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Ghasemi A, Ahlawat S, Fayad LM. Magnetic Resonance Imaging Biomarkers of Bone and Soft Tissue Tumors. Semin Musculoskelet Radiol 2024; 28:39-48. [PMID: 38330969 DOI: 10.1055/s-0043-1776433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
Magnetic resonance imaging (MRI) is essential in the management of musculoskeletal (MSK) tumors. This review delves into the diverse MRI modalities, focusing on anatomical, functional, and metabolic sequences that provide essential biomarkers for tumor detection, characterization, disease extent determination, and assessment of treatment response. MRI's multimodal capabilities offer a range of biomarkers that enhance MSK tumor evaluation, aiding in better patient management.
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Affiliation(s)
- Ali Ghasemi
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Shivani Ahlawat
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Laura Marie Fayad
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Medical Institutions, Baltimore, Maryland
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Kantzos AJ, Fayad LM, Abiad JE, Ahlawat S, Sabharwal S, Vaynrub M, Morris CD. The role of imaging in extremity sarcoma surgery. Skeletal Radiol 2024:10.1007/s00256-024-04586-7. [PMID: 38233634 DOI: 10.1007/s00256-024-04586-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/08/2024] [Accepted: 01/08/2024] [Indexed: 01/19/2024]
Abstract
The surgical management of extremity bone and soft tissue sarcomas has evolved significantly over the last 50 years. The introduction and refinement of high-resolution cross-sectional imaging has allowed accurate assessment of anatomy and tumor extent, and in the current era more than 90% of patients can successfully undergo limb-salvage surgery. Advances in imaging have also revolutionized the clinician's ability to assess treatment response, detect metastatic disease, and perform intraoperative surgical navigation. This review summarizes the broad and essential role radiology plays in caring for sarcoma patients from diagnosis to post-treatment surveillance. Present evidence-based imaging paradigms are highlighted along with key future directions.
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Affiliation(s)
- Andrew J Kantzos
- Orthopedic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY, 10065, USA
| | - Laura M Fayad
- Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD, USA
| | | | - Shivani Ahlawat
- Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD, USA
| | - Samir Sabharwal
- Orthopedic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY, 10065, USA
| | - Max Vaynrub
- Orthopedic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY, 10065, USA
| | - Carol D Morris
- Orthopedic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY, 10065, USA.
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Kim CS, Cho HS, Lee OJ, Ahn SY, Yoo JY. Primary pulmonary synovial sarcoma with delayed diagnosis in a 69-year-old man: A case report. Medicine (Baltimore) 2023; 102:e36620. [PMID: 38134089 PMCID: PMC10735115 DOI: 10.1097/md.0000000000036620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/22/2023] [Indexed: 12/24/2023] Open
Abstract
RATIONALE Primary pulmonary synovial sarcoma is a rare malignant pulmonary tumor accompanied by calcifications in approximately 15% of cases. These calcifications usually have a fine, stippled appearance; coarse shapes have seldom been reported. Moreover, the presence of coarse calcifications often suggests benign tumors, which vastly differ in treatment. We present a rare case of primary pulmonary sarcoma with coarse intratumoral calcifications, the diagnosis of which was delayed because of its radiologic appearance. PATIENT CONCERNS A computed tomography (CT) scan of a 69-year-old man with right upper quadrant (RUQ) pain revealed an incidental mass at the base of the right lower lobe, the margin of which was not well described with respect to the liver, and intratumoral coarse calcification was noted. Initially, the lesion was believed to be hepatic, and magnetic resonance imaging (MRI) was performed. Based on its imaging features, the mass was thought to be a pulmonary lesion, and a preliminary diagnosis of a benign lesion, such as a hamartoma or granuloma, was made. Four months after the initial CT scan, the patient's RUQ pain had aggravated; however, no change in the mass was observed on follow-up CT. DIAGNOSIS The final diagnosis was primary pulmonary sarcoma, proven by surgical biopsy. INTERVENTIONS Wedge resection of the right lower lobe was performed, and the patient received adjuvant chemotherapy. OUTCOMES The patient's RUQ pain improved, and no recurrence or metastasis has been reported to date. LESSONS This case describes a rare presentation of a primary pulmonary synovial sarcoma with coarse intratumoral calcifications and the MRI features of the lesion. Intratumoral coarse calcifications often suggest benign lesions, such as hamartomas or post-inflammatory granulomas; however, as malignant lesions cannot be completely excluded, other radiologic and clinical features should be considered carefully. Focal areas of enhancement and eccentric calcification distribution might suggest malignant lesions such as primary pulmonary synovial sarcoma. Furthermore, despite not being used routinely, MRI scans might be helpful because advanced MRI techniques, such as diffusion-weighted imaging, can help distinguish malignant lesions from benign lesions. If the clinical course of a patient suggests malignancy, a more aggressive biopsy strategy should be considered.
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Affiliation(s)
- Chan Seop Kim
- Department of Radiology, Chungbuk National University Hospital, Cheongju, Korea
| | - Hye Soo Cho
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Ok Jun Lee
- Department of Pathology, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Su Yeon Ahn
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Jin Young Yoo
- Department of Radiology, Chungbuk National University College of Medicine and Hospital, Cheongju, Korea
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Cho EB, Lee SK, Kim JY, Kim Y. Synovial Sarcoma in the Extremity: Diversity of Imaging Features for Diagnosis and Prognosis. Cancers (Basel) 2023; 15:4860. [PMID: 37835554 PMCID: PMC10571652 DOI: 10.3390/cancers15194860] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/15/2023] [Accepted: 10/02/2023] [Indexed: 10/15/2023] Open
Abstract
Synovial sarcomas are rare and highly aggressive soft-tissue sarcomas, primarily affecting adolescents and young adults aged 15-40 years. These tumors typically arise in the deep soft tissues, often near the large joints of the extremities. While the radiological features of these tumors are not definitely indicative, the presence of calcification in a soft-tissue mass (occurring in 30% of cases), adjacent to a joint, strongly suggests the diagnosis. Cross-sectional imaging characteristics play a crucial role in diagnosing synovial sarcomas. They often reveal significant characteristics such as multilobulation and pronounced heterogeneity (forming the "triple sign"), in addition to features like hemorrhage and fluid-fluid levels with septa (resulting in the "bowl of grapes" appearance). Nevertheless, the existence of non-aggressive features, such as gradual growth (with an average time to diagnosis of 2-4 years) and small size (initially measuring < 5 cm) with well-defined margins, can lead to an initial misclassification as a benign lesion. Larger size, older age, and higher tumor grade have been established as adverse predictive indicators for both local disease recurrence and the occurrence of metastasis. Recently, the prognostic importance of CT and MRI characteristics for synovial sarcomas was elucidated. These include factors like the absence of calcification, the presence of cystic components, hemorrhage, the bowl of grape sign, the triple sign, and intercompartmental extension. Wide surgical excision remains the established approach for definitive treatment. Gaining insight into and identifying the diverse range of presentations of synovial sarcomas, which correlate with the prognosis, might be helpful in achieving the optimal patient management.
