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Accuracy of MRI in characterization of soft tissue tumors and tumor-like lesions. A prospective study in 548 patients

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Abstract

The purpose of our study was to assess prospectively the value of MRI in characterization of soft tissue tumors (STT) and soft tissue tumor-like lesions in a multi-institutional setting by a group of experts. The material consisted of 548 untreated and proven STT or tumor-like lesions originating from a multi-institutional database of STT in which 930 consecutive patients with STT examined by MRI were registered between 1 January 2001 and 28 April 2003. Based on MRI findings, a suitably ordered differential diagnosis was made in consensus by two radiologists (J.L.M.A.G and A.M.D.S). MRI diagnoses were compared with histology results (455 cases, 83%) and/or 6-month follow-up (93 cases, 17%) as reference standards. The correlation between the MRI and histological diagnosis and between the radiological and histological phenotype were statistically determined. One hundred twenty-three patients presented with a malignant STT; 425 patients presented with a benign one. Concerning differentiation between malignant and benign lesions (dignity), a sensitivity of 93%, specificity of 82%, negative predictive value (NPV) of 98% and positive predictive value (PPV) of 60% with accuracy of 85% were obtained. Concerning phenotype characterization, if only the first MRI diagnosis was taken into account, a sensitivity of 67%, specificity of 98%, NPV of 98%, PPV of 70% and accuracy of 96% were obtained. For benign lesions, sensitivity of 75%, specificity of 98%, NPV of 98%, PPV of 76% and accuracy of 97% were obtained. The phenotype’s definition of malignant STT had a sensitivity of 37%, a specificity of 96%, NPV of 96%, PPV of 40% and an accuracy of 92%. A correct diagnosis compared with histological assessment was proposed in 227(50%) of the 455 histologically confirmed cases. Despite non-quantified MR parameter evaluation, the results of our prospective study were better than those reported in previous studies and demonstrated the need for a centralized approach to such rare pathology.

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References

  1. Aisen AM, Martel W, Braunstein EM, McMillin KI, Phillips WA, Kling TF (1986) MRI and CT evaluation of primary bone and soft-tissue tumors. Am J Roentgenol 146:749–756

    CAS  Google Scholar 

  2. Alexander A, Nazarian L, Feld R (1997) Superficial soft tissue masses suggestive of recurrent malignancy: sonographic localization and biopsy. Am J Roentgenol 169:1449–1451

    CAS  Google Scholar 

  3. Andrassy RJ (2002) Advances in the surgical management of sarcomas in children. Am J Surg 184:484–491

    Article  PubMed  Google Scholar 

  4. Arrivé L, Renard R, Carrat F, Belkacem A, Dahan A, Le Hir P, Monnier-Cholley L, Tubiana J-M (2000) A scale of methodological quality for clinical studies of radiologic examinations. Radiology 217:69–74

    PubMed  Google Scholar 

  5. Baliski CR, Temple WJ, Arthur K, Schachar NS (2002) Desmoid tumors: a novel approach for local control. J Surg Oncol 80:96–99

    Article  PubMed  Google Scholar 

  6. Balzarini L, Ceglia E, Petrillo R, Tesoro Tess JD, REitano A, Musumeci R (1989) Magnetic resonance in neoplasms of the adipose, fibrous and muscular tissues. Radiol Med 77:87–93

    CAS  Google Scholar 

  7. 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

    CAS  PubMed  Google Scholar 

  8. Berquist TH, Ehman RL, King BF, Hodgman CH, Ilstrup DM (1990) Value of MR imaging in differentiating benign from malignant soft-tissue masses: study of 95 lesions. Am J Roentgenol 155:1251–1255

    CAS  Google Scholar 

  9. Binkovitz LA, Berquist TH, Mc Leod RA (1990) Masses of the hand and wrist: detection and characterization with MR imaging. Am J Roentgenol 154:323–326

    CAS  Google Scholar 

  10. Capelastegui A, Astigarraga E, Fernandez-Canton G, Saralegui I, Larena JA, Merino A (1999) Masses and pseudomasses of the hand and wrist: MR findings in 134 cases. Skeletal Radiol 28:498–507

    Article  CAS  PubMed  Google Scholar 

  11. Cerofolini E, Landi A, Desantis G et al (1991) MR of benign peripheral nerve sheath tumors. J Comput Assist Tomogr 15:593–597

