Skip to main content

Advertisement

SpringerLink
Log in

Soft tissue sarcoma: adding diffusion-weighted imaging improves MR imaging evaluation of tumor margin infiltration

  • Musculoskeletal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Purpose

To determine the added value of diffusion-weighted imaging (DWI) to conventional magnetic resonance (MR) imaging in assessment of tumor margin infiltration in soft tissue sarcoma (STS) at 3T.

Materials and methods

The institutional review board approved this retrospective study. Forty-five patients who underwent 3T MR imaging including DWI and were pathologically confirmed were included in this study. Two readers retrospectively scored conventional MR imaging alone. Then, they assessed a combination of conventional MR imaging and DWI. At pathology, margin infiltration was retrospectively reviewed by one pathologist blinded to MR findings. Areas under the curve (AUCs) of the receiver-operating characteristic curve were obtained for diagnostic performance. Interobserver agreement for the scoring of margin infiltration of STS was assessed with kappa statistics.

Results

Among 45 cases of STS, 33 had infiltrative tumor margin at pathology. Sensitivity, specificity, and accuracy of each reader were 100%, 17%, and 78%; 97%, 25%, and 78% on conventional MR imaging alone and 94%, 67%, and 87%; 94%, 42%, and 80% on conventional MR imaging combined with DWI. AUCs of conventional MR imaging combined with DWI were significantly higher than those of conventional MR imaging alone: 0.890 vs 0.678 (p = .0123) and 0.846 vs 0.640 (p = .0305) for each reader. Interobserver agreements of conventional MR imaging alone and conventional MR imaging combined with DWI were moderate to substantial (κ = 0.646, κ = 0.496).

Conclusion

The addition of DWI to conventional MR imaging may improve specificity for assessing tumor margin infiltration in STS at 3T.

Key Points

• DWI has added value for assessment of tumor margin infiltration in soft tissue sarcoma.

• Addition of DWI to conventional MRI at 3T may improve specificity.

• Addition of DWI to conventional MRI may help orthopedic surgeon determine the extent of the resection margin.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Abbreviations

ADC:

Apparent diffusion coefficient

DWI:

Diffusion-weighted imaging

References

  1. Kolovich GG, Wooldridge AN, Christy JM, Crist MK, Mayerson JL, Scharschmidt TJ (2012) A retrospective statistical analysis of high-grade soft tissue sarcomas. Med Oncol 29:1335–1344

    Article  PubMed  Google Scholar 

  2. Robinson E, Bleakney RR, Ferguson PC, O'Sullivan B (2008) Oncodiagnosis panel: 2007: multidisciplinary management of soft-tissue sarcoma. Radiographics 28:2069–2086

    Article  Google Scholar 

  3. Kandel R, Coakley N, Werier J et al (2013) Surgical margins and handling of soft-tissue sarcoma in extremities: a clinical practice guideline. Curr Oncol 20:e247–e254

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Gerrand CH, Wunder JS, Kandel RA et al (2001) Classification of positive margins after resection of soft-tissue sarcoma of the limb predicts the risk of local recurrence. J Bone Joint Surg Br 83:1149–1155

    Article  CAS  PubMed  Google Scholar 

  5. Kransdorf MJ, Jelinek JS, Moser RP Jr et al (1989) Soft-tissue masses: diagnosis using MR imaging. AJR Am J Roentgenol 153:541–547

    Article  CAS  Google Scholar 

  6. Totty WG, Murphy WA, Lee JK (1986) Soft-tissue tumors: MR imaging. Radiology 160:135–141

    Article  CAS  PubMed  Google Scholar 

  7. Walker EA, Salesky JS, Fenton ME, Murphey MD (2011) Magnetic resonance imaging of malignant soft tissue neoplasms in the adult. Radiol Clin North Am 49:1219–1234

    Article  PubMed  Google Scholar 

  8. Lee SY, Jee WH, Jung JY et al (2016) Differentiation of malignant from benign soft tissue tumours: use of additive qualitative and quantitative diffusion-weighted MR imaging to standard MR imaging at 3.0 T. Eur Radiol 26:743–754

    Article  PubMed  Google Scholar 

  9. Nagata S, Nishimura H, Uchida M et al (2008) Diffusion-weighted imaging of soft tissue tumors: usefulness of the apparent diffusion coefficient for differential diagnosis. Radiat Med 26:287–295