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Affiliation(s)
- Eun Byul Cho
- Department of Radiology, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu 11765, Republic of Korea
| | - Seul Ki Lee
- Department of Radiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Jee-Young Kim
- Department of Radiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Yuri Kim
- Department of Radiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
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Lee S, Jung JY, Nam Y, Jung CK, Lee SY, Lee J, Shin SH, Chung YG. Diagnosis of Marginal Infiltration in Soft Tissue Sarcoma by Radiomics Approach Using T2-Weighted Dixon Sequence. J Magn Reson Imaging 2023; 57:752-760. [PMID: 35808915 DOI: 10.1002/jmri.28331] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Determination of preoperative soft tissue sarcoma (STS) margin is crucial for patient prognosis. PURPOSE To evaluate diagnostic performance of radiomics model using T2-weighted Dixon sequence for infiltration degree of STS margin. STUDY TYPE Retrospective. POPULATION Seventy-two STS patients consisted of training (n = 58) and test (n = 14) sets. FIELD STRENGTH/SEQUENCE A 3.0 T; T2-weighted Dixon images. ASSESSMENT Pathologic result of marginal infiltration in STS (circumscribed margin; n = 27, group 1, focally infiltrative margin; n = 31, group 2-A, diffusely infiltrative margin; n = 14, group 2-B) was the reference standard. Radiomic volume and shape (VS) and other (T2) features were extracted from entire tumor volume and margin, respectively. Twelve radiomics models were generated using four combinations of classifier algorithms (R, SR, LR, LSR) and three different inputs (VS, T2, VS + T2 [VST2] features) to differentiate the three groups. Three radiologists (reader 1, 2, 3) analyzed the marginal infiltration with 6-scale confidence score. STATISTICAL TESTS Area under the receiver operating characteristic curve (AUC) and concordance rate. RESULTS Averaged AUCs of R, SR, LR, LSR models were 0.438, 0.466, 0.438, 0.466 using VS features, 0.596, 0.584, 0.814, 0.815 using T2 features, and 0.581, 0.587, 0.821, 0.821 using VST2 features, respectively. The LR and LSR models constructed with T2 or VST2 features showed higher AUC and concordance rate compared to radiologists' analysis (AUC; 0.730, 0.675, 0.706, concordance rate; 0.46, 0.43, 0.47 in reader 1, 2, 3). DATA CONCLUSION Radiomics model constructed with features from tumor margin on T2-weighted Dixon sequence is a promising method for differentiating infiltration degree of STS margin. EVIDENCE LEVEL 4 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Seungeun Lee
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joon-Yong Jung
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yoonho Nam
- Division of Biomedical Engineering, Hankuk University of Foreign Studies, Gyeonggi-do, Republic of Korea
| | - Chan-Kwon Jung
- Department of Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - So-Yeon Lee
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jooyeon Lee
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Department of Applied Statistics, Hanyang University, Seoul, Republic of Korea
| | - Seung-Han Shin
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yang-Guk Chung
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Chatziantoniou C, Schoot RA, van Ewijk R, van Rijn RR, ter Horst SAJ, Merks JHM, Leemans A, De Luca A. Methodological considerations on segmenting rhabdomyosarcoma with diffusion-weighted imaging-What can we do better? Insights Imaging 2023; 14:19. [PMID: 36720720 PMCID: PMC9889596 DOI: 10.1186/s13244-022-01351-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 12/04/2022] [Indexed: 02/02/2023] Open
Abstract
PURPOSE Diffusion-weighted MRI is a promising technique to monitor response to treatment in pediatric rhabdomyosarcoma. However, its validation in clinical practice remains challenging. This study aims to investigate how the tumor segmentation strategy can affect the apparent diffusion coefficient (ADC) measured in pediatric rhabdomyosarcoma. MATERIALS AND METHODS A literature review was performed in PubMed using search terms relating to MRI and sarcomas to identify commonly applied segmentation strategies. Seventy-six articles were included, and their presented segmentation methods were evaluated. Commonly reported segmentation strategies were then evaluated on diffusion-weighted imaging of five pediatric rhabdomyosarcoma patients to assess their impact on ADC. RESULTS We found that studies applied different segmentation strategies to define the shape of the region of interest (ROI)(outline 60%, circular ROI 27%), to define the segmentation volume (2D 44%, multislice 9%, 3D 21%), and to define the segmentation area (excludes edge 7%, excludes other region 19%, specific area 27%, whole tumor 48%). In addition, details of the segmentation strategy are often unreported. When implementing and comparing these strategies on in-house data, we found that excluding necrotic, cystic, and hemorrhagic areas from segmentations resulted in on average 5.6% lower mean ADC. Additionally, the slice location used in 2D segmentation methods could affect ADC by as much as 66%. CONCLUSION Diffusion-weighted MRI studies in pediatric sarcoma currently employ a variety of segmentation methods. Our study shows that different segmentation strategies can result in vastly different ADC measurements, highlighting the importance to further investigate and standardize segmentation.
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Affiliation(s)
- Cyrano Chatziantoniou
- grid.7692.a0000000090126352Image Sciences Institute, UMC Utrecht, Utrecht, The Netherlands ,grid.487647.ePrincess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Reineke A. Schoot
- grid.487647.ePrincess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Roelof van Ewijk
- grid.487647.ePrincess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Rick R. van Rijn
- grid.7177.60000000084992262Department of Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Simone A. J. ter Horst
- grid.487647.ePrincess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands ,grid.417100.30000 0004 0620 3132Department of Radiology and Nuclear Medicine, Wilhelmina Children’s Hospital UMC Utrecht, Utrecht, The Netherlands
| | - Johannes H. M. Merks
- grid.487647.ePrincess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Alexander Leemans
- grid.7692.a0000000090126352Image Sciences Institute, UMC Utrecht, Utrecht, The Netherlands
| | - Alberto De Luca
- grid.7692.a0000000090126352Image Sciences Institute, UMC Utrecht, Utrecht, The Netherlands ,grid.7692.a0000000090126352Department of Neurology, UMC Utrecht Brain Center, UMCUtrecht, Utrecht, The Netherlands
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Osterloh J, Ludolph I, Grützmann R, Meyer A, Lang W, Horch RE, Fechner K, Arkudas A. Interdisciplinary Surgical Therapy of Extremity Soft-Tissue Sarcomas: A Personalized Resection and Reconstruction Algorithm. J Pers Med 2023; 13:262. [PMID: 36836496 PMCID: PMC9965817 DOI: 10.3390/jpm13020262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 01/23/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023] Open
Abstract
Soft-tissue sarcomas (STS) are rare, but potentially life-threatening malignancies. STS can occur anywhere in the human body with the limbs being the most common site. Referral to a specialized sarcoma center is crucial to guarantee prompt and appropriate treatment. STS treatment strategies should be discussed in an interdisciplinary tumor board to involve expertise from all available resources, including an experienced reconstructive surgeon for an optimal outcome. In many cases, extensive resection is needed to achieve R0 resection, resulting in large defects after surgery. Hence, an evaluation of whether plastic reconstruction might be required is mandatory to avoid complications due to insufficient primary wound closure. In this retrospective observational study, we present data of patients with extremity STS treated at the Sarcoma Center, University Hospital Erlangen, in 2021. We found that complications were more frequent in patients who received secondary flap reconstruction after insufficient primary wound closure compared to patients who received primary flap reconstruction. Additionally, we propose an algorithm for an interdisciplinary surgical therapy of soft-tissue sarcomas regarding resection and reconstruction and present two problematic cases to emphasize the complexity of surgical sarcoma therapy.
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Affiliation(s)
- Justus Osterloh
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlangen, Bavaria, Germany
| | - Ingo Ludolph
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlangen, Bavaria, Germany
| | - Robert Grützmann
- Department of Surgery, Comprehensive Cancer Center, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Bavaria, Germany
| | - Alexander Meyer
- Department of Vascular Surgery, Comprehensive Cancer Center, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Bavaria, Germany
| | - Werner Lang
- Department of Vascular Surgery, Comprehensive Cancer Center, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Bavaria, Germany
| | - Raymund E. Horch
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlangen, Bavaria, Germany
| | - Katja Fechner
- Department of Surgery, Comprehensive Cancer Center, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Bavaria, Germany
| | - Andreas Arkudas
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlangen, Bavaria, Germany
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Hu Y, Li A, Wu MJ, Ma Q, Mao CL, Peng XJ, Ye XH, Liu BJ, Xu HX. Added value of contrast-enhanced ultrasound to conventional ultrasound for characterization of indeterminate soft-tissue tumors. Br J Radiol 2023; 96:20220404. [PMID: 36400064 PMCID: PMC10997008 DOI: 10.1259/bjr.20220404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/05/2022] [Accepted: 11/10/2022] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To assess the added value of contrast-enhanced ultrasound (CEUS) to conventional ultrasound in differentiating benign soft-tissue tumors from malignant ones. METHODS 197 soft-tissue tumors underwent ultrasound examination with confirmed histopathology were retrospectively evaluated. The radiologists classified all the tumors as benign, malignant, or indeterminate according to ultrasound features. The indeterminate tumors underwent CEUS were reviewed afterwards for malignancy identification by using individual and combined CEUS features. RESULTS Ultrasound analysis classified 62 soft-tissue tumors as benign, 111 tumors as indeterminate and 24 tumors as malignant. There 104 indeterminate tumors were subject to CEUS. Three CEUS features including enlargement of enhancement area, infiltrative enhancement boundary, and intratumoral arrival time difference were significantly associated with the tumor nature in both univariable and multivariable analysis for the indeterminate tumors (all p < 0.05). When at least one out of the three discriminant CEUS features were present, the best sensitivity of 100% for malignancy identification was obtained with the specificity of 66.7% and the AUC of 0.833. When at least two of the three discriminant CEUS features were present, the best area under the receiver operating characteristic curve (AUC) of 0.924 for malignancy identification was obtained. The combination of at least two discriminant CEUS features showed much better diagnostic performance than the optimal combination of ultrasound features in terms of AUC (0.924 vs 0.608, p < 0.0001), sensitivity (94.0% vs 42.0%, p < 0.0001), and specificity (90.7% vs 79.6%, p = 0.210) for the indeterminate tumors. CONCLUSION The combination CEUS features of enlargement of enhancement area, infiltrative enhancement boundary and intratumoral arrival time difference are valuable to improve the discriminating performance for indeterminate soft-tissue tumors on conventional ultrasound. ADVANCES IN KNOWLEDGE The combination of peritumoral and arrival-time CEUS features can improve the discriminating performance for indeterminate soft-tissue tumors on conventional ultrasound.
