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Differentiating thymoma, thymic carcinoma and lymphoma based on collagen fibre patterns with T2- and diffusion-weighted magnetic resonance imaging

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Abstract

Objectives

The amount and distribution of intratumoural collagen fibre vary among different thymic tumours, which can be clearly detected with T2- and diffusion-weighted MR images. To explore the incidences of collagen fibre patterns (CFPs) among thymomas, thymic carcinomas and lymphomas on imaging, and to evaluate the efficacy and reproducibility of CFPs in differential diagnosis of thymic tumours.

Materials and methods

Three hundred and ninety-eight patients with pathologically diagnosed thymoma, thymic carcinoma and lymphoma who underwent T2- and diffusion-weighted MR imaging were retrospectively enrolled. CFPs were classified into four categories: septum sign, patchy pattern, mixed pattern and no septum sign. The incidences of CFPs were compared among different thymic tumours, and the efficacy and reproducibility in differentiating the defined tumour types were analysed.

Results

There were significant differences in CFPs among thymomas, thymic squamous cell carcinomas (TSCCs), other thymic carcinomas and neuroendocrine tumours (OTC&NTs) and thymic lymphomas. Septum signs were found in 209 (86%) thymomas, which differed between thymomas and any other thymic neoplasms (all p < 0.005). The patchy, mixed patterns and no septum sign were mainly seen in TSCCs (80.3%), OTC&NTs (78.9%) and thymic lymphomas (56.9%), respectively. The consistency of different CFP evaluation between two readers was either good or excellent. CFPs achieved high efficacy in identifying the thymic tumours.

Conclusion

The CFPs based on T2- and diffusion-weighted MR imaging were of great value in the differential diagnosis of thymic tumours.

Key Points

• Significant differences are found in intratumoural collagen fibre patterns among thymomas, thymic squamous cell carcinomas, other thymic carcinomas and neuroendocrine tumours and thymic lymphomas.

• The septum sign, patchy pattern, mixed pattern and no septum sign are mainly seen in thymomas (86%), thymic squamous cell carcinomas (80.3%), other thymic carcinomas and neuroendocrine tumours (79%) and thymic lymphomas (57%), respectively.

• The collagen fibre patterns have high efficacy and reproducibility in differentiating thymomas, thymic squamous cell carcinomas and thymic lymphomas.

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Abbreviations

CFP:

Collagen fibre pattern

DWI:

Diffusion-weighted imaging

FS-T2WI:

Fat-suppressed T2 weighted imaging

GCTs:

Germ cell tumours

NPV:

Negative predictive value

OTC&NT:

Other thymic carcinoma and neuroendocrine tumour

PPV:

Positive predictive value

TSCC:

Thymic squamous cell carcinoma

WHO:

World Health Organization

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Funding

This study has received funding by the Science and Technology Innovation Development Foundation of Tangdu Hospital (No. 2017LCYJ004).

Author information

Author notes

  1. Yu-Chuan Hu and Wei-Qiang Yan contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi’an, 710038, Shaanxi, People’s Republic of China

    Yu-Chuan Hu, Wei-Qiang Yan, Lin-Feng Yan, Gang Xiao, Yu Han, Chen-Xi Liu, Gang-Feng Li, Shi-Jun Duan, Bo Li, Wen Wang & Guang-Bin Cui

  2. Functional and Molecular Imaging Key Lab of Shaanxi Province, Xi’an, 710038, Shaanxi, People’s Republic of China

    Yu-Chuan Hu, Lin-Feng Yan, Gang Xiao, Yu Han, Chen-Xi Liu, Gang-Feng Li, Wen Wang & Guang-Bin Cui

  3. Faculty of Medical Technology, Shaanxi University of Traditional Chinese Medicine, Xianyang, 712046, Shaanxi, People’s Republic of China

    Sheng-Zhong Wang

  4. Department of Pathology, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi’an, 710038, Shaanxi, People’s Republic of China

    Shu-Mei Wang

  5. Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi’an, 710038, Shaanxi, People’s Republic of China

    Guang Yang

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  1. Yu-Chuan Hu
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Corresponding authors

Correspondence to Wen Wang or Guang-Bin Cui.

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Guarantor

The scientific guarantor of this publication is Guang-bin Cui.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in 77, 57, 189 and 182 thymic epithelial tumour patients, respectively [1–4]. Four previous articles explored the values of intravoxel incoherent motion DWI [1], DWI texture parameters [2] and MRI radiomics [3], and combined radiomics nomogram [4] in predicting the pathological classification of thymic epithelial tumours, whereas in this manuscript we reported the usefulness of CFPs in differentiating thymic tumours.

1. Li GF, Duan SJ, Yan LF et al (2017) Intravoxel incoherent motion diffusion-weighted MR imaging parameters predict pathological classification in thymic epithelial tumours. Oncotarget 8:44579-44592

2. Li B, Xin YK, Xiao G et al (2019) Predicting pathological subtypes and stages of thymic epithelial tumours using DWI: value of combining ADC and texture parameters. Eur Radiol 29:5330-5340

3. Xiao G, Rong WC, Hu YC et al (2019) MRI Radiomics Analysis for Predicting the Pathologic Classification and TNM Staging of Thymic Epithelial Tumors: A Pilot Study. AJR Am J Roentgenol. 10.2214/AJR.19.21696:1-13

4. Xiao G, Hu YC, Ren JL et al (2020) MR imaging of thymomas: a combined radiomics nomogram to predict histologic subtypes. Eur Radiol. 10.1007/s00330-020-07074-3.

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Hu, YC., Yan, WQ., Yan, LF. et al. Differentiating thymoma, thymic carcinoma and lymphoma based on collagen fibre patterns with T2- and diffusion-weighted magnetic resonance imaging. Eur Radiol 32, 194–204 (2022). https://doi.org/10.1007/s00330-021-08143-x

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