    CAS  PubMed  Google Scholar 

  12. Chang AE, Matory YL, Dwyer AJ, Hill SC, Girton ME, Steinberg SM, Knop RH, Frank JA, Hyams D, Doppman JL et al (1987) Magnetic resonance imaging versus computed tomography in the evaluation of soft tissue tumors of the extremities. Ann Surg 205:340–348

    CAS  PubMed  Google Scholar 

  13. Crim JR, Seeger LL, Yao L, Chandnani V, Eckardt J (1992) Diagnosis of soft tissue masses with MR imaging: can benign masses be differentiated from malignant ones? Radiology 185:581–586

    CAS  PubMed  Google Scholar 

  14. Daldrup H, Shames DM, Wendland M, Okuhata Y, Link TM, Rosenau W, Lu Y, Brasch RC et al (1998) Correlation of dynamic contrast enhanced magnetic resonance imaging with histologic tumor grade: comparison of macromolecular and small-molecular contrast media. Pediatr Radiol 28:67–78

    Article  CAS  PubMed  Google Scholar 

  15. De Beuckeleer LH, De Schepper AM, Vandevenne JE et al (2000) MR imaging of clear cell sarcoma (malignant melanoma of the soft parts): a multicenter correlative MRI–pathology study of 21 cases and literature review. Skeletal Radiol 29:187–195

    Article  PubMed  Google Scholar 

  16. De Schepper AM (2001) Grading and characterization of soft tissue tumors. In: De Schepper AM, Parizel PM, De Beukeleer L, Vanhoenacker F (eds) Imaging of soft tissue tumors, 2nd edn. Springer, Berlin Heidelberg New York, pp 123–141

    Google Scholar 

  17. De Schepper A, Ramon F, Degryse H (1992) Statistical analysis of MRI parameters predicting malignancy in 141 soft tissue masses. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 156:587–591

    PubMed  Google Scholar 

  18. De Schepper A, De Beuckeleer L, Vandevenne J, Somville J (2000) Magnetic resonance imaging of soft tissue tumors. Eur Radiol 10:213–222

    Article  PubMed  Google Scholar 

  19. Duchateau F, Vande Berg BC (2002) MR imaging of the articular cartilage of the knee with arthroscopy as gold standard: assessment of methodological quality of clinical studies. Eur Radiol 12:2977–2981

    PubMed  Google Scholar 

  20. Erlemann R, Reiser MF, Peters PE, Vasallo P, Nommensen B, Kusnierz-Glaz CR, Ritter J, Roessner A (1989) Musculoskeletal neoplasms: static and dynamic Gd-DTPA-enhanced MR imaging. Radiology 171:767–773

    CAS  PubMed  Google Scholar 

  21. Fletcher CDM, Mertens KK, Mertens F (eds) (2002) Pathology and genetics. Tumours of soft tissue and bone, WHO classification of tumours. IARC, Lyon

    Google Scholar 

  22. Galant J, Marti-Bonmati L, Soler R et al (1998) Grading of subcutaneous soft tissue tumors by means of their relationship with the superficial fascia on MR imaging. Skeletal Radiol 27:657–663

    Article  CAS  PubMed  Google Scholar 

  23. Galant J, Marti-Bonmati L, Saez F, Soler R, Alcala-Santaella R, Navarro M (2003) The value of fat-suppressed T2 or STIR sequences in distinguishing lipoma from well-differentiated liposarcoma. Eur Radiol 13:337–343

    CAS  PubMed  Google Scholar 

  24. Gielen JL, De Schepper AM, Parizel PM, Wang XL, Vanhoenacker F (2003) Additional value of magnetic resonance with spin echo T1-weighted imaging with fat suppression in characterization of soft tissue tumors. J Comput Assist Tomogr 27:434–441

    Article  CAS  PubMed  Google Scholar 

  25. Greenspan A, McGahan JP, Vogelsang P, Szabo RM (1992) Imaging strategies in the evaluation of soft-tissue hemangiomas of the extremities: correlation of the findings of plain radiography, angiography, CT, MRI and ultrasonography in 12 histologically proven cases. Skeletal Radiol 21:11–18

    CAS  PubMed  Google Scholar 

  26. Hanna SL, Fletcher BD (1995) MR imaging of malignant soft-tissue tumors. Magn Reson Imaging Clin North Am 3:629–650

    CAS  Google Scholar 

  27. Hasegawa T, Yamamoto S, Yokoyama R, Umeda T, Matsuno Y, Hirohashi S (2002) Prognostic significance of grading and staging systems using MIB-1 score in adult patients with soft tissue sarcoma of the extremities and trunk. Cancer 95:843–851