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Affiliation(s)
- Yu Hu
- Department of Medical Ultrasound, The First Affiliated
Hospital of Nanjing Medical University, Nanjing,
China
| | - Ao Li
- Department of Medical Ultrasound, The First Affiliated
Hospital of Nanjing Medical University, Nanjing,
China
| | - Meng-Jie Wu
- Department of Medical Ultrasound, The First Affiliated
Hospital of Nanjing Medical University, Nanjing,
China
| | - Qian Ma
- Department of Medical Ultrasound, The First Affiliated
Hospital of Nanjing Medical University, Nanjing,
China
| | - Cui-Lian Mao
- Department of Medical Ultrasound, The First Affiliated
Hospital of Nanjing Medical University, Nanjing,
China
| | - Xiao-Jing Peng
- Department of Medical Ultrasound, The First Affiliated
Hospital of Nanjing Medical University, Nanjing,
China
| | - Xin-Hua Ye
- Department of Medical Ultrasound, The First Affiliated
Hospital of Nanjing Medical University, Nanjing,
China
| | - Bo-Ji Liu
- Department of Medical Ultrasound, The First Affiliated
Hospital of Nanjing Medical University, Nanjing,
China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, The First Affiliated
Hospital of Nanjing Medical University, Nanjing,
China
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Zhang YY, Chu DG, Mao MH, Feng ZE, Li JZ, Qin LZ, Han ZX. The role of magnetic resonance imaging in assessing the extent of tongue squamous cell carcinoma: A prospective cohort study. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e822-e827. [PMID: 35257931 DOI: 10.1016/j.jormas.2022.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 01/16/2022] [Accepted: 03/02/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the false-positive and false-negative MRI results in evaluating the extent of tongue squamous cell carcinoma. METHODS A prospective cohort series of 165 patients was enrolled to assess the false-positive and false-negative MRI results in evaluating the extent of tongue squamous cell carcinoma by comparing intraoperative tumor profile images and postoperative pathological sections. The differences between two-dimensional tumor margins were analyzed using Mimics 15.0 and Geomagic Control 16.0. A paired-samples t-test was used to analyze the agreement among MRI, intraoperative and pathological findings regarding the extent of tongue tumors. Multiple linear regression analysis was used to analyze associated factors. RESULTS The mean and maximum false-positive values of pathological specimens was 1.95±1.39 mm (95% limit of agreement (LoA) 1.70-2.14) and 3.21 mm, respectively; the false-negative value was 0.44±0.49 mm. The false-positive value of intraoperative specimens was 1.52±0.87 mm (95% LoA 1.36-1.64); the false-negative value was 0.35±0.20 mm. Tumor morphology (ulcer type) (p<0.01) and depth of invasion (DOI) (≤5 mm) (p<0.01) were significantly correlated with the false-positive values of intraoperative and pathology specimens. CONCLUSION The false-positive values are important when judging the invasion margin of tongue cancer and forming MRI-based operative plans; the false-negative value was almost negligible.
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Affiliation(s)
- Yang-Yang Zhang
- Department of Stomatology, Beijing Chui Yang Liu Hospital Affiliated to Tsinghua University, Beijing 100022, PR China
| | - De-Guo Chu
- Department of Stomatology, Beijing Chui Yang Liu Hospital Affiliated to Tsinghua University, Beijing 100022, PR China
| | - Ming-Hui Mao
- Beijing Stomatological Hospital, Capital Medical University, Beijing 100050, PR China.
| | - Zhi-En Feng
- Beijing Stomatological Hospital, Capital Medical University, Beijing 100050, PR China
| | - Jin-Zhong Li
- Beijing Stomatological Hospital, Capital Medical University, Beijing 100050, PR China
| | - Li-Zheng Qin
- Beijing Stomatological Hospital, Capital Medical University, Beijing 100050, PR China
| | - Zheng-Xue Han
- Beijing Stomatological Hospital, Capital Medical University, Beijing 100050, PR China.
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Comparing Apparent Diffusion Coefficient and FNCLCC Grading to Improve Pretreatment Grading of Soft Tissue Sarcoma-A Translational Feasibility Study on Fusion Imaging. Cancers (Basel) 2022; 14:cancers14174331. [PMID: 36077866 PMCID: PMC9454612 DOI: 10.3390/cancers14174331] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 11/18/2022] Open
Abstract
Simple Summary Histological subtype and grading are essential for the planning of soft tissue sarcoma. Pretherapeutic grading based on core needle biopsies is frequently not reliable due to intratumoral heterogeneity. This pilot study assessed the ability of functional radiological imaging to improve histopathological grading. Multiple biopsies were taken from the sarcoma specimens during tumor resection and radiopaque markers were placed. Subsequently, fusion of preoperative magnetic resonance imaging and postoperative computed tomography of the specimen allowed for comparison of histopathological grading and diffusion-weighted imaging. The apparent diffusion coefficient appears to correlate with FNCLCC criteria and may supplement pretreatment assessment and multimodal treatment allocation in soft tissue sarcoma. Abstract Histological subtype and grading are cornerstones of treatment decisions in soft tissue sarcoma (STS). Due to intratumoral heterogeneity, pretreatment grading assessment is frequently unreliable and may be improved through functional imaging. In this pilot study, 12 patients with histologically confirmed STS were included. Preoperative functional magnetic resonance imaging was fused with a computed tomography scan of the resected specimen after collecting core needle biopsies and placing radiopaque markers at distinct tumor sites. The Fédération Nationale des Centres de Lutte Contre le Cancer (FNCLCC) grading criteria of the biopsies and apparent diffusion coefficients (ADCs) of the biopsy sites were correlated. Concordance in grading between the specimen and at least one biopsy was achieved in 9 of 11 cases (81.8%). In 7 of 12 cases, fusion imaging was feasible without relevant contour deviation. Functional analysis revealed a tendency for high-grade regions (Grade 2/3 (G2/G3)) (median (range) ± standard deviation: 1.13 (0.78–1.70) ± 0.23 × 10−3 mm2/s) to have lower ADC values than low-grade regions (G1; 1.43 (0.64–2.03) ± 0.46 × 10−3 mm2/s). In addition, FNCLCC scoring of multiple tumor biopsies proved intratumoral heterogeneity as expected. The ADC appears to correlate with the FNCLCC grading criteria. Further studies are needed to determine whether functional imaging may supplement histopathological grading.
