Role of resolve DWI and DCE MRI in differentiating benign and malignant skull base lesions.

Purpose: To assess the utility of RESOLVE Diffusion-Weighted Imaging (DWI) and Dynamic Contrast-Enhanced (DCE) MRI in differentiating benign and malignant skull base lesions using qualitative and quantitative imaging parameters.

Methods: This prospective study included 44 patients with 45 skull base lesions who underwent MRI with RESOLVE DWI and DCE-MRI. Apparent diffusion coefficient (ADC) values and lesion-to-medulla ADC ratios were calculated from DWI. Perfusion parameters (Ktrans, Kep, Ve) and time-intensity curve (TIC) were derived from DCE-MRI. Benign and malignant lesions were statistically compared, and receiver operating characteristic analysis was performed to evaluate diagnostic capability.

Results: Malignant lesions had significantly lower mean ADC values (0.88 × 10⁻³ mm²/s) than benign lesions (1.05 × 10⁻³ mm²/s, p = 0.033). The lesion-to-medulla ADC ratio was also significantly lower in malignant lesions (1.03 vs. 1.25, p = 0.029), yielding 89% sensitivity and 44% specificity at a cutoff ≤ 1.167 (AUC = 0.695). Among DCE-MRI parameters, both Kep and the distribution of time-intensity curve (TIC) showed significant differences between benign and malignant lesions (p = 0.037 and p < 0.001, respectively). Kep was higher in malignant lesions (0.98 vs. 0.78), with an AUC of 0.689, 94% sensitivity, and 52% specificity at a cutoff of ≥ 0.581. Ktrans and Ve did not show significant statistical difference.

Conclusion: RESOLVE DWI and DCE-MRI are effective non-invasive tools for differentiating benign and malignant skull base lesions. The ADC ratio and Kep are valuable quantitative markers, while TIC pattern analysis offers complementary qualitative insights, enhancing diagnostic confidence.