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Use of diagnostic dynamic contrast-enhanced (DCE)-MRI for targeting of soft tissue tumour biopsies at 3T: preliminary results

  • Magnetic Resonance
  • Published:
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Abstract

Objectives

To test the feasibility and accuracy of MR-guided soft tissue tumour biopsy at 3T, using the dynamic contrast-enhanced (DCE) information from staging MRI for intralesional targeting.

Methods

After obtaining written informed consent for this institutional review board-approved study, 53 patients with suspected soft tissue tumours prospectively underwent preoperative staging MRI at 3T, including DCE, and subsequent MR-guided core needle biopsy. In 44/53 cases, DCE was heterogeneous and was used for intralesional biopsy targeting. Surgical, whole-specimen histology was used as the gold standard in 43/44 patients and revealed 42 soft tissue tumours (24 men; 18 women; mean age, 52 years; range, 19 – 84).

Results

Final surgical histology revealed eight benign lesions, six tumours of intermediate dignity, and 28 malignancies. All malignancies had shown heterogeneous DCE. The diagnostic yield of the biopsies was 100 % (42/42). Histological accuracy rates of biopsy were 100 % in predicting the dignity (42/42; 95 % CI [0.916 – 1.000]), 95.2 % for the tissue-specific entity (40/42; 95 % CI [0.847 – 0.987]), and 90.5 % for the tumour grade (38/42; 95 % CI [0.779 – 0.962]).

Conclusions

Our preliminary study indicates that biopsy of soft tissue tumours can be performed accurately and safely with DCE targeted MR-guidance at 3T, using a combined staging/biopsy MRI protocol.

Key Points

• MR-guided soft tissue tumour biopsy using DCE for intralesional targeting is feasible.

• Targeting by staging-MRI allows reliable planning of the biopsy approach.

• The method seems accurate and safe as a combined staging/biopsy procedure in outpatients.

• DCE-targeted biopsy seems useful in challenging large and heterogeneous tumours.

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References

  1. Fletcher CDM, Unni KK, Mertens F (eds) (2002) World Health Organization Classification of Tumours. Pathology and genetics of tumours of soft tissue and bone. IARC Press, Lyon

    Google Scholar 

  2. Fletcher CDM (2014) The evolving classification of soft tissue tumours - an update based on the new 2013 WHO classification. Histopathology 64:2–11

    Article  PubMed  Google Scholar 

  3. (2012) Soft tissue and visceral sarcomas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 23:vii92–99

  4. Nakamura T, Matsumine A, Matsubara T, Asanuma K, Uchida A, Sudo A (2011) The symptom-to-diagnosis delay in soft tissue sarcoma influence the overall survival and the development of distant metastasis. J Surg Oncol 104:771–775

    Article  PubMed  Google Scholar 

  5. Rougraff BT, Aboulafia A, Biermann JS, Healey J (2009) Biopsy of soft tissue masses: evidence-based medicine for the musculoskeletal tumor society. Clin Orthop Relat Res 467:2783–2791

    Article  PubMed Central  PubMed  Google Scholar 

  6. Network NCC (2012) NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines )® - Soft Tissue Sarcoma. Available via http://www.gistonline.it/Portali/1/Documents/NCCN%20Soft%20Tissue%20Sarcoma%20v.3.2012.pdf

  7. Ball AB, Fisher C, Pittam M, Watkins RM, Westbury G (1990) Diagnosis of soft tissue tumours by Tru-Cut biopsy. Br J Surg 77:756–758

    Article  CAS  PubMed  Google Scholar 

  8. Carrino JA, Khurana B, Ready JE, Silverman SG, Winalski CS (2007) Magnetic resonance imaging-guided percutaneous biopsy of musculoskeletal lesions. J Bone Joint Surg Am 89:2179–2187

    Article  PubMed  Google Scholar 

  9. Sung KS, Seo SW, Shon MS (2009) The diagnostic value of needle biopsy for musculoskeletal lesions. Int Orthop 33:1701–1706

    Article  PubMed Central  PubMed  Google Scholar 

  10. Oliveira AM, Nascimento AG (2001) Grading in soft tissue tumors: principles and problems. Skelet Radiol 30:543–559

    Article  CAS  Google Scholar 

  11. van Rijswijk CS, Geirnaerdt MJ, Hogendoorn PC et al (2004) Soft-tissue tumors: value of static and dynamic gadopentetate dimeglumine-enhanced MR imaging in prediction of malignancy. Radiology 233:493–502

    Article  PubMed  Google Scholar 

  12. van Rijswijk CS, Kunz P, Hogendoorn PC, Taminiau AH, Doornbos J, Bloem JL (2002) Diffusion-weighted MRI in the characterization of soft-tissue tumors. J Magn Reson Imaging 15:302–307

