Diagnosis and differential diagnosis of dermatofibrosarcoma protuberans: Utility of high-resolution dynamic contrast-enhanced (DCE) MRI

Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in differentiation of soft tissue sarcoma from benign lesions: a systematic review of literature

OBJECTIVE

To systematically review the literature assessing the role of Dynamic Contrast-Enhanced Magnetic Resonance Imaging (DCE-MRI) in the differentiation of soft tissue sarcomas from benign lesions.

MATERIALS AND METHODS

A comprehensive literature search was performed with the following keywords: multiparametric magnetic resonance imaging, DCE-MR perfusion, soft tissue, sarcoma, and neoplasm. Original studies evaluating the role of DCE-MRI for differentiating benign soft-tissue lesions from soft-tissue sarcomas were included.

RESULTS

Eighteen studies with a total of 965 imaging examinations were identified. Ten of twelve studies evaluating qualitative parameters reported improvement in discriminative power. One of the evaluated qualitative parameters was time-intensity curves (TIC), and malignant curves (TIC III, IV) were found in 74% of sarcomas versus 26.5% benign lesions. Six of seven studies that used the semiquantitative approach found it relatively beneficial. Four studies assessed quantitative parameters including Ktrans (contrast transit from the vascular compartment to the interstitial compartment), Kep (contrast return to the vascular compartment), and Ve (the volume fraction of the extracellular extravascular space) in addition to other parameters. All found Ktrans, and 3 studies found Kep to be significantly different between sarcomas and benign lesions. The values for Ve were variable. Additionally, eight studies assessed diffusion-weighted imaging (DWI), and 6 of them found it useful.

CONCLUSION

Of different DCE-MRI approaches, qualitative parameters showed the best evidence in increasing the diagnostic performance of MRI. Semiquantitative and quantitative approaches seemed to improve the discriminative power of MRI, but which parameters and to what extent is still unclear and needs further investigation.

Fibrosarcomatous Dermatofibrosarcoma Protuberans of the Head

This article highlights the case of a 37-year-old male who presented with a recurrent, exponentially enlarging head mass, emphasizing the diagnostic and therapeutic challenges associated with a very rare type of tumor, fibrosarcomatous dermatofibrosarcoma protuberans (DFSP) of the head. Our patient presented with a rapidly growing head mass, initially diagnosed as a spindle cell tumor, and was managed with surgical excision and skin flap grafting. Follow-up revealed relapse and interval development of hemiparesis and hemisensory loss. MRI revealed tumor recurrence, with compression of the right parietal lobe and superior sagittal sinus. Histopathology revealed stroma with fascicles of spindle cells homogenous to fibrillar cytoplasm, with oval vesicular nuclei. Immunohistochemical staining showed positivity for CD34 and SMA. Oral chemotherapy with imatinib 800 mg/day was started. Follow-up imaging showed a marked reduction in the size of the tumor and resolution of the compression of the underlying brain parenchyma with cystic degeneration and decreased contrast enhancement. Future plans include possible surgical tumor debulking and/or radiation therapy. Although extremely rare, awareness of this tumor, with a multi-disciplinary approach to the management of the case, is vital to maximize treatment outcomes.

Skin ultrasonography and magnetic resonance; new clinical applications and instrumentation

BACKGROUND

Technological advances in skin ultrasonography and magnetic resonance are discussed.

METHODS

Literature review.

RESULTS

40 publications cited.

CONCLUSION

This article illustrates crucial contributions made by the Editors, the Editorial Board and this Journal to these fields.

Integrating vascularity into the pattern classification of pilomatricomas on ultrasound provides a more competent approach for discriminative evaluation

BACKGROUND

Pilomatricoma has various manifestations on color Doppler ultrasound, and a differential diagnosis is challenging. The objective of this study was to investigate which characteristics of skin lesions on color Doppler ultrasound are effective in distinguishing pilomatricoma from epidermoid cyst and dermatofibrosarcoma protuberans.

MATERIALS AND METHODS

Records of patients with pilomatricomas (n = 63), epidermoid cysts (n = 76), and dermatofibrosarcoma protuberans (n = 19) who underwent color Doppler ultrasound evaluation and surgical excision were reviewed. The anatomical distribution and color Doppler ultrasound characteristics of these lesions were analyzed. The 63 pilomatricomas were categorized into five types based on their color Doppler ultrasound characteristics, and the roles of these five types in the differential diagnosis of the aforementioned diseases were studied.

RESULTS

Pilomatricomas, epidermoid cysts, and dermatofibrosarcoma protuberans exhibited some similar characteristics. Dominantly markedly hyperechoic or hyperechoic appearance, posterior acoustic shadowing, and the presence of vascularity were the major characteristics of pilomatricomas. The pilomatricomas could be categorized into five types, with type II having a diagnostic performance of sensitivity of 65.08%, specificity of 98.95%, area under the receiver operating characteristic curve (AUC) of 0.743, positive predictive value of 97.62%, and negative predictive value of 81.03% for the diagnosis of the aforementioned skin diseases.

CONCLUSION

A combination of dominantly markedly hyperechoic or hyperechoic appearance, posterior acoustic shadowing, and the presence of vascularity exhibits higher diagnostic performance for the differential diagnosis of pilomatricomas, epidermoid cysts, and dermatofibrosarcoma protuberans.

Diagnosis and differential diagnosis of tertiary androgenetic alopecia with severe alopecia areata based on high-resolution MRI

BACKGROUND AND AIM

No previous study investigated the anatomical changes of the scalp and hair follicles between tertiary androgenetic alopecia and severe alopecia areata using high-resolution magnetic resonance imaging (HR-MRI). This study aimed to explore the value of HR-MRI in assessing alopecia.

MATERIALS AND METHODS

Forty-eight people were included in this study. The imaging indicators of the vertex and occipital scalp were recorded and compared. The logistic regression model was developed for the indicators that differed between tertiary androgenetic alopecia and severe alopecia areata. The receiver-operating characteristic (ROC) curve was used to assess the diagnostic efficacy of the model for tertiary androgenetic alopecia and severe alopecia areata.

RESULTS

At the vertex, the thickness of the subcutaneous tissue layer, follicle depth, relative follicle depth, total number of follicles within a 2-cm distance, and number of strands reaching the middle and upper third of the subcutaneous fat layer within a 2-cm distance were statistically different between patients with tertiary androgenetic alopecia, those with severe alopecia areata, and healthy volunteers (p < 0.05). The logistic regression model suggested that the subcutaneous tissue layer thickness was important in discriminating tertiary androgenetic alopecia from severe alopecia areata. The ROC curve showed that the area under the curve, sensitivity, specificity, and best cutoff values of the subcutaneous tissue layer were 0.886, 94.4%, 70%, and 4.31 mm, respectively.

CONCLUSIONS

HR-MRI can observe the changes in anatomical structures of the scalp and hair follicles in patients with alopecia. HR-MRI can be applied to the differential diagnosis of tertiary androgenetic alopecia and severe alopecia areata.