Detection of soft-tissue sarcoma recurrence

Added value of functional MR imaging techniques at 3.0 T

Filippo Del Grande, Ty Subhawong, Kristy Weber, Michael Aro, Charles Mugera, Laura M. Fayad

Research output: Contribution to journalArticle

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Abstract

Purpose: To determine the added value of functional magnetic resonance (MR) sequences (dynamic contrast material- enhanced [DCE] and quantitative diffusion-weighted [DW] imaging with apparent diffusion coefficient [ADC] mapping) for the detection of recurrent soft-tissue sarcomas following surgical resection. Materials and Methods: This retrospective study was approved by the institutional review board. The requirement to obtain informed consent was waived. Thirty-seven patients referred for postoperative surveillance after resection of soft-tissue sarcoma (35 with high-grade sarcoma) were studied. Imaging at 3.0 T included conventional (T1-weighted, fluid-sensitive, and contrast-enhanced T1-weighted imaging) and functional (DCE MR imaging, DW imaging with ADC mapping) sequences. Recurrences were confirmed with biopsy or resection. A disease-free state was determined with at least 6 months of follow-up. Two readers independently recorded the signal and morphologic characteristics with conventional sequences, the presence or absence of arterial enhancement at DCE MR imaging, and ADCs of the surgical bed. The accuracy of conventional MR imaging in the detection of recurrence was compared with that with the addition of functional sequences. The Fisher exact and Wilcoxon rank sum tests were used to define the accuracy of imaging features, the Cohen k and Lin interclass correlation were used to define interobserver variability, and receiver operating characteristic analysis was used to define a threshold to detect recurrence and assess reader confidence after the addition of functional imaging to conventional sequences. Results: There were six histologically proved recurrences in 37 patients. Sensitivity and specificity of MR imaging in the detection of tumor recurrence were 100% (six of six patients) and 52% (16 of 31 patients), respectively, with conventional sequences, 100% (six of six patients) and 97% (30 of 31 patients) with the addition of DCE MR imaging, and 60% (three of five patients) and 97% (30 of 31 patients) with the addition of DW imaging and ADC mapping. The average ADC of recurrence (1.08 mm2/sec ± 0.19) was significantly different from those of postoperative scarring (0.9 mm2/sec ± 0.00) and hematomas (2.34 mm2/sec ± 0.72) (P = .03 for both). Conclusion: The addition of functional MR sequences to a routine MR protocol, in particular DCE MR imaging, offers a specificity of more than 95% for distinguishing recurrent sarcoma from postsurgical scarring.

Original languageEnglish
Pages (from-to)499-511
Number of pages13
JournalRadiology
Volume271
Issue number2
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

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Sarcoma
Magnetic Resonance Imaging
Recurrence
Contrast Media
Magnetic Resonance Spectroscopy
Nonparametric Statistics
Cicatrix
Diffusion Magnetic Resonance Imaging
Observer Variation
Research Ethics Committees
Informed Consent
ROC Curve
Hematoma
Retrospective Studies
Biopsy
Sensitivity and Specificity
Neoplasms

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Detection of soft-tissue sarcoma recurrence : Added value of functional MR imaging techniques at 3.0 T. / Del Grande, Filippo; Subhawong, Ty; Weber, Kristy; Aro, Michael; Mugera, Charles; Fayad, Laura M.

In: Radiology, Vol. 271, No. 2, 01.01.2014, p. 499-511.