    Article  PubMed  Google Scholar 

  13. Fayad LM, Barker PB, Jacobs MA et al (2007) Characterization of musculoskeletal lesions on 3-T proton MR spectroscopy. AJR Am J Roentgenol 188:1513–1520

    Article  PubMed  Google Scholar 

  14. Fayad LM, Jacobs MA, Wang X, Carrino JA, Bluemke DA (2012) Musculoskeletal tumors: how to use anatomic, functional, and metabolic MR techniques. Radiology 265:340–356

    Article  PubMed Central  PubMed  Google Scholar 

  15. Verstraete KL, De Deene Y, Roels H, Dierick A, Uyttendaele D, Kunnen M (1994) Benign and malignant musculoskeletal lesions: dynamic contrast-enhanced MR imaging–parametric “first-pass” images depict tissue vascularization and perfusion. Radiology 192:835–843

    Article  CAS  PubMed  Google Scholar 

  16. Wang CK, Li CW, Hsieh TJ, Chien SH, Liu GC, Tsai KB (2004) Characterization of bone and soft-tissue tumors with in vivo 1H MR spectroscopy: initial results. Radiology 232:599–605

    Article  PubMed  Google Scholar 

  17. Maeda M, Matsumine A, Kato H et al (2007) Soft-tissue tumors evaluated by line-scan diffusion-weighted imaging: influence of myxoid matrix on the apparent diffusion coefficient. J Magn Reson Imaging 25:1199–1204

    Article  PubMed  Google Scholar 

  18. Qi ZH, Li CF, Li ZF, Zhang K, Wang Q, Yu DX (2009) Preliminary study of 3T 1H MR spectroscopy in bone and soft tissue tumors. Chins Med J (Engl) 122:39–43

    Google Scholar 

  19. Verstraete KL, Lang P (2000) Bone and soft tissue tumors: the role of contrast agents for MR imaging. Eur J Radiol 34:229–246

    Article  CAS  PubMed  Google Scholar 

  20. Zoga A (2012) ACR appropriateness criteria ® soft-tissue masses. Revised

  21. Kasraeian S, Allison DC, Ahlmann ER, Fedenko AN, Menendez LR (2010) A comparison of fine-needle aspiration, core biopsy, and surgical biopsy in the diagnosis of extremity soft tissue masses. Clin Orthop Relat Res 468:2992–3002

    Article  PubMed Central  PubMed  Google Scholar 

  22. Pohlig F, Kirchhoff C, Lenze U et al (2012) Percutaneous core needle biopsy versus open biopsy in diagnostics of bone and soft tissue sarcoma: a retrospective study. Eur J Med Res 17:29

    Article  PubMed Central  PubMed  Google Scholar 

  23. Clayer M (2010) Open incisional biopsy is a safe and accurate technique for soft tissue tumours. ANZ J Surg 80:786–788

    Article  PubMed  Google Scholar 

  24. 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  PubMed  Google Scholar 

  25. Shapeero LG, Vanel D, Verstraete KL, Bloem JL (2002) Fast magnetic resonance imaging with contrast for soft tissue sarcoma viability. Clin Orthop Relat Res 397:212–227

    Article  PubMed  Google Scholar 

  26. van der Woude HJ, Verstraete KL, Hogendoorn PC, Taminiau AH, Hermans J, Bloem JL (1998) Musculoskeletal tumors: does fast dynamic contrast-enhanced subtraction MR imaging contribute to the characterization? Radiology 208:821–828

    Article  PubMed  Google Scholar 

  27. Riches SF, Payne GS, Morgan VA et al (2009) MRI in the detection of prostate cancer: combined apparent diffusion coefficient, metabolite ratio, and vascular parameters. AJR Am J Roentgenol 193:1583–1591

    Article  PubMed  Google Scholar 

  28. Yacoub JH, Verma S, Moulton JS, Eggener S, Aytekin O (2012) Imaging-guided prostate biopsy: conventional and emerging techniques. Radiographics 32:819–837

    Article  PubMed  Google Scholar 

  29. Fletcher CD, Gustafson P, Rydholm A, Willen H, Akerman M (2001) Clinicopathologic re-evaluation of 100 malignant fibrous histiocytomas: prognostic relevance of subclassification. J Clin Oncol 19:3045–3050

    CAS  PubMed  Google Scholar 

  30. Adams SC, Potter BK, Pitcher DJ, Temple HT (2010) Office-based core needle biopsy of bone and soft tissue malignancies: an accurate alternative to open biopsy with infrequent complications. Clin Orthop Relat Res 468:2774–2780

