Can MR Imaging Be Used to Predict Tumor Grade in Soft-Tissue Sarcoma?

Zhao, Fang; Ahlawat, Shivani; Farahani, Sahar J; Weber, Kristy; Montgomery, Elizabeth A.; Carrino, John A.; Fayad, Laura M.

doi:10.1148/radiol.14131871

Cited by 109 publications

(88 citation statements)

References 28 publications

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“…The association between a decrease in edema and good response did not surprise us. Surrounding edema is associated with high‐grade STS and satellite tumor cells . NAC efficacy should logically go with reduced satellite tumor cells, and thus a decrease of signal anomalies surrounding STS on MRI.…”

Section: Discussionmentioning

confidence: 99%

T₂‐based MRI Delta‐radiomics improve response prediction in soft‐tissue sarcomas treated by neoadjuvant chemotherapy.

Crombé

Périer

Kind

et al. 2018

Magnetic Resonance Imaging

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Background Standard of care for patients with high‐grade soft‐tissue sarcoma (STS) are being redefined since neoadjuvant chemotherapy (NAC) has demonstrated a positive effect on patients' outcome. Yet response evaluation in clinical trials still relies on RECIST criteria. Purpose To investigate the added value of a Delta‐radiomics approach for early response prediction in patients with STS undergoing NAC. Study Type Retrospective. Population Sixty‐five adult patients with newly‐diagnosed, locally‐advanced, histologically proven high‐grade STS of trunk and extremities. All were treated by anthracycline‐based NAC followed by surgery and had available MRI at baseline and after two chemotherapy cycles. Field Strength/Sequence Pre‐ and postcontrast enhanced T1‐weighted imaging (T1‐WI), turbo spin echo T2‐WI at 1.5 T. Assessment A threshold of <10% viable cells on surgical specimens defined good response (Good‐HR). Two senior radiologists performed a semantic analysis of the MRI. After 3D manual segmentation of tumors at baseline and early evaluation, and standardization of voxel‐sizes and intensities, absolute changes in 33 texture and shape features were calculated. Statistical Tests Classification models based on logistic regression, support vector machine, k‐nearest neighbors, and random forests were elaborated using crossvalidation (training and validation) on 50 patients ("training cohort") and was validated on 15 other patients ("test cohort"). Results Sixteen patients were good‐HR. Neither RECIST status (P = 0.112) nor semantic radiological variables were associated with response (range of P‐values: 0.134–0.490) except an edema decrease (P = 0.003), although 14 shape and texture features were (range of P‐values: 0.002–0.037). On the training cohort, the highest diagnostic performances were obtained with random forests built on three features: Δ_Histogram_Entropy, Δ_Elongation, Δ_Surrounding_Edema, which provided: area under the curve the receiver operating characteristic = 0.86, accuracy = 88.1%, sensitivity = 94.1%, and specificity = 66.3%. On the test cohort, this model provided an accuracy of 74.6% but 3/5 good‐HR were systematically ill‐classified. Data Conclusion A T2‐based Delta‐radiomics approach might improve early response assessment in STS patients with a limited number of features. Level of Evidence: 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:497–510.

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Section: Discussionmentioning

confidence: 99%

T₂‐based MRI Delta‐radiomics improve response prediction in soft‐tissue sarcomas treated by neoadjuvant chemotherapy.

Crombé

Périer

Kind

et al. 2018

Magnetic Resonance Imaging

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“…MRI is the imaging method of choice for the evaluation of musculoskeletal tumors , including primary tumor staging, biopsy planning for the areas of viable tumor and the detection of residual or recurrent disease. Advanced MR techniques, such as spectroscopy, perfusion MRI and diffusion‐weighted MRI, are now used in addition to conventional sequences to improve the accuracy of MRI in the characterization of STT .…”

Section: Discussionmentioning

confidence: 99%

Relationship between diffusion parameters derived from intravoxel incoherent motion MRI and perfusion measured by dynamic contrast‐enhanced MRI of soft tissue tumors

Marzi¹,

Stefanetti

Sperati³

et al. 2015

NMR in Biomedicine

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Our aim was to evaluate the link between diffusion parameters measured by intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) and the perfusion metrics obtained with dynamic contrast-enhanced (DCE) MRI in soft tissue tumors (STTs). Twenty-eight patients affected by histopathologically confirmed STT were included in a prospective study. All patients underwent both DCE MRI and IVIM DWI. The perfusion fraction f, diffusion coefficient D and perfusion-related diffusion coefficient D* were estimated using a bi-exponential function to fit the DWI data. DCE MRI was acquired with a temporal resolution of 3-5 s. Maps of the initial area under the gadolinium concentration curve (IAUGC), time to peak (TTP) and maximum slope of increase (MSI) were derived using commercial software. The relationships between the DCE MRI and IVIM DWI measurements were assessed by Spearman's test. To exclude false positive results under multiple testing, the false discovery rate (FDR) procedure was applied. The Mann-Whitney test was used to evaluate the differences between all variables in patients with non-myxoid and myxoid STT. No significant relationship was found between IVIM parameters and any DCE MRI parameters. Higher f and D*f values were found in non-myxoid tumors compared with myxoid tumors (p = 0.004 and p = 0.003, respectively). MSI was significantly higher in non-myxoid tumors than in myxoid tumors (p = 0.029). From the visual assessments of single clinical cases, both f and D*f maps were in satisfactory agreement with DCE maps in the extreme cases of an avascular mass and a highly vascularized mass, whereas, for tumors with slight vascularity or with a highly heterogeneous perfusion pattern, this association was not straightforward. Although IVIM DWI was demonstrated to be feasible in STT, our data did not support evident relationships between perfusion-related IVIM parameters and perfusion measured by DCE MRI.

