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Published in: Skeletal Radiology 11/2020

01-11-2020 | Magnetic Resonance Imaging | Scientific Article

Soft tissue sarcoma: can dynamic contrast-enhanced (DCE) MRI be used to predict the histological grade?

Authors: Xiangwen Li, Qimeng Wang, Yanping Dou, Yu Zhang, Juan Tao, Lin Yang, Shaowu Wang

Published in: Skeletal Radiology | Issue 11/2020

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Abstract

Objective

To determine if dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) parameters reflect histological grade of soft tissue sarcoma (STS)

Materials and methods

The medical records of 50 patients diagnosed with pathologically confirmed STS were retrospectively reviewed. Each STS was assessed with conventional contrast-enhanced MRI and DCE-MRI using a 3.0-T MRI system. The conventional MRI characteristics of low-grade (grade 1) and high-grade (grade 2 and grade 3) tumors were analyzed. Semi-quantitative parameters, including iAUC and TTP, and quantitative parameters, including Ktrans, Kep, and Ve, were derived from DCE-MRI. The diagnostic performances and optimal thresholds of various combinations of DCE-MRI parameters for predicting histological grades of STS were investigated using receiver operator characteristic (ROC) curves.

Results

On conventional MRI, high-grade STSs were significantly larger (≥ 5 cm) and more likely to show a heterogeneous signal intensity on T2WI (> 75%), peritumoral hyperintensity on T2WI, or tumor necrosis (> 50%) compared with low-grade STS. On DCE-MRI, iAUC, TTP, Ktrans, and Kep were significant predictors of STS histological grade. Ktrans had a high diagnostic value for differentiating between high-grade and low-grade STSs. The combination of iAUC, TTP, and Ktrans yielded a higher AUC value (0.841) than the other models.