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11
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Zhao K, Melamud K, Hindman N. Peripheral vascular lesions in adults referred to MRI/MRA: Multivariable analysis of imaging features to help differentiate benign vascular anomalies from malignancies. Clin Imaging 2022; 91:45-51. [PMID: 35988473 DOI: 10.1016/j.clinimag.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/29/2022] [Accepted: 08/11/2022] [Indexed: 11/20/2022]
Abstract
PURPOSE Symptomatic peripheral vascular lesions in adults are often clinically diagnosed as benign vascular anomalies and may receive MRI/MRA for pre-treatment vascular mapping. Malignant neoplasms are difficult to distinguish from benign vascular anomalies on MRI/MRA. This study was performed to determine if there are imaging signs that can distinguish malignancies from benign vascular anomalies in adults imaged with MRI/MRA. MATERIALS AND METHODS A radiology database was retrospectively searched for ISSVA classification terms in MRI/MRA reports from 1/1/2002-1/1/2019. Adult patients (n = 50, 52 corresponding lesions) with contrast-enhanced MRI/MRA, peripheral soft tissue based lesion (s), and available pathology or long-term (>1 year) imaging follow-up were included. MRI/MRA images were reviewed by 3 readers for the following lesional characteristics: morphology (marginal lobulation, internal septations, distinct soft tissue mass), peri-articular location, T2-weighted characteristics (hyperintensity, heterogeneity, perilesional edema, and adjacent triangular T2-peaks), bulk fat, hemorrhage, enhancement pattern (peripheral, diffuse, or absent), neovascularity, low-flow venous malformation type enhancement, arterial enhancement within 6 s, enhancement curve (progressive, plateau, or washout), measured size, and multifocality. The MRI/MRA features' associated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. To identify factors predictive of malignancy, a two-stage multivariable analysis was performed. RESULTS 23% (12/52) of the lesions, corresponding to 22% (11/50) of the patients, were malignant neoplasms. No single imaging feature reliably predicted malignancy (PPV ≤ 60%). Absence of distinct soft tissue mass excluded malignancy (NPV 100%). Multivariate analysis derived a summary score based on the five strongest predictors of malignancy: adjacent T2 peaks, age ≥ 70 years, distinct soft tissue mass, lesion size ≥ 5 cm, and absence of septations. A score ≥ 3 resulted in sensitivity of 92% and specificity of 85%. CONCLUSION Extremity MRI/MRA rarely differentiates malignant from benign soft-tissue vascular tumors in adults. However, MRI/MRA can suggest malignancy when patient age and multiple imaging features are considered. Periodic clinical follow-up after the planned endovascular or operative procedure should be performed to avoid missing a malignancy.
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Affiliation(s)
- Ken Zhao
- Memorial Sloan Kettering, United States of America
| | - Kira Melamud
- NYU School of Medicine, United States of America.
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12
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Kim M, Jee WH, Lee Y, Hong JH, Jung CK, Chung YG, Lee SY. Tumor Margin Infiltration in Soft Tissue Sarcomas: Prediction Using 3T MRI Texture Analysis. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:112-126. [PMID: 36237350 PMCID: PMC9238208 DOI: 10.3348/jksr.2021.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/27/2021] [Accepted: 05/11/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Minji Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Radiology, Uijeongbu St. Mary's hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Won-Hee Jee
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Youngjun Lee
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Radiology, Uijeongbu St. Mary's hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Hyun Hong
- Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Chan Kwon Jung
- Department of Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yang-Guk Chung
- Departments of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - So-Yeon Lee
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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13
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Rodriguez JD, Selleck AM, Abdel Razek AAK, Huang BY. Update on MR Imaging of Soft Tissue Tumors of Head and Neck. Magn Reson Imaging Clin N Am 2021; 30:151-198. [PMID: 34802577 DOI: 10.1016/j.mric.2021.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article reviews soft tissue tumors of the head and neck following the 2020 revision of WHO Classification of Soft Tissue and Bone Tumours. Common soft tissue tumors in the head and neck and tumors are discussed, along with newly added entities to the classification system. Salient clinical and imaging features that may allow for improved diagnostic accuracy or to narrow the imaging differential diagnosis are covered. Advanced imaging techniques are discussed, with a focus on diffusion-weighted and dynamic contrast imaging and their potential to help characterize soft tissue tumors and aid in distinguishing malignant from benign tumors.
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Affiliation(s)
- Justin D Rodriguez
- Department of Radiology, Duke University, 2301 Erwin Rd, Durham, NC 27705, USA
| | - A Morgan Selleck
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina Hospitals, 170 Manning Drive, CB 7070, Physicians Office Building, Rm G190A, Chapel Hill, NC 27599, USA
| | | | - Benjamin Y Huang
- Department of Radiology, UNC School of Medicine, 101 Manning Drive, CB#7510, Chapel Hill, NC 27599, USA.
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14
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Vibhakar AM, Cassels JA, Botchu R, Rennie WJ, Shah A. Imaging update on soft tissue sarcoma. J Clin Orthop Trauma 2021; 22:101568. [PMID: 34567971 PMCID: PMC8449057 DOI: 10.1016/j.jcot.2021.101568] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/13/2021] [Accepted: 08/14/2021] [Indexed: 01/15/2023] Open
Abstract
Soft tissue sarcomas (STS) are rare tumours presenting as soft tissue lumps. Ultrasound is often the primary modality for the initial assessment, with MRI the mainstay for lesion characterisation. PET/CT along with other emerging MRI sequences are used in certain situations as an adjunct and problem solving tool in STS staging and assessment of disease recurrence. Recent advances include the promise of whole body MRI, hybrid PET/MRI, diffusion weighted imaging, dynamic contrast enhanced MRI and advances in artificial intelligence. This article discusses current concepts in extremity STS imaging and highlights recent advances.
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Affiliation(s)
- Aanand M. Vibhakar
- Department of Radiology, Leicester Royal Infirmary, University Hospitals of Leicester, Leicester, United Kingdom,Corresponding author. Department of Radiology, Leicester Royal Infirmary, Infirmary Square, Leicester, LE1 5WW, United Kingdom.
| | - James A. Cassels
- Department of Radiology, Kettering General Hospital, Kettering, United Kingdom
| | - Rajesh Botchu
- Department of Radiology, Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - Winston J. Rennie
- Department of Radiology, Leicester Royal Infirmary, University Hospitals of Leicester, Leicester, United Kingdom
| | - Amit Shah
- Department of Radiology, Leicester Royal Infirmary, University Hospitals of Leicester, Leicester, United Kingdom
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15
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Radiomics of diffusion-weighted MRI compared to conventional measurement of apparent diffusion-coefficient for differentiation between benign and malignant soft tissue tumors. Sci Rep 2021; 11:15276. [PMID: 34315971 PMCID: PMC8316538 DOI: 10.1038/s41598-021-94826-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 07/19/2021] [Indexed: 11/13/2022] Open
Abstract
Diffusion-weighted imaging (DWI) is proven useful to differentiate benign and malignant soft tissue tumors (STTs). Radiomics utilizing a vast array of extracted imaging features has a potential to uncover disease characteristics. We aim to assess radiomics using DWI can outperform the conventional DWI for STT differentiation. In 151 patients with 80 benign and 71 malignant tumors, ADCmean and ADCmin were measured on solid portion within the mass by two different readers. For radiomics approach, tumors were segmented and 100 original radiomic features were extracted on ADC map. Eight radiomics models were built with training set (n = 105), using combinations of 2 different algorithms—multivariate logistic regression (MLR) and random forest (RF)—and 4 different inputs: radiomics features (R), R + ADCmin (I), R + ADCmean (E), R + ADCmin and ADCmean (A). All models were validated with test set (n = 46), and AUCs of ADCmean, ADCmin, MLR-R, RF-R, MLR-I, RF-I, MLR-E, RF-E, MLR-A and RF-A models were 0.729, 0.753 0.698, 0.700, 0.773, 0.807, 0.762, 0.744, 0.773 and 0.807, respectively, without statistically significant difference. In conclusion, radiomics approach did not add diagnostic value to conventional ADC measurement for differentiating benign and malignant STTs.
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16
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Kumar R. Soft Tissue Sarcomas. Semin Ultrasound CT MR 2021; 42:194-200. [PMID: 33814105 DOI: 10.1053/j.sult.2020.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Imaging evaluation of soft tissue masses is essential for diagnosis, preoperative staging, and post-treatment follow-up. Magnetic resonance imaging plays the major role because of its superior resolution that helps in better tissue characterization, and its multiplanar imaging capability in evaluation of soft tissue masses. Additional imaging techniques, such as radiographs, computed tomography, positron-emission tomography-CT, radionuclide scintigraphy and ultrasonography, also play vital roles by providing additional information required in management of soft tissue masses. Knowledge of the usefulness and limitations of these imaging techniques is essential for their judicious selection. This article reviews the current role of various imaging techniques in diagnosis, presurgical planning, and post-treatment follow-up of soft tissue masses.
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Affiliation(s)
- Rajendra Kumar
- Department of Musculoskeletal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX.
