Diffusion-weighted imaging of bone and soft tissue tumors: a systematic review.

This article systematically reviews the utility of diffusion-weighted imaging (DWI), a magnetic resonance imaging (MRI) technique analyzing water diffusion to reflect tissue cellularity, in the diagnosis and management of bone and soft tissue tumors. It evaluates DWI's accuracy in three areas: differentiating bone and soft tissue sarcoma subtypes and grades, correlating DWI findings with chemotherapy response in Ewing's sarcoma and osteosarcoma, and distinguishing benign from malignant bone and soft tissue lesions. The review of 22 studies found that DWI shows promise with variable sensitivity and specificity across these applications, with apparent diffusion coefficient (ADC) cutoff values aiding tumor characterization and treatment monitoring. Despite encouraging results, limitations such as study heterogeneity, retrospective designs, and reliance on histopathology as the gold standard highlight the need for further prospective research to standardize and validate DWI's clinical role in musculoskeletal oncology.