Conclusion

High-grade STSs were usually larger than low-grade STSs, had unclear boundaries, a heterogeneous signal intensity on T2-weighted image (T2WI), and extensive necrosis. On DCE-MRI, iAUC, TTP, Ktrans, and Kep could differentiate between high-grade and low-grade STSs. The combination of iAUC, TTP, and Ktrans had a high diagnostic performance for differentiating between STS histological grades.
Literature
1.
go back to reference Gronchi A, Ferrari S, Quagliuolo V, et al. Histotype-tailored neoadjuvant chemotherapy versus standard chemotherapy in patients with high-risk soft-tissue sarcomas (ISG-STS 1001): an international, open-label, randomised, controlled, phase 3, multicentre trial. Lancet Oncol. 2017;18(6):812–22.PubMed Gronchi A, Ferrari S, Quagliuolo V, et al. Histotype-tailored neoadjuvant chemotherapy versus standard chemotherapy in patients with high-risk soft-tissue sarcomas (ISG-STS 1001): an international, open-label, randomised, controlled, phase 3, multicentre trial. Lancet Oncol. 2017;18(6):812–22.PubMed
2.
go back to reference Issels RD, Lindner LH, Verweij J, et al. Neo-adjuvant chemotherapy alone or with regional hyperthermia for localised high-risk soft-tissue sarcoma: a randomised phase 3 multicentre study. Lancet Oncol. 2010;11(6):561–70.PubMedPubMedCentral Issels RD, Lindner LH, Verweij J, et al. Neo-adjuvant chemotherapy alone or with regional hyperthermia for localised high-risk soft-tissue sarcoma: a randomised phase 3 multicentre study. Lancet Oncol. 2010;11(6):561–70.PubMedPubMedCentral
3.
go back to reference Lucas DR, Kshirsagar MP, Biermann JS, et al. Histologic alterations from neoadjuvant chemotherapy in high-grade extremity soft tissue sarcoma: clinicopathological correlation. Oncologist. 2008;13(4):451–8.PubMed Lucas DR, Kshirsagar MP, Biermann JS, et al. Histologic alterations from neoadjuvant chemotherapy in high-grade extremity soft tissue sarcoma: clinicopathological correlation. Oncologist. 2008;13(4):451–8.PubMed
4.
go back to reference Menendez LR, Ahlmann ER, Savage K, Cluck M, Fedenko AN. Tumor necrosis has no prognostic value in neoadjuvant chemotherapy for soft tissue sarcoma. Clin Orthop Relat Res. 2007;455:219–24.PubMed Menendez LR, Ahlmann ER, Savage K, Cluck M, Fedenko AN. Tumor necrosis has no prognostic value in neoadjuvant chemotherapy for soft tissue sarcoma. Clin Orthop Relat Res. 2007;455:219–24.PubMed
5.
go back to reference Pasquali S, Gronchi A. Neoadjuvant chemotherapy in soft tissue sarcomas: latest evidence and clinical implications. Ther Adv Med Oncol. 2017;9(6):415–29.PubMedPubMedCentral Pasquali S, Gronchi A. Neoadjuvant chemotherapy in soft tissue sarcomas: latest evidence and clinical implications. Ther Adv Med Oncol. 2017;9(6):415–29.PubMedPubMedCentral
6.
go back to reference Saponara M, Stacchiotti S, Casali PG, Gronchi A. (Neo)adjuvant treatment in localised soft tissue sarcoma: the unsolved affair. Eur J Cancer. 2017;70:1–11.PubMed Saponara M, Stacchiotti S, Casali PG, Gronchi A. (Neo)adjuvant treatment in localised soft tissue sarcoma: the unsolved affair. Eur J Cancer. 2017;70:1–11.PubMed
7.
go back to reference Coindre JM, Terrier P, Bui NB, et al. Prognostic factors in adult patients with locally controlled soft tissue sarcoma. A study of 546 patients from the French Federation of Cancer Centers Sarcoma Group. J Clin Oncol. 1996;14(3):869–77.PubMed Coindre JM, Terrier P, Bui NB, et al. Prognostic factors in adult patients with locally controlled soft tissue sarcoma. A study of 546 patients from the French Federation of Cancer Centers Sarcoma Group. J Clin Oncol. 1996;14(3):869–77.PubMed
8.