    Article  PubMed  Google Scholar 

  28. Hogeboom WR, Hoekstra HJ, Mooyaart EL, Freling NJ, Schraffordt Koops H (1991) MRI and CT in the preoperative evaluation of soft-tissue tumors. Arch Orthop Trauma Surg 110:162–164

    CAS  PubMed  Google Scholar 

  29. Jelinek JS, Kransdorf MJ (1995) MR imaging of soft-tissue masses: mass-like lesions that simulate neoplasms. Magn Reson Imaging Clin North Am 3:727–741

    CAS  Google Scholar 

  30. Kransdorf MJ (1995) Malignant soft-tissue tumors in a large referral population. Am J Roentgenol 164:129–134

    CAS  Google Scholar 

  31. Kransdorf MJ (1995) Benign soft-tissue tumors in a large referral population. Am J Roentgenol 164:395–402

    CAS  Google Scholar 

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

    CAS  Google Scholar 

  33. Kreicbergs A, Tibukait B, Willems J, Bauer HC (1987) DNA flow analysis of soft tissue tumors. Cancer 59:128

    CAS  PubMed  Google Scholar 

  34. Lattes R (1982) Tumors of the soft tissue, 2nd edn. Armed Forces Institute of Pathology, Washington

    Google Scholar 

  35. Levine EA, Holzmayer T, Bacus S et al (1997) Evaluation of newer prognostic markers for adult soft tissue sarcoma. J Clin Oncol 15:3249–3257

    CAS  PubMed  Google Scholar 

  36. Lucas JD, O’Doherty MJ, Wong JC, Bingham JB, McKee PH, Fletcher CD, Smith MA (1998) Evaluation of fluorodeoxyglucose positron emission tomography in the management of soft-tissue sarcomas. J Bone Joint Surg Br 80:441–447

    Article  CAS  PubMed  Google Scholar 

  37. Ma LD, Frassica FJ, Scott WW Jr, Fishman EK, Zerbouni EA (1995) Differentiation of benign and malignant musculoskeletal tumors: potential pitfalls with MR imaging. Radiographics 15:349–366

    CAS  PubMed  Google Scholar 

  38. Ma LD, Frassica FJ, McCarthy EF, Bluemke DA, Zerhouni EA (1997) Benign and malignant musculoskeletal masses: MR imaging differentiation with rim-to-center differential enhancement ratios. Radiology 202:739–744

    CAS  PubMed  Google Scholar 

  39. Matsuno T, Gebhardt MC, Schiller AL et al (1988) The use of flow cytometry as a diagnostic aid in the management of soft-tissue tumors. J Bone Joint Surg 70:751

    CAS  PubMed  Google Scholar 

  40. Mc Kenzie AF (1997) The role of magnetic resonance imaging. When to use it and what to look for. Acta Orthop Scand Suppl 273:21–24

    Google Scholar 

  41. Meis-Kindblom J, Enzinger F (1996) Color atlas of soft tissue tumors. Mosby-Wolfe, St Louis

    Google Scholar 

  42. Miller TT, Potter HG, LcCormack RR (1994) Benign soft tissue masses of the wrist and hand: MRI appearances. Skeletal Radiol 23:327–332

    CAS  PubMed  Google Scholar 

  43. Moulton JS, Blebea JS, Dunco DM, Braley SE, Bisset GS III, Emery KH (1995) MR imaging of soft-tissue masses: diagnostic efficacy and value of distinguishing between benign and malignant lesions. Am J Roentgenol 164:1191–1199

    CAS  Google Scholar 

  44. Myhre-Jensen O (1981) A consecutive 7-year series of 1331 benign soft tissue tumors: clinicopathologic data-comparison with sarcomas. Acta Orthop Scand 52:287–293

    CAS  PubMed  Google Scholar 

  45. Okuno SH, Edmonson JH (2003) Combination chemotherapy for desmoid tumors. Cancer 97:1134–1135

    Article  PubMed  Google Scholar 

  46. Panicek DM, Gatsonis C, Rosenthal DI et al (1997) CT and MR imaging in the local staging of primary malignant musculoskeletal neoplasms: report of the radiology diagnostic oncology group. Radiology 202:237–246