    Article  PubMed Central  PubMed  Google Scholar 

  31. Dupuy DE, Rosenberg AE, Punyaratabandhu T, Tan MH, Mankin HJ (1998) Accuracy of CT-guided needle biopsy of musculoskeletal neoplasms. AJR Am J Roentgenol 171:759–762

    Article  CAS  PubMed  Google Scholar 

  32. Genant JW, Vandevenne JE, Bergman AG et al (2002) Interventional musculoskeletal procedures performed by using MR imaging guidance with a vertically open MR unit: assessment of techniques and applicability. Radiology 223:127–136

    Article  PubMed  Google Scholar 

  33. Puri A, Shingade VU, Agarwal MG et al (2006) CT-guided percutaneous core needle biopsy in deep seated musculoskeletal lesions: a prospective study of 128 cases. Skelet Radiol 35:138–143

    Article  CAS  Google Scholar 

  34. Huang AJ, Kattapuram SV (2011) Musculoskeletal neoplasms: biopsy and intervention. Radiol Clin N Am 49:1287–1305, vii

    Article  PubMed  Google Scholar 

  35. UyBico SJ, Motamedi K, Omura MC et al (2012) Relevance of compartmental anatomic guidelines for biopsy of musculoskeletal tumors: retrospective review of 363 biopsies over a 6-year period. J Vasc Interv Radiol 23:511–518, 518 e511-512

    Article  PubMed  Google Scholar 

  36. Schnapauff D, Zeile M, Niederhagen MB et al (2009) Diffusion-weighted echo-planar magnetic resonance imaging for the assessment of tumor cellularity in patients with soft-tissue sarcomas. J Magn Reson Imaging 29:1355–1359

    Article  PubMed  Google Scholar 

  37. Einarsdottir H, Karlsson M, Wejde J, Bauer HC (2004) Diffusion-weighted MRI of soft tissue tumours. Eur Radiol 14:959–963

    Article  PubMed  Google Scholar 

  38. Aoyagi T, Shuto K, Okazumi S et al (2012) Apparent diffusion coefficient correlation with oesophageal tumour stroma and angiogenesis. Eur Radiol 22:1172–1177

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We would like to thank the technical assistants who contributed to this study —Petra Peley, Barbara Domnanich, and Cornelia List — for their patient care and meticulous acquisition of MR sequences.

I.M. Noebauer-Huhmann is currently receiving an AMSOS grant. S. Trattnig is currently receiving a grant from Vienna Spots of Excellence of the Vienna Science and Technology Fund (WWTF): Vienna Advanced Imaging Center – VIACLIC FA102A0017.

The scientific guarantor of this publication is Prof. Christian Herold, M.D., Head of the Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. One of the authors has significant statistical expertise. Institutional review board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: prospective, randomised controlled trial/experimental, performed at one institution.

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Authors and Affiliations

  1. Department of Biomedical Imaging and Image-guided Therapy, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria

    Iris-Melanie Noebauer-Huhmann, Michael Weber, Christian Czerny & Stefan Nemec

  2. High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria

    Iris-Melanie Noebauer-Huhmann, Martin Krssak, Pavol Szomolanyi, Guenther Grabner, Wolfgang Bogner & Siegfried Trattnig

  3. Clinical Institute for Pathology, Medical University of Vienna, Vienna, Austria

    Gabriele Amann

  4. Department of Internal Medicine III, Endocrinology and Metabolism, Medical University of Vienna, Vienna, Austria

    Martin Krssak

  5. Department of Orthopaedics, Medical University of Vienna, Vienna, Austria

    Joannis Panotopoulos, Philipp Funovics & Reinhard Windhager

  6. Department of Imaging Methods, Institute of Measurement Science, Slovak Academy of Sciences, Bratislava, Slovakia

    Pavol Szomolanyi

  7. Landesklinikum Waldviertel Horn, Horn, Austria

    Martin Breitenseher

  8. Orthopaedics Hospital Speising, Vienna, Austria

    Martin Dominkus

  9. Austrian Cluster for Tissue Regeneration, Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria

    Siegfried Trattnig

  10. Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna/Vienna General Hospital, Waehringer Guertel 18-20, 1090, Vienna, Austria

    Iris-Melanie Noebauer-Huhmann

Authors
  1. Iris-Melanie Noebauer-Huhmann
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  2. Gabriele Amann
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  15. Siegfried Trattnig
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Corresponding author

Correspondence to Iris-Melanie Noebauer-Huhmann.

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Noebauer-Huhmann, IM., Amann, G., Krssak, M. et al. Use of diagnostic dynamic contrast-enhanced (DCE)-MRI for targeting of soft tissue tumour biopsies at 3T: preliminary results. Eur Radiol 25, 2041–2048 (2015). https://doi.org/10.1007/s00330-014-3576-0

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  • DOI: https://doi.org/10.1007/s00330-014-3576-0

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