go back to reference Guillou L, Coindre JM, Bonichon F, et al. Comparative study of the National Cancer Institute and French Federation of Cancer Centers Sarcoma Group grading systems in a population of 410 adult patients with soft tissue sarcoma. J Clin Oncol. 1997;15(1):350–62.PubMed Guillou L, Coindre JM, Bonichon F, et al. Comparative study of the National Cancer Institute and French Federation of Cancer Centers Sarcoma Group grading systems in a population of 410 adult patients with soft tissue sarcoma. J Clin Oncol. 1997;15(1):350–62.PubMed
9.
go back to reference Coindre JM, Terrier P, Guillou L, et al. Predictive value of grade for metastasis development in the main histologic types of adult soft tissue sarcomas: a study of 1240 patients from the French Federation of Cancer Centers Sarcoma Group. Cancer. 2001;91(10):1914–26.PubMed Coindre JM, Terrier P, Guillou L, et al. Predictive value of grade for metastasis development in the main histologic types of adult soft tissue sarcomas: a study of 1240 patients from the French Federation of Cancer Centers Sarcoma Group. Cancer. 2001;91(10):1914–26.PubMed
10.
go back to reference Zagars GK, Ballo MT, Pisters PW, et al. Prognostic factors for patients with localized soft-tissue sarcoma treated with conservation surgery and radiation therapy: an analysis of 1225 patients. Cancer. 2003;97(10):2530–43.PubMed Zagars GK, Ballo MT, Pisters PW, et al. Prognostic factors for patients with localized soft-tissue sarcoma treated with conservation surgery and radiation therapy: an analysis of 1225 patients. Cancer. 2003;97(10):2530–43.PubMed
11.
go back to reference Atalar H, Basarir K, Yildiz Y, Saglik Y. Prognostic factors in patients with malignant fibrous histiocytoma of the extremities. Acta Orthop Traumatol Turc. 2007;41(4):271–6.PubMed Atalar H, Basarir K, Yildiz Y, Saglik Y. Prognostic factors in patients with malignant fibrous histiocytoma of the extremities. Acta Orthop Traumatol Turc. 2007;41(4):271–6.PubMed
12.
go back to reference Crombe A, Marcellin PJ, Buy X, et al. Soft-tissue sarcomas: assessment of MRI features correlating with histologic grade and patient outcome. Radiology. 2019;291(3):710–21.PubMed Crombe A, Marcellin PJ, Buy X, et al. Soft-tissue sarcomas: assessment of MRI features correlating with histologic grade and patient outcome. Radiology. 2019;291(3):710–21.PubMed
13.
go back to reference Yang J, Frassica FJ, Fayad L, Clark DP, Weber KL. Analysis of nondiagnostic results after image-guided needle biopsies of musculoskeletal lesions. Clin Orthop Relat Res. 2010;468(11):3103–11.PubMedPubMedCentral Yang J, Frassica FJ, Fayad L, Clark DP, Weber KL. Analysis of nondiagnostic results after image-guided needle biopsies of musculoskeletal lesions. Clin Orthop Relat Res. 2010;468(11):3103–11.PubMedPubMedCentral
14.
go back to reference Noebauer-Huhmann IM, Weber MA, Lalam RK, et al. Soft tissue tumors in adults: ESSR-approved guidelines for diagnostic imaging. Semin Musculoskelet Radiol. 2015;19(5):e1.PubMed Noebauer-Huhmann IM, Weber MA, Lalam RK, et al. Soft tissue tumors in adults: ESSR-approved guidelines for diagnostic imaging. Semin Musculoskelet Radiol. 2015;19(5):e1.PubMed
15.
go back to reference Barrientos-Ruiz I, Ortiz-Cruz EJ, Serrano-Montilla J, Bernabeu-Taboada D, Pozo-Kreilinger JJ. Are biopsy tracts a concern for seeding and local recurrence in sarcomas? Clin Orthop Relat Res. 2017;475(2):511–8.PubMed Barrientos-Ruiz I, Ortiz-Cruz EJ, Serrano-Montilla J, Bernabeu-Taboada D, Pozo-Kreilinger JJ. Are biopsy tracts a concern for seeding and local recurrence in sarcomas? Clin Orthop Relat Res. 2017;475(2):511–8.PubMed
16.
go back to reference Siddiqi MA, Kim HS, Jede F, Han I. Association of core needle biopsy tract resection with local recurrence in extremity soft tissue sarcoma. Skelet Radiol. 2017;46(4):507–12. Siddiqi MA, Kim HS, Jede F, Han I. Association of core needle biopsy tract resection with local recurrence in extremity soft tissue sarcoma. Skelet Radiol. 2017;46(4):507–12.
