High-grade soft-tissue sarcoma: optimizing injection improves MRI evaluation of tumor response
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To determine the acquisition delay after gadolinium-chelate injection that optimizes the prediction of the histological response during anthracycline-based neoadjuvant chemotherapy (NAC) for locally advanced high-grade soft-tissue sarcomas (STS).
Thirty patients (mean age 62 years) were included in this IRB-approved study. All patients received 5-6 cycles of NAC followed by surgery. A good response was defined as ≤ 10% viable cells on histological analysis of the surgical specimen. DCE-MRI was performed before treatment (MRI0) and after two cycles (MRI1). Images were obtained every 8 s. Change in contrast enhancement (CE) between MRI0 and MRI1 was calculated for each acquisition delay ‘t’ on the whole tumor volume. Area under the receiver-operating characteristics curves (AUROC) for change in CE was calculated at each acquisition delay, as well as the accuracy of the Choi criteria.
There were 22 (73.3%) poor responders. Acquisition delay had a significant effect on change in CE and on the response status according to Choi (p = 0.0014 and 0.0270, respectively). The highest AUROC was obtained at t = 58 s (0.792) with an optimal threshold of a -30.5% decrease in CE. At t = 58 s, accuracy to predict a poor response was 82.8% above this threshold, while it was 72.4% and 70% with no objective response according to the Choi criteria and RECIST1.1, respectively.
Optimization of acquisition delay after injection to estimate change in CE improves the prediction of histological response. For STS undergoing NAC, a 60-s delay can be recommended with MRI.
• Accuracy of response criteria based on contrast enhancement, like the Choi criteria, is dependent on the acquisition delay after gadolinium-chelate injection.
• DCE-MRI helps determine the optimal acquisition delay after gadolinium-chelate injection for improving evaluation of tumor response.
• In soft tissue sarcoma, an acquisition delay at 60 s optimizes the evaluation of the response and accuracy of the Choi criteria.
KeywordsResponse evaluation criteria in solid tumors Sarcoma Magnetic resonance imaging Chemotherapy
Apparent diffusion coefficient
Area under the ROC curve
95% confidence interval
European Organization for Research and Treatment of Cancer
Fédération Nationale des Centres de Lutte contre le Cancer
Good histological responder
Magnetic resonance imaging
Negative predictive value
Poor histological responder
Predictive positive value
Response evaluation criteria in solid tumors
Turbo spin echo
The authors state that this work has not received any funding.
Compliance with ethical standards
The scientific guarantor of this publication is Dr. Xavier Buy (interventional radiologist, head of the Department of Radiology of Institut Bergonié, comprehensive cancer center of Bordeaux, France, email@example.com).
Conflict of interest
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.
Statistics and biometry
No complex statistical method was necessary for this paper. Statistical analysis was performed by A. Crombe, a PhD student in applied mathematics at the Institut de Mathématiques de Bordeaux (MOnc Team, INRIA Bordeaux Sud-Ouest CNRS UMR 5251).
Written informed consent was waived by the Institutional Review Board.
Institutional Review Board approval was obtained.
• diagnostic or prognostic study
• performed at one institution
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