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17
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Manikis GC, Nikiforaki K, Lagoudaki E, de Bree E, Maris TG, Marias K, Karantanas AH. Differentiating low from high-grade soft tissue sarcomas using post-processed imaging parameters derived from multiple DWI models. Eur J Radiol 2021; 138:109660. [PMID: 33756189 DOI: 10.1016/j.ejrad.2021.109660] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 02/14/2021] [Accepted: 03/15/2021] [Indexed: 01/18/2023]
Abstract
PURPOSE To investigate and histopathologically validate the role of model selection in the design of novel parametric meta-maps towards the discrimination of low from high-grade soft tissue sarcomas (STSs) using multiple Diffusion Weighted Imaging (DWI) models. METHODS DWI data of 28 patients were quantified using the mono-exponential, bi-exponential, stretched-exponential and the diffusion kurtosis model. Akaike Weights (AW) were calculated from the corrected Akaike Information Criteria (AICc) to select the most suitable model for every pixel within the tumor volume. Pseudo-colorized classification maps were then generated to depict model suitability, hypothesizing that every single model underpins different tissue properties and cannot solely characterize the whole tumor. Single model parametric maps were turned into meta-maps using the classification map and a histological validation of the model suitability results was conducted on several subregions of different tumors. Several histogram metrics were calculated from all derived maps before and after model selection, statistical analysis was conducted using the Mann-Whitney U test, p-values were adjusted for multiple comparisons and performance of all statistically significant metrics was evaluated using the Receiver Operator Characteristic (ROC) analysis. RESULTS The histologic analysis on several tumor subregions confirmed model suitability results on these areas. Only 3 histogram metrics, all derived from the meta-maps, were found to be statistically significant in differentiating low from high-grade STSs with an AUC higher than 89 %. CONCLUSION Embedding model selection in the design of the diffusion parametric maps yields to histogram metrics of high discriminatory power in grading STSs.
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Affiliation(s)
- Georgios C Manikis
- Department of Radiology, Medical School-University of Crete, Heraklion, Greece; Computational BioMedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology-Hellas (FORTH), Heraklion, Greece.
| | - Katerina Nikiforaki
- Department of Radiology, Medical School-University of Crete, Heraklion, Greece; Computational BioMedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology-Hellas (FORTH), Heraklion, Greece.
| | - Eleni Lagoudaki
- Department of Pathology, University Hospital of Crete, Heraklion, Greece.
| | - Eelco de Bree
- Department of Surgical Oncology, University of Crete, Heraklion, Greece.
| | - Thomas G Maris
- Department of Radiology, Medical School-University of Crete, Heraklion, Greece; Computational BioMedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology-Hellas (FORTH), Heraklion, Greece.
| | - Kostas Marias
- Computational BioMedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology-Hellas (FORTH), Heraklion, Greece; Department of Electrical & Computer Engineering, Hellenic Mediterranean University, Crete, Heraklion, Greece.
| | - Apostolos H Karantanas
- Department of Radiology, Medical School-University of Crete, Heraklion, Greece; Computational BioMedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology-Hellas (FORTH), Heraklion, Greece; Department of Medical Imaging, University Hospital, Heraklion, Greece.
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18
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Spinnato P, Sambri A, Fujiwara T, Ceccarelli L, Clinca R, Medellin MR, Paolis MD, Donati DM, Bianchi G. Myxofibrosarcoma: Clinical and Prognostic Value of MRI Features. Curr Med Imaging 2021; 17:217-224. [PMID: 32729425 DOI: 10.2174/1573405616999200729152135] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 05/02/2020] [Accepted: 05/13/2020] [Indexed: 12/16/2022]
Abstract
Myxofibrosarcoma is one of the most common soft tissue sarcomas in the elderly. It is characterized by an extremely high rate of local recurrence, higher than other soft tissue tumors, and a relatively low risk of distant metastases.Magnetic resonance imaging (MRI) is the imaging modality of choice for the assessment of myxofibrosarcoma, which plays a key role in the preoperative setting of these patients. MRI features associated with the high risk of local recurrence are: high myxoid matrix content (water-like appearance of the lesions), high grade of contrast enhancement and presence of an infiltrative pattern ("tail sign"). On the other hand, MRI features associated with worse sarcoma specific survival are: large size of the lesion, deep location, high grade of contrast enhancement. Recognizing the above-mentioned imaging features of myxofibrosarcoma may be helpful in stratifying the risk for local recurrence and disease-specific survival. Moreover, the surgical planning should be adjusted according to the MRI features.
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Affiliation(s)
- Paolo Spinnato
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Andrea Sambri
- Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Tomohiro Fujiwara
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Luca Ceccarelli
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Roberta Clinca
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | | | - Davide M Donati
- Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giuseppe Bianchi
- Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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19
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Tsukamoto S, Mavrogenis AF, Tanaka Y, Errani C. Imaging of Soft Tissue Tumors. Curr Med Imaging 2021; 17:197-216. [PMID: 32660406 DOI: 10.2174/1573405616666200713183400] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/08/2020] [Accepted: 06/20/2020] [Indexed: 02/07/2023]
Abstract
Differentiation of malignant from benign soft tissue tumors is challenging with imaging alone, including that by magnetic resonance imaging and computed tomography. However, the accuracy of this differentiation has increased owing to the development of novel imaging technology. Detailed patient history and physical examination remain essential for differentiation between benign and malignant soft tissue tumors. Moreover, measurement only of tumor size based on Response Evaluation Criteria In Solid Tumors criteria is insufficient for the evaluation of response to chemotherapy or radiotherapy. Change in metabolic activity measured by 18F-fluorodeoxyglucose positron emission tomography or dynamic contrast enhanced-derived quantitative endpoints can more accurately evaluate treatment response compared to change in tumor size. Magnetic resonance imaging can accurately evaluate essential factors in surgical planning such as vascular or bone invasion and "tail sign". Thus, imaging plays a critical role in the diagnosis and treatment of soft tissue tumors.
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Affiliation(s)
- Shinji Tsukamoto
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | - Costantino Errani
- Department Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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20
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Li X, Liu Y, Tao J, Yin Z, Zhu Y, Zhang Y, Wang S. Value of intravoxel incoherent motion and diffusion kurtosis imaging in predicting peritumoural infiltration of soft-tissue sarcoma: a prospective study based on MRI-histopathology comparisons. Clin Radiol 2021; 76:532-539. [PMID: 33736880 DOI: 10.1016/j.crad.2021.02.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 02/11/2021] [Indexed: 12/27/2022]
Abstract
AIM To investigate the performance of intravoxel incoherent motion (IVIM) and diffusion kurtosis imaging (DKI) in the identification of peritumoural infiltration of soft-tissue sarcoma (STS). MATERIALS AND METHODS From July 2018 to January 2020, 34 STS patients who underwent 3-T magnetic resonance imaging (MRI), including IVIM and DKI, were reviewed. The standard apparent diffusion coefficient (ADC), true diffusion (D), pseudo-diffusion coefficient (D∗), perfusion fraction (f), mean kurtosis (MK), and mean diffusion (MD) of each lesion were analysed independently by two observers. An MRI-histopathology control method was used to ensure the correspondence of MRI sections with histopathological sections. Differences in STS with and without infiltration were evaluated. The area under the curve (AUC) was used to determine the best cut-off point for different parameters. Interobserver agreement was assessed using the intraclass correlation coefficient. RESULTS Standard ADC, D, MK, and MD values reliably distinguished STS that had positive and negative infiltration. The MD value had the best diagnostic performance. Use of an MD cut-off value of 2.35 × 10-3 mm2/s to distinguish positive and negative infiltration had an AUC of 0.85, accuracy of 88.2%, sensitivity of 94.4%, and specificity of 81.3%. The two independent observers had nearly perfect agreement for all parameters. CONCLUSION The standard ADC and D value of IVIM, and the MK and MD values of DKI reliably identify the presence of peritumoural infiltration of STS.
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Affiliation(s)
- X Li
- Department of Radiology, The Second Hospital, Dalian Medical University, Dalian, China
| | - Y Liu
- Department of Radiology, The Second Hospital, Dalian Medical University, Dalian, China
| | - J Tao
- Department of Histopathology, The Second Hospital, Dalian Medical University, Dalian, China
| | - Z Yin
- Department of Radiology, The Second Hospital, Dalian Medical University, Dalian, China
| | - Y Zhu
- Department of Radiology, The Second Hospital, Dalian Medical University, Dalian, China
| | - Y Zhang
- Department of Radiology, The Second Hospital, Dalian Medical University, Dalian, China
| | - S Wang
- Department of Radiology, The Second Hospital, Dalian Medical University, Dalian, China.
