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Can we use MRI to detect clinically silent recurrent soft-tissue sarcoma?
- Source :
-
European radiology [Eur Radiol] 2020 Sep; Vol. 30 (9), pp. 4724-4733. Date of Electronic Publication: 2020 Apr 20. - Publication Year :
- 2020
-
Abstract
- Purpose: The impact of MRI on early detection of local recurrence (LR) in high-grade soft-tissue sarcomas (STS) is unsubstantiated. To identify the contribution of MRI criteria including dynamic contrast-enhanced (DCE) MRI and knowledge of surgical margins that can be used in detecting recurrence prior to obvious proven presence of LR in soft-tissue sarcomas. The secondary aim was to determine causes for misdiagnosing LR.<br />Methods: MRI of 23 patients (12 men; mean age, 59.7 years ± 16.5 years) with LR of STS and that of 22 age- and histology-matched controls with STS but without LR were retrospectively analyzed by two musculoskeletal radiologists. Preoperative MRI characteristics (conventional and DCE) were compared to those of MRIs made after treatment, but before LR was proven. Likelihood of recurrence was rated on a 5-point Likert scale for morphological and dynamic assessment separately, before and after adding knowledge of surgical margins. Descriptive statistics and receiver operating characteristic analysis were performed.<br />Results: Differentiation of LR from post-therapeutic changes was the highest combining result of conventional MRI, DCE-MRI, and knowledge of surgical margins (area under the curve (AUC) 0.779), followed by DCE-MRI (AUC 0.706) and conventional MRI (AUC 0.648). Suboptimal MRI technique and overcalling post-therapeutic changes in microscopic positive margins were the main reasons for false negative and false positive results, respectively.<br />Conclusion: MRI including DCE improves the detection of recurrent, clinically silent soft-tissue sarcoma when combined with knowledge of achieved surgical margins. LR may be missed on inadequate MRI protocols.<br />Key Points: • Dynamic contrast-enhanced MRI is useful in the differentiation of recurrent soft-tissue sarcoma and post-therapeutic fibrosis. • Knowledge of surgical margins substantially increases the value of MRI in detecting recurrent soft-tissue sarcoma. • MR with all three image orientations, covering the entire part of the extremity in at least one sequence and comparison to initial tumor characteristics and location, is beneficial.
- Subjects :
- Adult
Aged
Aged, 80 and over
Area Under Curve
Contrast Media
Diagnostic Errors
Early Diagnosis
Extremities diagnostic imaging
Female
Fibrosis diagnostic imaging
Humans
Male
Margins of Excision
Middle Aged
Neoplasm Recurrence, Local surgery
ROC Curve
Retrospective Studies
Sarcoma surgery
Soft Tissue Neoplasms surgery
Magnetic Resonance Imaging methods
Neoplasm Recurrence, Local diagnostic imaging
Sarcoma diagnostic imaging
Soft Tissue Neoplasms diagnostic imaging
Subjects
Details
- Language :
- English
- ISSN :
- 1432-1084
- Volume :
- 30
- Issue :
- 9
- Database :
- MEDLINE
- Journal :
- European radiology
- Publication Type :
- Academic Journal
- Accession number :
- 32314057
- Full Text :
- https://doi.org/10.1007/s00330-020-06810-z