    CAS  PubMed  Google Scholar 

  47. Petasnick J, Turner D, Charters J, Gitelis Z, Zacharias C (1986) Soft-tissue masses of the locomotor system: comparison of MR imaging with CT. Radiology 160:125–133

    CAS  PubMed  Google Scholar 

  48. Petterson H, Thurman G III, Hamlin D et al (1987) Primary musculoskeletal tumors: examination with MR imaging compared with conventional modalities. Radiology 164:237–241

    PubMed  Google Scholar 

  49. Pisters PWT, Leung DHY, Woodruff J, She W, Brennan MF (1996) Analysis of prognostic factors in 1041 patients with localized soft tissue sarcomas of the extremities. J Clin Oncol 1:1679–1689

    Google Scholar 

  50. Sundaram M, Sharafudding M (1995) MR imaging of benign soft tissue masses. Magn Reson Imaging Clin North Am 3:609–627

    CAS  Google Scholar 

  51. Tacikowska M (2002) Dynamic MR imaging of soft tissue tumors with assessment of the rate and character of lesion enhancement. Med Sci Monit 8:31–35

    Google Scholar 

  52. Teo EL, Strousse PJ, Hernandez RJ (2000) MR imaging differentiation of soft-tissue hemangiomas from malignant soft-tissue masses. Am J Roentgenol 174:1623–1628

    CAS  Google Scholar 

  53. Terrier-Lacombe MJ, Guillou L, Maire G, Terrier P, Vince DR, De Saint Aubain Somerhausen N, Collin F, Pedeutour F, Coindre JM (2003) Dermatofibrosarcoma protuberans, giant cell fibroblastoma, and hybrid lesions in children: clinicopathologic comparative analysis of 28 cases with molecular data. A study from the French Federation of Cancer Centers Sarcoma Group. Am J Surg Pathol 27:27–39

    Article  PubMed  Google Scholar 

  54. Tung G, Davis L (1993) The role of magnetic resonance imaging in the evaluation of soft tissue mass. Crit Rev Diagn Imaging 34:239–308

    CAS  PubMed  Google Scholar 

  55. Ueda T, Aozasa K, Tsujimoto M et al (1989) Prognostic significance of Ki-67 reactivity in soft tissue sarcomas. Cancer 63:1607

    CAS  PubMed  Google Scholar 

  56. Vandevenne JE, De Schepper AM, De Beuckeleer L, Van Marck E, Aparisi F, Bloem JL, Erkorkmaz Z, Brijs S (1997) New concepts in understanding evolution of desmoid tumors: MR imaging of 30 lesions. Eur Radiol 7:1013–1019

    Article  CAS  PubMed  Google Scholar 

  57. Van der Woude HJ, Bloem JL, Schipper J, Hermans J Van Eck-Smit BLF, Van Oostayen J, Taminiau AHM, Holscher HJ, Hogendoorn PCW (1994) Changes of tumor perfusion in bone sarcomas induced by chemotherapy: color Doppler flow imaging and three phase bone scintigraphy. Radiology 191:421–431

    PubMed  Google Scholar 

  58. Van der Woude H, Verstraete K, Taminiau A, Hogendoorn P, Vanzieleghem B, Bloem J (1995) Double slice dynamic contrast-enhanced subtraction MR images in 60 patients with musculoskeleletal tumors or tumorlike lesions. Eur Radiol 5:181

    Google Scholar 

  59. Van Rijswijk CS, Geirnaerdt MJ, Hogendoorn PC et al (2003) Dynamic contrast-enhanced MR imaging in monitoring response to isolated limb perfusion in high-grade soft tissue sarcoma: initial results. Eur Radiol 13:1849–1858

    Article  PubMed  Google Scholar 

  60. Verstraete KL, Vanzieleghem B, De Deene Y, Palmans H, De Greef D, Kristoffersen DT, Uyttendaele D, Roels H, Hamers J, Kunnen M (1995) Static, dynamic and first-pass MR imaging of musculoskeletal lesions using gadodiamide injection. Acta Radiol 36:27–36

    CAS  PubMed  Google Scholar 

  61. Waldt S, Rechl H, Rummeny EJ, Woertler K (2003) Imaging of benign and malignant soft tissue masses of the foot. Eur Radiol 13:1125–1136

    PubMed  Google Scholar 

  62. Weiss SH, Goldblum JR (2001) General considerations. In: Weiss SH, Goldblum JR (eds) Enzinger and Weiss’s soft tissue tumors, 4th edn. Mosby, St Louis, pp 1–19