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21
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Ashikyan O, Bradshaw SB, Dettori NJ, Hwang H, Chhabra A. Conventional and advanced MR imaging insights of synovial sarcoma. Clin Imaging 2021; 76:149-155. [PMID: 33607418 DOI: 10.1016/j.clinimag.2021.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/26/2021] [Accepted: 02/05/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Synovial sarcomas commonly involve extremities. The purpose of this study was to systematically assess and describe the appearance of pathologically proven synovial sarcomas on conventional MR sequences, diffusion weighted imaging and dynamic contrast enhanced imaging. METHODS In this cross-sectional retrospective study, fifteen pre-operative MRIs were analyzed separately by two musculoskeletal radiologists and a fellow. MRI features of synovial sarcomas were evaluated in a systematic fashion on conventional and advanced MR sequences. RESULTS The tumors demonstrated heterogeneous appearance on conventional MR sequences. Peritumoral edema was absent in four of 15 (27%) lesions including grade 2 and grade 3 tumors. Average minimum ADC was 0.8 × 10-3 mm2/s and average mean ADC was 1.2 × 10-3 mm2/s. There was avid early arterial phase enhancement on contrast imaging. Average relative enhancement of the tumors was 5.7 times compared to the adjacent skeletal muscle. CONCLUSION Synovial sarcomas demonstrate avid early arterial phase post-contrast enhancement on contrast images, low ADC values, and heterogeneous appearance on conventional MRI sequences. Peritumoral edema may be absent in such tumors despite being high grade tumors.
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Affiliation(s)
- Oganes Ashikyan
- Department of Radiology, UT Southwestern, United States of America.
| | | | - Nathan J Dettori
- Department of Radiology, UT Southwestern, United States of America
| | - Helena Hwang
- Department of Pathology, UT Southwestern, United States of America
| | - Avneesh Chhabra
- Department of Radiology, UT Southwestern, United States of America; Department of Orthopedic Surgery, UT Southwestern, United States of America
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22
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Alramdan MHA, Kasalak Ö, Been LB, Suurmeijer AJH, Yakar D, Kwee TC. MRI after Whoops procedure: diagnostic value for residual sarcoma and predictive value for an incomplete second resection. Skeletal Radiol 2021; 50:2213-2220. [PMID: 33900432 PMCID: PMC8449770 DOI: 10.1007/s00256-021-03790-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the value of MRI for the detection and assessment of the anatomic extent of residual sarcoma after a Whoops procedure (unplanned sarcoma resection) and its utility for the prediction of an incomplete second resection. MATERIALS AND METHODS This study included consecutive patients who underwent a Whoops procedure, successively followed by gadolinium chelate-enhanced MRI and second surgery at a tertiary care sarcoma center. RESULTS Twenty-six patients were included, of whom 19 with residual tumor at the second surgery and 8 with an incomplete second resection (R1: n = 6 and R2: n = 2). Interobserver agreement for residual tumor at MRI after a Whoops procedure was perfect (κ value: 1.000). MRI achieved a sensitivity of 47.4% (9/19), a specificity of 100% (7/7), a positive predictive value of 100% (9/9), and a negative predictive value of 70.0% (7/17) for the detection of residual tumor. MRI correctly classified 2 of 19 residual sarcomas as deep-seated (i.e., extending beyond the superficial muscle fascia) but failed to correctly classify 3 of 19 residual sarcomas as deep-seated. There were no significant associations between MRI findings (presence of residual tumor, maximum tumor diameter, anatomic tumor extent, tumor margins, tumor spiculae, and tumor tail on the superficial fascia) with an incomplete (R1 or R2) second resection. CONCLUSION Gadolinium chelate-enhanced MRI is a reproducible method to rule in residual sarcoma, but it is insufficiently accurate to rule out and assess the anatomic extent or residual sarcoma after a Whoops procedure. Furthermore, MRI has no utility in predicting an incomplete second resection.
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Affiliation(s)
- Mohammed H. A. Alramdan
- grid.4494.d0000 0000 9558 4598Department of Radiology, Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | - Ömer Kasalak
- grid.4494.d0000 0000 9558 4598Department of Radiology, Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | - Lukas B. Been
- grid.4494.d0000 0000 9558 4598Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Albert J. H. Suurmeijer
- grid.4494.d0000 0000 9558 4598Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Derya Yakar
- grid.4494.d0000 0000 9558 4598Department of Radiology, Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | - Thomas C. Kwee
- grid.4494.d0000 0000 9558 4598Department of Radiology, Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
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Sedaghat S, Schmitz F, Meschede J, Sedaghat M. Systematic analysis of post-treatment soft-tissue edema and seroma on MRI in 177 sarcoma patients. Surg Oncol 2020; 35:218-223. [DOI: 10.1016/j.suronc.2020.08.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 06/08/2020] [Accepted: 08/19/2020] [Indexed: 11/24/2022]
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24
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Lee SK, Jee WH, Jung CK, Chung YG. Multiparametric quantitative analysis of tumor perfusion and diffusion with 3T MRI: differentiation between benign and malignant soft tissue tumors. Br J Radiol 2020; 93:20191035. [PMID: 32649224 DOI: 10.1259/bjr.20191035] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To evaluate multiparametric MRI for differentiating benign and malignant soft tissue tumors. METHODS This retrospective study included 67 patients (mean age, 55 years; 18-82 years) with 35 benign and 32 malignant soft tissue tumors. Intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI)-derived parameters (D, D*, f), apparent diffusion coefficient (ADC), and dynamic contrast-enhanced (DCE)-MRI parameters (Ktrans, Kep, Ve, iAUC) were calculated. Myxoid and non-myxoid soft tissue tumors were divided for subgroup analysis. The parameters were compared between benign and malignant tumors. RESULTS ADC and D were significantly lower in malignant than benign soft tissue tumors (1170 ± 488 vs 1472 ± 349 µm2/s; 1132 ± 500 vs 1415 ± 374 µm2/s; p < 0.05). Ktrans, Kep, Ve, and iAUC were significantly different between malignant and benign soft tissue tumors (0.209 ± 0.160 vs 0.092 ± 0.067 min-1; 0.737 ± 0.488 vs 0.311 ± 0.230 min-1; 0.32 ± 0.17 vs 0.44 ± 0.28; 0.23 ± 0.14 vs 0.12 ± 0.09, p < 0.05, respectively). ADC (0.752), D (0.742), and Kep (0.817) had high AUCs. Subgroup analysis showed that only Ktrans, and iAUC were significantly different in myxoid tumors, while, ADC, D, Ktrans, Kep, and iAUC were significantly different in non-myxoid tumor for differentiating benign and malignant tumors. D, Kep, and iAUC were the most significant parameters predicting malignant soft tissue tumors. CONCLUSION Multiparametric MRI can be useful to differentiate benign and malignant soft tissue tumors using IVIM-DWI and DCE-MRI. ADVANCES IN KNOWLEDGE 1. Pure tissue diffusion (D), transfer constant (Ktrans), rate constant (Kep), and initial area under time-signal intensity curve (iAUC) can be used to differentiate benign malignant soft tissue tumors.2. Ktrans and iAUC enable differentiation of benign and malignant myxoid soft tissue tumors.
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Affiliation(s)
- Seul Ki Lee
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Won-Hee Jee
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Department of Radiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chan Kwon Jung
- Departments of Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yang-Guk Chung
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Howe BM, Broski SM, Littrell LA, Pepin KM, Wenger DE. Quantitative Musculoskeletal Tumor Imaging. Semin Musculoskelet Radiol 2020; 24:428-440. [PMID: 32992370 DOI: 10.1055/s-0040-1708825] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The role of quantitative magnetic resonance imaging (MRI) and positron emission tomography/computed tomography (PET/CT) techniques continues to grow and evolve in the evaluation of musculoskeletal tumors. In this review we discuss the MRI quantitative techniques of volumetric measurement, chemical shift imaging, diffusion-weighted imaging, elastography, spectroscopy, and dynamic contrast enhancement. We also review quantitative PET techniques in the evaluation of musculoskeletal tumors, as well as virtual surgical planning and three-dimensional printing.