    Article  Google Scholar 

  10. Khoo MM, Tyler PA, Saifuddin A, Padhani AR (2011) Diffusion-weighted imaging (DWI) in musculoskeletal MRI: a critical review. Skeletal Radiol 40:665–681

    Article  PubMed  Google Scholar 

  11. Suzuki C, Maeda M, Matsumine A et al (2007) Apparent diffusion coefficient of subcutaneous epidermal cysts in the head and neck comparison with intracranial epidermoid cysts. Acad Radiol 14:1020–1028

    Article  PubMed  Google Scholar 

  12. Altman D (1991) Practical statistics for medical research, 1st edn. Chapman & Hall, London, pp 403–409

  13. Lintz F, Moreau A, Odri GA, Waast D, Maillard O, Gouin F (2012) Critical study of resection margins in adult soft-tissue sarcoma surgery. Orthop Traumatol Surg Res 98:S9–S18

    Article  CAS  PubMed  Google Scholar 

  14. Beltran J, Simon DC, Katz W, Weis LD (1987) Increased MR signal intensity in skeletal muscle adjacent to malignant tumors: pathologic correlation and clinical relevance. Radiology 162:251–255

    Article  CAS  PubMed  Google Scholar 

  15. White LM, Wunder JS, Bell RS et al (2005) Histologic assessment of peritumoral edema in soft tissue sarcoma. Int J Radiat Oncol Biol Phys 61:1439–1445

    Article  PubMed  Google Scholar 

  16. Enneking WF, Spanier SS, Malawer MM (1981) The effect of the anatomic setting on the results of surgical procedures for soft parts sarcoma of the thigh. Cancer 47:1005–1022

    Article  CAS  PubMed  Google Scholar 

  17. Hanna SL, Fletcher BD, Parham DM, Bugg MF (1991) Muscle edema in musculoskeletal tumors: MR imaging characteristics and clinical significance. J Magn Reson Imaging 1:441–449

    Article  CAS  PubMed  Google Scholar 

  18. Kransdorf M, Murphey M (1997) Imaging of soft tissue tumors, 1st edn. WB Saunders, Philadelphia, pp 37–56

  19. Kroon HM, Bloem JL, Holscher HC, van der Woude HJ, Reijnierse M, Taminiau AH (1994) MR imaging of edema accompanying benign and malignant bone tumors. Skeletal Radiol 23:261–269

    Article  CAS  PubMed  Google Scholar 

  20. Steen RG (1992) Edema and tumor perfusion: characterization by quantitative 1H MR imaging. AJR Am J Roentgenol 158:259–264

    Article  CAS  PubMed  Google Scholar 

  21. Zhao F, Ahlawat S, Farahani SJ et al (2014) Can MR imaging be used to predict tumor grade in soft-tissue sarcoma? Radiology 272:192–201

    Article  PubMed  Google Scholar 

  22. Lang P, Honda G, Roberts T et al (1995) Musculoskeletal neoplasm: perineoplastic edema versus tumor on dynamic postcontrast MR images with spatial mapping of instantaneous enhancement rates. Radiology 197:831–839

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

The authors state that this work has not received any funding.

Author information

Author notes

  1. Ji Hyun Hong

    Present address: Department of Radiology, Kangdong Seong-Sim Hospital, College of Medicine, Hallym University, 150 Seongan-ro, Gangdong-gu, Seoul, 05355, South Korea

Authors and Affiliations

  1. Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, South Korea

    Ji Hyun Hong, Won-Hee Jee & Joon-Yong Jung

  2. Department of Pathology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, South Korea

    Chan-Kwon Jung

  3. Orthopedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, South Korea

    Seung Han Shin & Yang-Guk Chung

Authors
  1. Ji Hyun Hong
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Won-Hee Jee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chan-Kwon Jung
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Joon-Yong Jung
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Seung Han Shin
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yang-Guk Chung
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Won-Hee Jee.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Won-Hee Jee.

Conflict of interest

The authors declare that they have no conflict of interest.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• diagnostic or prognostic study

• performed at one institution

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hong, J.H., Jee, WH., Jung, CK. et al. Soft tissue sarcoma: adding diffusion-weighted imaging improves MR imaging evaluation of tumor margin infiltration. Eur Radiol 29, 2589–2597 (2019). https://doi.org/10.1007/s00330-018-5817-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-018-5817-0

Keywords

Search

Navigation