17.
go back to reference Van Houdt WJ, Schrijver AM, Cohen-Hallaleh RB, et al. Needle tract seeding following core biopsies in retroperitoneal sarcoma. Eur J Surg Oncol. 2017;43(9):1740–5.PubMed Van Houdt WJ, Schrijver AM, Cohen-Hallaleh RB, et al. Needle tract seeding following core biopsies in retroperitoneal sarcoma. Eur J Surg Oncol. 2017;43(9):1740–5.PubMed
18.
go back to reference Chhabra A, Ashikyan O, Slepicka C, et al. Conventional MR and diffusion-weighted imaging of musculoskeletal soft tissue malignancy: correlation with histologic grading. Eur Radiol. 2019;29(8):4485–94.PubMed Chhabra A, Ashikyan O, Slepicka C, et al. Conventional MR and diffusion-weighted imaging of musculoskeletal soft tissue malignancy: correlation with histologic grading. Eur Radiol. 2019;29(8):4485–94.PubMed
19.
go back to reference Fayad LM, Mugera C, Soldatos T, Flammang A, del Grande F. Technical innovation in dynamic contrast-enhanced magnetic resonance imaging of musculoskeletal tumors: an MR angiographic sequence using a sparse k-space sampling strategy. Skelet Radiol. 2013;42(7):993–1000. Fayad LM, Mugera C, Soldatos T, Flammang A, del Grande F. Technical innovation in dynamic contrast-enhanced magnetic resonance imaging of musculoskeletal tumors: an MR angiographic sequence using a sparse k-space sampling strategy. Skelet Radiol. 2013;42(7):993–1000.
20.
go back to reference Noebauer-Huhmann IM, Amann G, Krssak M, et al. Use of diagnostic dynamic contrast-enhanced (DCE)-MRI for targeting of soft tissue tumour biopsies at 3T: preliminary results. Eur Radiol. 2015;25(7):2041–8.PubMed Noebauer-Huhmann IM, Amann G, Krssak M, et al. Use of diagnostic dynamic contrast-enhanced (DCE)-MRI for targeting of soft tissue tumour biopsies at 3T: preliminary results. Eur Radiol. 2015;25(7):2041–8.PubMed
21.
go back to reference Xia W, Yan Z, Gao X. Volume fractions of DCE-MRI parameter as early predictor of histologic response in soft tissue sarcoma: a feasibility study. Eur J Radiol. 2017;95:228–35.PubMed Xia W, Yan Z, Gao X. Volume fractions of DCE-MRI parameter as early predictor of histologic response in soft tissue sarcoma: a feasibility study. Eur J Radiol. 2017;95:228–35.PubMed
22.
go back to reference Choi YJ, Lee IS, Song YS, Kim JI, Choi KU, 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;50(3):798–809.PubMed Choi YJ, Lee IS, Song YS, Kim JI, Choi KU, 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;50(3):798–809.PubMed
23.
go back to reference Egeland TA, Gulliksrud K, Gaustad JV, Mathiesen B, Rofstad EK. Dynamic contrast-enhanced-MRI of tumor hypoxia. Magn Reson Med. 2012;67(2):519–30.PubMed Egeland TA, Gulliksrud K, Gaustad JV, Mathiesen B, Rofstad EK. Dynamic contrast-enhanced-MRI of tumor hypoxia. Magn Reson Med. 2012;67(2):519–30.PubMed
24.
go back to reference O'Connor JP, Jackson A, Parker GJ, Roberts C, Jayson GC. Dynamic contrast-enhanced MRI in clinical trials of antivascular therapies. Nat Rev Clin Oncol. 2012;9(3):167–77.PubMed O'Connor JP, Jackson A, Parker GJ, Roberts C, Jayson GC. Dynamic contrast-enhanced MRI in clinical trials of antivascular therapies. Nat Rev Clin Oncol. 2012;9(3):167–77.PubMed
25.
go back to reference Alic L, van Vliet M, Wielopolski PA, et al. Regional heterogeneity changes in DCE-MRI as response to isolated limb perfusion in experimental soft-tissue sarcomas. Contrast Media Mol Imaging. 2013;8(4):340–9.PubMed Alic L, van Vliet M, Wielopolski PA, et al. Regional heterogeneity changes in DCE-MRI as response to isolated limb perfusion in experimental soft-tissue sarcomas. Contrast Media Mol Imaging. 2013;8(4):340–9.PubMed
