobants S, Kuijer J, et al. Diffusion-weighted (DW) MRI in lung cancers: ADC test-retest repeatability. Eur Radiol. 2017 Nov;27(11):4552–62.
  11. Nagata S, Nishimura H, Uchida M, Sakoda J, Tonan T, Hiraoka K, et al. Diffusion-weighted imaging of soft tissue tumors: usefulness of the apparent diffusion coefficient for differential diagnosis. Radiat Med. 2008 Jun;26(5):287–95.
  12. Boruah DK, Gogoi B, Patni RS, Sarma K, Hazarika K. Added Value of Diffusion-Weighted Magnetic Resonance Imaging in Differentiating Musculoskeletal Tumors Using Sensitivity and Specificity: A Retrospective Study and Review of Literature. Cureus [Internet]. 2021 Jan 1 [cited 2023 Nov 28]; Available from:
  13. Neubauer H, Evangelista L, Hassold N, Winkler B, Schlegel PG, Köstler H, et al. Diffusion-weighted MRI for detection and differentiation of musculoskeletal tumorous and tumor-like lesions in pediatric patients. World J Pediatr. 2012 Nov;8(4):342–9.
  14. Choi YJ, Lee IS, Song YS, Kim JI, Choi K, Song JW. Diagnostic performance of diffusion‐weighted (DWI) and dynamic contrast‐enhanced (DCE) MRI for the differentiation of benign from malignant soft‐tissue tumors. J Magn Reson Imaging. 2019 Sep;50(3):798–809.
  15. Robba T, Chianca V, Albano D, Clementi V, Piana R, Linari A, et al. Diffusion-weighted imaging for the cellularity assessment and matrix characterization of soft tissue tumour. Radiol Med (Torino). 2017 Nov;122(11):871–9.
  16. Lee SY, Jee WH, Jung JY, Park MY, Kim SK, Jung CK, et al. Differentiation of malignant from benign soft tissue tumours: use of additive qualitative and quantitative diffusion-weighted MR imaging to standard MR imaging at 3.0 T. Eur Radiol. 2016 Mar;26(3):743–54.
  17. Costa FM, Ferreira EC, Vianna EM. Diffusion-Weighted Magnetic Resonance Imaging for the Evaluation of Musculoskeletal Tumors. Magn Reson Imaging Clin N Am. 2011 Feb;19(1):159–80.
  18. Nagata S, Nishimura H, Uchida M, Hayabuchi N. [Usefulness of diffusion-weighted MRI in differentiating benign from malignant musculoskeletal tumors]. Nihon Igaku Hoshasen Gakkai Zasshi Nippon Acta Radiol. 2005 Jan;65(1):30–6.
  19. Douis H, Jeys L, Grimer R, Vaiyapuri S, Davies AM. Is there a role for diffusion-weighted MRI (DWI) in the diagnosis of central cartilage tumors? Skeletal Radiol. 2015 Jul;44(7):963–9.
  20. Douis H, Singh L, Saifuddin A. MRI differentiation of low-grade from high-grade appendicular chondrosarcoma. Eur Radiol. 2014 Jan;24(1):232–40.
  21. Garrett KM, Kim HK, Stanek J, Emery KH. MR findings of primary bone lymphoma in a 15-year-old girl: emphasis on diffusion-weighted imaging. Pediatr Radiol. 2011 May;41(5):658–62.
  22. Einarsdo'ttir H, Karlsson M, Wejde J, Bauer HCF. Diffusion-weighted MRI of soft tissue tumours. Eur Radiol. 2004 Jun 1;14(6):959–63.
  23. Martadiani ED, Sumadi IWJ, Putra IWGAE, Anggreni FN, Martono B, Primanda Y, Nike F, Triningsih. Diagnostic value of qualitative, semiquantitative, and quantitative parameter of dynamic contrast-enhanced MRI in musculoskeletal tumor. Bali Med J. 2022;11(3):2075-84.

How to Cite

Elysanti Dwi Martadiani, I Wayan Juli Sumadi, I Wayan Gede Artawan Eka Putra, Jonathan Andryanto, Anak Agung Gede Agung Priyastana, & Felicia Nike. (2023). Characteristics and Role of Apparent Diffusion Coefficient (ADC) Value in Musculoskeletal Soft Tissue Tumor. Indonesia Journal of Biomedical Science, 17(2), 289–294.




Search Panel

Elysanti Dwi Martadiani
Google Scholar
IJBS Journal

I Wayan Juli Sumadi
Google Scholar
IJBS Journal

I Wayan Gede Artawan Eka Putra
Google Scholar
IJBS Journal

Jonathan Andryanto
Google Scholar
IJBS Journal

Anak Agung Gede Agung Priyastana
Google Scholar
IJBS Journal

Felicia Nike
Google Scholar
IJBS Journal