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Affiliation(s)
- B Matthew Howe
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Kay M Pepin
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Doris E Wenger
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
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26
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Dodin G, Salleron J, Jendoubi S, Abou Arab W, Sirveaux F, Blum A, Gondim Teixeira PA. Added-value of advanced magnetic resonance imaging to conventional morphologic analysis for the differentiation between benign and malignant non-fatty soft-tissue tumors. Eur Radiol 2020; 31:1536-1547. [PMID: 32885297 DOI: 10.1007/s00330-020-07190-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/01/2020] [Accepted: 08/12/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the added value of DWI, qualitative proton MR spectroscopy (H-MRS) and dynamic contrast-enhanced perfusion (DCE-P) to conventional MRI in differentiating benign and malignant non-fatty soft tissue tumors (NFSTT). METHODS From November 2009 to August 2017, 288 patients with NFSTT that underwent conventional and advanced MRI were prospectively evaluated. The study was approved by the local ethics committee. All patients signed an informed consent. A musculoskeletal (R1) and a general (R2) radiologist classified all tumors as benign, malignant, or indeterminate according to morphologic MRI features. Then, DWI, H-MRS, and DCE-P data of indeterminate tumors were analyzed by two additional radiologists (R3 and R4). Advanced techniques were considered individually and in combination for tumor benign-malignant differentiation using histology as the gold standard. RESULTS There were 104 (36.1%) malignant and 184 (63.9%) benign tumors. Conventional MRI analysis classified 99 tumors for R1 and 135 for R2 as benign or malignant, an accuracy for the identification of malignancy of 87.9% for R1 and 83.7% for R2, respectively. There were 189 indeterminate tumors for R1. For these tumors, the combination of DWI and H-MRS yielded the best accuracy for malignancy identification (77.4%). DWI alone provided the best sensitivity (91.8%) while the combination of DCE-P, DWI, and H-MRS yielded the best specificity (100%). The reproducibility of the advanced imaging parameters was considered good to excellent (Kappa and ICC > 0.86). An advanced MRI evidence-based evaluation algorithm was proposed allowing to characterize 28.1 to 30.1% of indeterminate non-myxoid tumors. CONCLUSION The prioritized use of advanced MRI techniques allowed to decrease by about 30% the number of non-myxoid NFSTT deemed indeterminate after conventional MRI analysis alone. KEY POINTS • When morphological characterization of non-fatty soft tissue tumors is possible, the diagnostic performance is high and there is no need for advanced imaging techniques. • Following morphologic analysis, advanced MRI techniques reduced by about 30% the number of non-myxoid indeterminate tumors. • DWI is the keystone of advanced imaging techniques yielding the best sensitivity (91.8%). Optimal specificity (> 90%) is obtained by a combination of advanced techniques.
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Affiliation(s)
- Gauthier Dodin
- Service d'imagerie Guilloz, Hôpital Central, Centre Hospitalier Régional Universitaire de Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035, Nancy cedex, France.
| | - Julia Salleron
- Département de Biostatistique, Institut de Cancérologie de Lorraine, 6 avenue de Bourgogne, F-54519, Vandœuvre-lès-Nancy cedex, France
| | - Salma Jendoubi
- Service d'imagerie Guilloz, Hôpital Central, Centre Hospitalier Régional Universitaire de Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035, Nancy cedex, France
| | - Waled Abou Arab
- Service d'imagerie Guilloz, Hôpital Central, Centre Hospitalier Régional Universitaire de Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035, Nancy cedex, France
| | - François Sirveaux
- Centre Chirurgical Emile-Gallé, Centre Hospitalier Régional Universitaire de Nancy, 49, rue Hermite, 54000, Nancy cedex, France
| | - Alain Blum
- Service d'imagerie Guilloz, Hôpital Central, Centre Hospitalier Régional Universitaire de Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035, Nancy cedex, France
| | - Pedro Augusto Gondim Teixeira
- Service d'imagerie Guilloz, Hôpital Central, Centre Hospitalier Régional Universitaire de Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035, Nancy cedex, France
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Chodyla M, Demircioglu A, Schaarschmidt BM, Bertram S, Bruckmann NM, Haferkamp J, Li Y, Bauer S, Podleska L, Rischpler C, Forsting M, Herrmann K, Umutlu L, Grueneisen J. Evaluation of 18F-FDG PET and DWI Datasets for Predicting Therapy Response of Soft-Tissue Sarcomas Under Neoadjuvant Isolated Limb Perfusion. J Nucl Med 2020; 62:348-353. [PMID: 32737246 DOI: 10.2967/jnumed.120.248260] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 06/26/2020] [Indexed: 01/16/2023] Open
Abstract
Our purpose was to evaluate and compare the clinical utility of simultaneously obtained quantitative 18F-FDG PET and diffusion-weighted MRI datasets for predicting the histopathologic response of soft-tissue sarcoma (STS) to neoadjuvant isolated limb perfusion (ILP). Methods: In total, 37 patients with a confirmed STS of the extremities underwent 18F-FDG PET/MRI before and after ILP with melphalan and tumor necrosis factor-α. For each patient, the maximum tumor size, metabolic activity (SUV), and diffusion restriction (apparent diffusion coefficient, ADC) were determined in pre- and posttherapeutic examinations, and percentage changes during treatment were calculated. Mann-Whitney U testing and receiver-operating-characteristic analysis were used to compare the results of the different quantitative parameters to predict the histopathologic response to therapy. Results from histopathologic analysis after tumor resection served as the reference standard, and patients were defined as responders or nonresponders based on the grading scale by Salzer-Kuntschik. Results: Histopathologic analysis categorized 22 (59%) patients as responders (grades I-III) and 15 (41%) as nonresponders (grades IV-VI). Under treatment, tumors in responders showed a mean reduction in size (-9.7%) and metabolic activity (SUVpeak, -51.9%; SUVmean, -43.8%), as well as an increase of the ADC values (ADCmin, +29.4%; ADCmean, +32.8%). The percentage changes in nonresponders were -6.2% in tumor size, -17.3% in SUVpeak, -13.9% in SUVmean, +15.3% in ADCmin, and +14.6% in ADCmean Changes in SUV and ADCmean significantly differed between responders and nonresponders (<0.01), whereas differences in tumor size and ADCmin did not (>0.05). The corresponding AUCs were 0.63 for tumor size, 0.87 for SUVpeak, 0.82 for SUVmean, 0.63 for ADCmin, 0.84 for ADCmean, and 0.89 for ratio of ADCmean to SUVpeak Conclusion: PET- and MRI-derived quantitative parameters (SUV and ADCmean) and their combination performed well in predicting the histopathologic therapy response of STS to neoadjuvant ILP. Therefore, integrated PET/MRI could serve as a valuable tool for pretherapeutic assessment as well as monitoring of neoadjuvant treatment strategies of STS.
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Affiliation(s)
- Michal Chodyla
- Department of Diagnostic and Interventional Radiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Aydin Demircioglu
- Department of Diagnostic and Interventional Radiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Benedikt M Schaarschmidt
- Department of Diagnostic and Interventional Radiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Stefanie Bertram
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Nils Martin Bruckmann
- Department of Diagnostic and Interventional Radiology, University Hospital Dusseldorf, University of Dusseldorf, Dusseldorf, Germany
| | - Jennifer Haferkamp
- Department of Diagnostic and Interventional Radiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Yan Li
- Department of Diagnostic and Interventional Radiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Sebastian Bauer
- Sarcoma Center, Western German Cancer Center, University of Duisburg-Essen, Essen, Germany
| | - Lars Podleska
- Sarcoma Surgery Division, Department of General, Visceral, and Transplantation Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; and
| | - Christoph Rischpler
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Michael Forsting
- Department of Diagnostic and Interventional Radiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Johannes Grueneisen
- Department of Diagnostic and Interventional Radiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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Gómez J, Tsagozis P. Multidisciplinary treatment of soft tissue sarcomas: An update. World J Clin Oncol 2020; 11:180-189. [PMID: 32355640 PMCID: PMC7186235 DOI: 10.5306/wjco.v11.i4.180] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 03/13/2020] [Accepted: 03/22/2020] [Indexed: 02/06/2023] Open
Abstract
Standard treatment for soft tissue sarcoma, based on complete surgical resection with or without adjuvant radiotherapy and chemotherapy, has not substantially changed during the last several decades. Nevertheless, recent advances have contributed to considerable improvement in the management of these patients; for example, new magnetic resonance imaging sequences such as diffusion-weighted imaging and magnetic resonance imaging radiomics can better assess tumor extension and even estimate its grade. Detection of circulating genetic material (liquid biopsy) and next-generation sequencing are powerful techniques for genetic analysis, which will increase our understanding of the underlying molecular mechanisms and may reveal potential therapeutic targets. The role of chemotherapy in non-metastatic disease is still controversial, and there is a need to identify patients who really benefit from this treatment. Novel chemotherapeutic regimens have entered clinical praxis and can change the outcome of patients with metastatic disease. Advances in radiotherapy have helped decrease local adverse effects and sustain good local control of the disease. The following report provides an updated view of the diagnosis, treatment, and future perspectives on the management of patients with soft tissue sarcomas.