26.
go back to reference Lee JH, Yoon YC, Seo SW, Choi YL, Kim HS. Soft tissue sarcoma: DWI and DCE-MRI parameters correlate with Ki-67 labeling index. Eur Radiol. 2020;30(2):914–24.PubMed Lee JH, Yoon YC, Seo SW, Choi YL, Kim HS. Soft tissue sarcoma: DWI and DCE-MRI parameters correlate with Ki-67 labeling index. Eur Radiol. 2020;30(2):914–24.PubMed
27.
go back to reference Reynoso D, Subbiah V, Trent JC, et al. Neoadjuvant treatment of soft-tissue sarcoma: a multimodality approach. J Surg Oncol. 2010;101(4):327–33.PubMed Reynoso D, Subbiah V, Trent JC, et al. Neoadjuvant treatment of soft-tissue sarcoma: a multimodality approach. J Surg Oncol. 2010;101(4):327–33.PubMed
28.
go back to reference Sundby Hall K, Bruland OS, Bjerkehagen B, et al. Adjuvant chemotherapy and postoperative radiotherapy in high-risk soft tissue sarcoma patients defined by biological risk factors-a Scandinavian Sarcoma Group study (SSG XX). Eur J Cancer. 2018;99:78–85.PubMed Sundby Hall K, Bruland OS, Bjerkehagen B, et al. Adjuvant chemotherapy and postoperative radiotherapy in high-risk soft tissue sarcoma patients defined by biological risk factors-a Scandinavian Sarcoma Group study (SSG XX). Eur J Cancer. 2018;99:78–85.PubMed
29.
go back to reference Zhao F, Ahlawat S, Farahani SJ, et al. Can MR imaging be used to predict tumor grade in soft-tissue sarcoma? Radiology. 2014;272(1):192–201.PubMed Zhao F, Ahlawat S, Farahani SJ, et al. Can MR imaging be used to predict tumor grade in soft-tissue sarcoma? Radiology. 2014;272(1):192–201.PubMed
30.
go back to reference Lefkowitz RA, Landa J, Hwang S, et al. Myxofibrosarcoma: prevalence and diagnostic value of the “tail sign” on magnetic resonance imaging. Skelet Radiol. 2013;42(6):809–18. Lefkowitz RA, Landa J, Hwang S, et al. Myxofibrosarcoma: prevalence and diagnostic value of the “tail sign” on magnetic resonance imaging. Skelet Radiol. 2013;42(6):809–18.
31.
go back to reference Lee AY, Agaram NP, Qin LX, et al. Optimal percent myxoid component to predict outcome in high-grade myxofibrosarcoma and undifferentiated pleomorphic sarcoma. Ann Surg Oncol. 2016;23(3):818–25.PubMedPubMedCentral Lee AY, Agaram NP, Qin LX, et al. Optimal percent myxoid component to predict outcome in high-grade myxofibrosarcoma and undifferentiated pleomorphic sarcoma. Ann Surg Oncol. 2016;23(3):818–25.PubMedPubMedCentral
32.
go back to reference Kim SH, Choi MS, Kim MJ, Kim YH, Cho SH. Role of semi-quantitative dynamic contrast-enhanced MR imaging in characterization and grading of prostate cancer. Eur J Radiol. 2017;94:154–9.PubMed Kim SH, Choi MS, Kim MJ, Kim YH, Cho SH. Role of semi-quantitative dynamic contrast-enhanced MR imaging in characterization and grading of prostate cancer. Eur J Radiol. 2017;94:154–9.PubMed
33.
go back to reference Chen J, Chen C, Xia C, et al. Quantitative free-breathing dynamic contrast-enhanced MRI in hepatocellular carcinoma using gadoxetic acid: correlations with Ki67 proliferation status, histological grades, and microvascular density. Abdom Radiol (NY). 2018;43(6):1393–403. Chen J, Chen C, Xia C, et al. Quantitative free-breathing dynamic contrast-enhanced MRI in hepatocellular carcinoma using gadoxetic acid: correlations with Ki67 proliferation status, histological grades, and microvascular density. Abdom Radiol (NY). 2018;43(6):1393–403.
34.
go back to reference Koo HR, Cho N, Song IC, et al. Correlation of perfusion parameters on dynamic contrast-enhanced MRI with prognostic factors and subtypes of breast cancers. J Magn Reson Imaging. 2012;36(1):145–51.PubMed Koo HR, Cho N, Song IC, et al. Correlation of perfusion parameters on dynamic contrast-enhanced MRI with prognostic factors and subtypes of breast cancers. J Magn Reson Imaging. 2012;36(1):145–51.PubMed