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“…13 Other predictors of high grade in the study included larger tumour size, poorly defined margins, heterogeneity on T2WI and high peritumoral T2 signal. However, the study included a heterogeneous group of .15 sarcomas.…”

Section: Correlation Of Imaging Features With Metastatic Diseasementioning

confidence: 98%

Imaging features of primary and metastatic extremity synovial sarcoma: a single institute experience of 78 patients

Baheti

Tirumani²,

Sewatkar³

et al. 2015

BJR

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Objective: To study the appearance of primary and metastatic extremity synovial sarcoma (SS) on crosssectional imaging. Methods: In this institutional review board-approved, Health Insurance Portability and Accountability Act-compliant retrospective study, the imaging features of 78 patients (42 males and 36 females; mean age, 40 years) with primary and metastatic extremity SS on MRI and multidetector CT were reviewed, with baseline MRI of the primary available in 31 patients. Results: Primary SSs were predominantly wellcircumscribed (27/31) and heterogeneously enhancing solid (18/31) or solid-cystic (13/31) tumours. Imaging features visualized included the presence of perilesional oedema (14/31), interfascial (15/31) and intercompartmental extension (7/31), triple sign (11/31), intratumoral haemorrhage (10/31), calcification (6/31), bowl of grapes appearance (5/31) and bone involvement (3/31). Smaller T1 stage tumours (8/31) appeared as heterogeneously enhancing lesions, with some lesions demonstrating interfascial and intercompartmental extension and perilesional oedema. Recurrent/metastatic disease developed in 49/78 (63%) patients. Of these, 20/78 (26%) had metastasis at presentation, while the remaining developed metastatic disease at a median interval of 27 months (range, 3-161 months). Pleuropulmonary metastases (46/78) were the most common sites, with most of the metastases being pleural based. On univariate analysis, larger tumour size, the presence of perilesional oedema, intercompartmental extension, the presence of intralesional haemorrhage and bowl of grapes appearance on MRI were associated with a significantly higher incidence of metastatic disease. Conclusion: Certain imaging features of primary SS predict the risk of development of metastatic disease. Imaging features of T1 stage tumours included heterogeneous enhancement, interfascial extension and perilesional oedema. Pleural-based metastases are commonly seen in SSs. Advances in knowledge: Imaging features of primary SS correlate with metastatic disease. Pleural-based metastases are often present in SSs.Synovial sarcoma (SS) is a relatively common high-grade sarcoma, accounting for 5-10% of soft-tissue sarcomas.

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Can MR Imaging Be Used to Predict Tumor Grade in Soft-Tissue Sarcoma?

Abstract: Among several MR imaging features that aid in the discrimination of high-grade from low-grade sarcomas, the presence of peritumoral contrast enhancement is a feature that may be solely used to diagnose high-grade STS.

Cited by 109 publications

References 28 publications

T₂‐based MRI Delta‐radiomics improve response prediction in soft‐tissue sarcomas treated by neoadjuvant chemotherapy.

T₂‐based MRI Delta‐radiomics improve response prediction in soft‐tissue sarcomas treated by neoadjuvant chemotherapy.

Relationship between diffusion parameters derived from intravoxel incoherent motion MRI and perfusion measured by dynamic contrast‐enhanced MRI of soft tissue tumors

Imaging features of primary and metastatic extremity synovial sarcoma: a single institute experience of 78 patients

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Can MR Imaging Be Used to Predict Tumor Grade in Soft-Tissue Sarcoma?

Abstract: Among several MR imaging features that aid in the discrimination of high-grade from low-grade sarcomas, the presence of peritumoral contrast enhancement is a feature that may be solely used to diagnose high-grade STS.

Cited by 109 publications

References 28 publications

T2‐based MRI Delta‐radiomics improve response prediction in soft‐tissue sarcomas treated by neoadjuvant chemotherapy.

T2‐based MRI Delta‐radiomics improve response prediction in soft‐tissue sarcomas treated by neoadjuvant chemotherapy.

Relationship between diffusion parameters derived from intravoxel incoherent motion MRI and perfusion measured by dynamic contrast‐enhanced MRI of soft tissue tumors

Imaging features of primary and metastatic extremity synovial sarcoma: a single institute experience of 78 patients

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T₂‐based MRI Delta‐radiomics improve response prediction in soft‐tissue sarcomas treated by neoadjuvant chemotherapy.

T₂‐based MRI Delta‐radiomics improve response prediction in soft‐tissue sarcomas treated by neoadjuvant chemotherapy.