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Affiliation(s)
- Jorge Gómez
- Department of Orthopedic Surgery, Clínica Universidad de Navarra, University of Navarra, Pamplona 31008, Spain
| | - Panagiotis Tsagozis
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm 17176, Sweden
- Muskuloskeletal Tumour Service, Karolinska University Hospital, Stockholm 17176, Sweden
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29
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Can we use MRI to detect clinically silent recurrent soft-tissue sarcoma? Eur Radiol 2020; 30:4724-4733. [DOI: 10.1007/s00330-020-06810-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/04/2020] [Accepted: 03/13/2020] [Indexed: 12/15/2022]
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Inarejos Clemente EJ, Navallas M, Barber Martínez de la Torre I, Suñol M, Munuera Del Cerro J, Torner F, Garraus M, Navarro OM. MRI of Rhabdomyosarcoma and Other Soft-Tissue Sarcomas in Children. Radiographics 2020; 40:791-814. [PMID: 32243230 DOI: 10.1148/rg.2020190119] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Soft-tissue sarcomas in children comprise a heterogeneous group of entities with variable manifestation depending on the age of the patient and the location of the tumor. MRI is the modality of choice for evaluating musculoskeletal soft-tissue tumors and plays a paramount role in both initial diagnosis and assessment of tumor response during and after treatment. Conventional MRI sequences, such as T1- and T2-weighted imaging, offer morphologic information, which is important for localizing the lesion and describing anatomic relationships but not accurate for determining its malignant or benign nature and may be limited in differentiating tumor response from therapy-related changes. Advanced multiparametric MRI offers further functional information that can help with these tasks by using different imaging sequences and biomarkers. The authors present the role of MRI in rhabdomyosarcoma and other soft-tissue sarcomas in children, emphasizing a multiparametric approach with focus on the utility and potential added value of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced MRI in characterization and staging, determination of pretreatment extent, and evaluation of tumor response and recurrence after treatment. ©RSNA, 2020.
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Affiliation(s)
- Emilio J Inarejos Clemente
- From the Departments of Diagnostic Imaging (E.J.I.C., M.N., I.B.M.d.l.T., J.M.d.C.), Pathology (M.S.), Orthopaedics (F.T.), and Oncology and Haematology (M.G.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; Department of Medical Imaging, University of Toronto, Toronto, Ont, Canada (O.M.N.); and Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ont, Canada (O.M.N.)
| | - María Navallas
- From the Departments of Diagnostic Imaging (E.J.I.C., M.N., I.B.M.d.l.T., J.M.d.C.), Pathology (M.S.), Orthopaedics (F.T.), and Oncology and Haematology (M.G.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; Department of Medical Imaging, University of Toronto, Toronto, Ont, Canada (O.M.N.); and Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ont, Canada (O.M.N.)
| | - Ignasi Barber Martínez de la Torre
- From the Departments of Diagnostic Imaging (E.J.I.C., M.N., I.B.M.d.l.T., J.M.d.C.), Pathology (M.S.), Orthopaedics (F.T.), and Oncology and Haematology (M.G.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; Department of Medical Imaging, University of Toronto, Toronto, Ont, Canada (O.M.N.); and Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ont, Canada (O.M.N.)
| | - Mariona Suñol
- From the Departments of Diagnostic Imaging (E.J.I.C., M.N., I.B.M.d.l.T., J.M.d.C.), Pathology (M.S.), Orthopaedics (F.T.), and Oncology and Haematology (M.G.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; Department of Medical Imaging, University of Toronto, Toronto, Ont, Canada (O.M.N.); and Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ont, Canada (O.M.N.)
| | - Josep Munuera Del Cerro
- From the Departments of Diagnostic Imaging (E.J.I.C., M.N., I.B.M.d.l.T., J.M.d.C.), Pathology (M.S.), Orthopaedics (F.T.), and Oncology and Haematology (M.G.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; Department of Medical Imaging, University of Toronto, Toronto, Ont, Canada (O.M.N.); and Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ont, Canada (O.M.N.)
| | - Ferran Torner
- From the Departments of Diagnostic Imaging (E.J.I.C., M.N., I.B.M.d.l.T., J.M.d.C.), Pathology (M.S.), Orthopaedics (F.T.), and Oncology and Haematology (M.G.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; Department of Medical Imaging, University of Toronto, Toronto, Ont, Canada (O.M.N.); and Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ont, Canada (O.M.N.)
| | - Moira Garraus
- From the Departments of Diagnostic Imaging (E.J.I.C., M.N., I.B.M.d.l.T., J.M.d.C.), Pathology (M.S.), Orthopaedics (F.T.), and Oncology and Haematology (M.G.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; Department of Medical Imaging, University of Toronto, Toronto, Ont, Canada (O.M.N.); and Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ont, Canada (O.M.N.)
| | - Oscar M Navarro
- From the Departments of Diagnostic Imaging (E.J.I.C., M.N., I.B.M.d.l.T., J.M.d.C.), Pathology (M.S.), Orthopaedics (F.T.), and Oncology and Haematology (M.G.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; Department of Medical Imaging, University of Toronto, Toronto, Ont, Canada (O.M.N.); and Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ont, Canada (O.M.N.)
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Can radiomics improve the prediction of metastatic relapse of myxoid/round cell liposarcomas? Eur Radiol 2020; 30:2413-2424. [PMID: 31953663 DOI: 10.1007/s00330-019-06562-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 10/24/2019] [Accepted: 10/30/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The strongest adverse prognostic factor in myxoid/round cell liposarcomas (MRC-LPS) is the presence of a round cell component above 5% within the tumor bulk. Its identification is underestimated on biopsies and in the neoadjuvant setting. The aim was to improve the prediction of patients' prognosis through a radiomics approach. METHODS Thirty-five out of 89 patients with MRC-LPS managed at our sarcoma reference center from 2008 to 2017 were included in this IRB-approved retrospective study as they presented with a pre-treatment contrast-enhanced MRI (median age, 49 years old). Two radiologists reported usual conventional/semantic radiological variables. After signal intensity (SI) normalization, voxel size standardization of T2-WI, and whole tumor volume segmentation, 44 3D-radiomics features were extracted. Using least absolute shrinkage and selection operator penalized Cox regression on prefiltered features, a radiomics score based on 3 weighted radiomics features was generated. Four prognostic multivariate models for MRFS were compared using concordance index: (1) clinical model, (2) semantic radiological model, (3) radiomics model, and (4) radiomics + semantic radiological model. RESULTS Twelve patients showed a metastatic relapse. The radiomics score included FOS_Skewness, GLRLM_LRHGE, and SHAPE_Volume and correlated with MRFS (hazard ratio = 19.37, p = 0.0009) and visual heterogeneity on T2-WI (p < 0.0001). A high score indicated a poorer prognosis. After adjustment, the best predictive performances were obtained with model (4) (concordance index = 0.937) and the lowest with model (1) (concordance index = 0.637). CONCLUSION Adding selected radiomics features that quantify tumor heterogeneity and shape at baseline to a conventional radiological analysis improves prediction of MRC-LPS patients' prognosis. KEY POINTS • Fourteen radiomics features quantifying shape and heterogeneity of myxoid/round cell liposarcomas on T2-WI were associated with metastatic relapse in univariate analysis. • A radiomics score based on 3 selected and weighted radiomics features was a strong and independent prognostic factor for metastatic relapse-free survival. • The best prediction of metastatic relapse-free survival for myxoid/round cell liposarcomas was achieved by combining the radiomics score to relevant radiological features.
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