35.
go back to reference Jain RK. Normalization of tumor vasculature: an emerging concept in antiangiogenic therapy. Science. 2005;307(5706):58–62.PubMed Jain RK. Normalization of tumor vasculature: an emerging concept in antiangiogenic therapy. Science. 2005;307(5706):58–62.PubMed
36.
go back to reference Mills SJ, Soh C, Rose CJ, et al. Candidate biomarkers of extravascular extracellular space: a direct comparison of apparent diffusion coefficient and dynamic contrast-enhanced MR imaging--derived measurement of the volume of the extravascular extracellular space in glioblastoma multiforme. AJNR Am J Neuroradiol. 2010;31(3):549–53.PubMed Mills SJ, Soh C, Rose CJ, et al. Candidate biomarkers of extravascular extracellular space: a direct comparison of apparent diffusion coefficient and dynamic contrast-enhanced MR imaging--derived measurement of the volume of the extravascular extracellular space in glioblastoma multiforme. AJNR Am J Neuroradiol. 2010;31(3):549–53.PubMed
37.
go back to reference Li SP, Padhani AR, Taylor NJ, et al. Vascular characterisation of triple negative breast carcinomas using dynamic MRI. Eur Radiol. 2011;21(7):1364–73.PubMed Li SP, Padhani AR, Taylor NJ, et al. Vascular characterisation of triple negative breast carcinomas using dynamic MRI. Eur Radiol. 2011;21(7):1364–73.PubMed
38.
go back to reference Jansen JF, Carlson DL, Lu Y, et al. Correlation of a priori DCE-MRI and (1)H-MRS data with molecular markers in neck nodal metastases: initial analysis. Oral Oncol. 2012;48(8):717–22.PubMedPubMedCentral Jansen JF, Carlson DL, Lu Y, et al. Correlation of a priori DCE-MRI and (1)H-MRS data with molecular markers in neck nodal metastases: initial analysis. Oral Oncol. 2012;48(8):717–22.PubMedPubMedCentral
39.
go back to reference Li X, Zhu Y, Kang H, et al. Glioma grading by microvascular permeability parameters derived from dynamic contrast-enhanced MRI and intratumoral susceptibility signal on susceptibility weighted imaging. Cancer Imaging. 2015;15:4.PubMedPubMedCentral Li X, Zhu Y, Kang H, et al. Glioma grading by microvascular permeability parameters derived from dynamic contrast-enhanced MRI and intratumoral susceptibility signal on susceptibility weighted imaging. Cancer Imaging. 2015;15:4.PubMedPubMedCentral
40.
go back to reference Jia Z, Geng D, Xie T, Zhang J, Liu Y. Quantitative analysis of neovascular permeability in glioma by dynamic contrast-enhanced MR imaging. J Clin Neurosci. 2012;19(6):820–3.PubMed Jia Z, Geng D, Xie T, Zhang J, Liu Y. Quantitative analysis of neovascular permeability in glioma by dynamic contrast-enhanced MR imaging. J Clin Neurosci. 2012;19(6):820–3.PubMed
41.
go back to reference Tofts PS. Modeling tracer kinetics in dynamic Gd-DTPA MR imaging. J Magn Reson Imaging. 1997;7(1):91–101.PubMed Tofts PS. Modeling tracer kinetics in dynamic Gd-DTPA MR imaging. J Magn Reson Imaging. 1997;7(1):91–101.PubMed
42.
go back to reference Khalifa F, Soliman A, El-Baz A, et al. Models and methods for analyzing DCE-MRI: a review. Med Phys. 2014;41(12):124301.PubMed Khalifa F, Soliman A, El-Baz A, et al. Models and methods for analyzing DCE-MRI: a review. Med Phys. 2014;41(12):124301.PubMed
Metadata
Title
Soft tissue sarcoma: can dynamic contrast-enhanced (DCE) MRI be used to predict the histological grade?
Authors
Xiangwen Li
Qimeng Wang
Yanping Dou
Yu Zhang
Juan Tao
Lin Yang
Shaowu Wang
Publication date
01-11-2020
Publisher
Springer Berlin Heidelberg
Published in
Skeletal Radiology / Issue 11/2020
Print ISSN: 0364-2348
Electronic ISSN: 1432-2161
DOI
https://doi.org/10.1007/s00256-020-03491-z

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