Research output: Contribution to journalArticle

Del Grande, Filippo ; Subhawong, Ty ; Weber, Kristy ; Aro, Michael ; Mugera, Charles ; Fayad, Laura M. / Detection of soft-tissue sarcoma recurrence : Added value of functional MR imaging techniques at 3.0 T. In: Radiology. 2014 ; Vol. 271, No. 2. pp. 499-511.
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abstract = "Purpose: To determine the added value of functional magnetic resonance (MR) sequences (dynamic contrast material- enhanced [DCE] and quantitative diffusion-weighted [DW] imaging with apparent diffusion coefficient [ADC] mapping) for the detection of recurrent soft-tissue sarcomas following surgical resection. Materials and Methods: This retrospective study was approved by the institutional review board. The requirement to obtain informed consent was waived. Thirty-seven patients referred for postoperative surveillance after resection of soft-tissue sarcoma (35 with high-grade sarcoma) were studied. Imaging at 3.0 T included conventional (T1-weighted, fluid-sensitive, and contrast-enhanced T1-weighted imaging) and functional (DCE MR imaging, DW imaging with ADC mapping) sequences. Recurrences were confirmed with biopsy or resection. A disease-free state was determined with at least 6 months of follow-up. Two readers independently recorded the signal and morphologic characteristics with conventional sequences, the presence or absence of arterial enhancement at DCE MR imaging, and ADCs of the surgical bed. The accuracy of conventional MR imaging in the detection of recurrence was compared with that with the addition of functional sequences. The Fisher exact and Wilcoxon rank sum tests were used to define the accuracy of imaging features, the Cohen k and Lin interclass correlation were used to define interobserver variability, and receiver operating characteristic analysis was used to define a threshold to detect recurrence and assess reader confidence after the addition of functional imaging to conventional sequences. Results: There were six histologically proved recurrences in 37 patients. Sensitivity and specificity of MR imaging in the detection of tumor recurrence were 100{\%} (six of six patients) and 52{\%} (16 of 31 patients), respectively, with conventional sequences, 100{\%} (six of six patients) and 97{\%} (30 of 31 patients) with the addition of DCE MR imaging, and 60{\%} (three of five patients) and 97{\%} (30 of 31 patients) with the addition of DW imaging and ADC mapping. The average ADC of recurrence (1.08 mm2/sec ± 0.19) was significantly different from those of postoperative scarring (0.9 mm2/sec ± 0.00) and hematomas (2.34 mm2/sec ± 0.72) (P = .03 for both). Conclusion: The addition of functional MR sequences to a routine MR protocol, in particular DCE MR imaging, offers a specificity of more than 95{\%} for distinguishing recurrent sarcoma from postsurgical scarring.",
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T1 - Detection of soft-tissue sarcoma recurrence

T2 - Added value of functional MR imaging techniques at 3.0 T

AU - Del Grande, Filippo

AU - Subhawong, Ty

AU - Weber, Kristy

AU - Aro, Michael

AU - Mugera, Charles

AU - Fayad, Laura M.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Purpose: To determine the added value of functional magnetic resonance (MR) sequences (dynamic contrast material- enhanced [DCE] and quantitative diffusion-weighted [DW] imaging with apparent diffusion coefficient [ADC] mapping) for the detection of recurrent soft-tissue sarcomas following surgical resection. Materials and Methods: This retrospective study was approved by the institutional review board. The requirement to obtain informed consent was waived. Thirty-seven patients referred for postoperative surveillance after resection of soft-tissue sarcoma (35 with high-grade sarcoma) were studied. Imaging at 3.0 T included conventional (T1-weighted, fluid-sensitive, and contrast-enhanced T1-weighted imaging) and functional (DCE MR imaging, DW imaging with ADC mapping) sequences. Recurrences were confirmed with biopsy or resection. A disease-free state was determined with at least 6 months of follow-up. Two readers independently recorded the signal and morphologic characteristics with conventional sequences, the presence or absence of arterial enhancement at DCE MR imaging, and ADCs of the surgical bed. The accuracy of conventional MR imaging in the detection of recurrence was compared with that with the addition of functional sequences. The Fisher exact and Wilcoxon rank sum tests were used to define the accuracy of imaging features, the Cohen k and Lin interclass correlation were used to define interobserver variability, and receiver operating characteristic analysis was used to define a threshold to detect recurrence and assess reader confidence after the addition of functional imaging to conventional sequences. Results: There were six histologically proved recurrences in 37 patients. Sensitivity and specificity of MR imaging in the detection of tumor recurrence were 100% (six of six patients) and 52% (16 of 31 patients), respectively, with conventional sequences, 100% (six of six patients) and 97% (30 of 31 patients) with the addition of DCE MR imaging, and 60% (three of five patients) and 97% (30 of 31 patients) with the addition of DW imaging and ADC mapping. The average ADC of recurrence (1.08 mm2/sec ± 0.19) was significantly different from those of postoperative scarring (0.9 mm2/sec ± 0.00) and hematomas (2.34 mm2/sec ± 0.72) (P = .03 for both). Conclusion: The addition of functional MR sequences to a routine MR protocol, in particular DCE MR imaging, offers a specificity of more than 95% for distinguishing recurrent sarcoma from postsurgical scarring.

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