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European Radiology
Published in: European Radiology 9/2020

01-09-2020 | Magnetic Resonance Imaging | Musculoskeletal

Can we use MRI to detect clinically silent recurrent soft-tissue sarcoma?

Authors: Anna Hirschmann, Veroniek M. van Praag, Rick L. Haas, Michiel A. J. van de Sande, Johan L. Bloem

Published in: European Radiology | Issue 9/2020

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Abstract

Purpose

The impact of MRI on early detection of local recurrence (LR) in high-grade soft-tissue sarcomas (STS) is unsubstantiated. To identify the contribution of MRI criteria including dynamic contrast-enhanced (DCE) MRI and knowledge of surgical margins that can be used in detecting recurrence prior to obvious proven presence of LR in soft-tissue sarcomas. The secondary aim was to determine causes for misdiagnosing LR.

Methods

MRI of 23 patients (12 men; mean age, 59.7 years ± 16.5 years) with LR of STS and that of 22 age- and histology-matched controls with STS but without LR were retrospectively analyzed by two musculoskeletal radiologists. Preoperative MRI characteristics (conventional and DCE) were compared to those of MRIs made after treatment, but before LR was proven. Likelihood of recurrence was rated on a 5-point Likert scale for morphological and dynamic assessment separately, before and after adding knowledge of surgical margins. Descriptive statistics and receiver operating characteristic analysis were performed.

Results

Differentiation of LR from post-therapeutic changes was the highest combining result of conventional MRI, DCE-MRI, and knowledge of surgical margins (area under the curve (AUC) 0.779), followed by DCE-MRI (AUC 0.706) and conventional MRI (AUC 0.648). Suboptimal MRI technique and overcalling post-therapeutic changes in microscopic positive margins were the main reasons for false negative and false positive results, respectively.

Conclusion

MRI including DCE improves the detection of recurrent, clinically silent soft-tissue sarcoma when combined with knowledge of achieved surgical margins. LR may be missed on inadequate MRI protocols.

Key Points

• Dynamic contrast-enhanced MRI is useful in the differentiation of recurrent soft-tissue sarcoma and post-therapeutic fibrosis.
• Knowledge of surgical margins substantially increases the value of MRI in detecting recurrent soft-tissue sarcoma.
• MR with all three image orientations, covering the entire part of the extremity in at least one sequence and comparison to initial tumor characteristics and location, is beneficial.
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Metadata
Title
Can we use MRI to detect clinically silent recurrent soft-tissue sarcoma?
Authors
Anna Hirschmann
Veroniek M. van Praag
Rick L. Haas
Michiel A. J. van de Sande
Johan L. Bloem
Publication date
01-09-2020
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 9/2020
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-020-06810-z

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