    Google Scholar 

  63. Wetzel LH, Levine E (1990) Soft-tissue tumors of the foot: value of MR imaging for specific diagnosis. Am J Roentgenol 155:1025–1030

    CAS  Google Scholar 

  64. Wetzel L, Levin E, Murphey M (1987) A comparison of MR imaging and CT in the evaluation of musculoskeletal masses. Radiographics 7:851–874

    CAS  PubMed  Google Scholar 

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Acknowledgments

We would like to thank the coinvestigators of the Belgian Soft Tissue Neoplasm Registry (BSTNR) and the members of the pathological peer review committee. Dr. Patrick Aerts, Jean Alexiou, Michel Baeyaert, Dario Bigattini, Eric Bijnens, Isabel Biltjes, Edith Bleus, Jean Bonnet, Peter Bracke, Stefaan Brijs, Jan Broeckx, Alain Broeders, Peter Brys, Lieve Buyl, Eric Bynens, Ben Caerts, Vincent Caucheteur, Bart Claikens, Clybouw, Ilse Crevits, Bénédicte Daenen, Adelard De Backer, Frank De Belder, Christophe de Bergeyck, Luc De Beuckeleer, Y. De Breuck, Damienne de la Kethulle, Michel De Maeseneer, N. De Saint Aubain, De Surgeloose, Guy De Vriendt, Dimitri De Vuyst, Geert Debakker, Filip Deckers, Hugo Declercq, Hendrik Degryse, Johan Dehem, Piet Dekimpe, Marc Deldinne, Luc Denis, J. Desimpelaere, L. Divano, Julien Djekic, Laurent Dorthu, J. Doyen, P. Flandroy, Jan Fraeyman, Eric Fumiere, Wim Geyskens, Ghijselings, Dirk Ghysen, Grignard, M. Guffens, A. Hacourt, Ester Hauben, Evert Heindryckx, Brat Hughes, Tjeerd Jager, Marie-Anne Labaisse, Anne Lampaert, H. Lauwers, Isabelle Layalle, Marc Lemort, Bart Maes, Menno Maes, Frederic Maisse, Jacques Malghem, Sam Mampaey, Peter Matthijs, Hendrik Mertens, Eva Mortelmans, Lieven Mortelmans, Tom Mulkens, Yolande Nackaerts, Jean-François Nisolle, Jacques Olette, P. Pauwels, Johan Peeters, Dirk Perdieus, Benoït Poucet, Kristof Ramboer, Léon Rausin, Willem Roelandt, Philippe Rosoux, Frederik Rosseel, Rodrigo Salgado, Karlien Schutyzer, Patrick Seynaeve, Maryam Shahabpour, William Simoens, Philip Simons, Dana Smolders, Roel Stappaerts, Rudi Stokmans, Linus Swinnen, Carlo Thywissen, M.R. Timmermans, K. Trap, Luc Van Breuseghem, Marc Van Campenhoudt, B. Van Den Bossche, Luc Van den Hauwe, Pieter Van Dyck, Johan Van Goethem, Filip Van Grimberge, Eddy Van Hedent, Eric Van Marck, R. Van Ratthinge, Walter Van Rompaey, Christian Van Ruyssevelt, Van Tournhoudt, Bruno Vande Berg, Jan Vandevenne, Frederik Vanrietvelde, Bart Vanzieleghem, Johan Vercruysse, Huguette Vereycken, Dieter Verhulst, Frans Vermaut, Koenraad Verstraete, S. Vyt, Jan Willems, C. Ziegels.

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Authors and Affiliations

  1. Department of Radiology and Medical Imaging, University Hospital Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium

    Jan L. M. A. Gielen, Arthur M. De Schepper, Filip Vanhoenacker, Paul M. Parizel & Xiaoling L. Wang

  2. University and university hospital of Louvain, Louvain, Belgium

    Raf Sciot

  3. Department of Epidemiology, University of Antwerp, Edegem, Belgium

    Joost Weyler

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  1. Jan L. M. A. Gielen
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  2. Arthur M. De Schepper
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Correspondence to Jan L. M. A. Gielen.

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Gielen, J.L.M.A., De Schepper, A.M., Vanhoenacker, F. et al. Accuracy of MRI in characterization of soft tissue tumors and tumor-like lesions. A prospective study in 548 patients. Eur Radiol 14, 2320–2330 (2004). https://doi.org/10.1007/s00330-004-2431-0

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