European Radiology

, Volume 29, Issue 5, pp 2589–2597 | Cite as

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

  • Ji Hyun Hong
  • Won-Hee JeeEmail author
  • Chan-Kwon Jung
  • Joon-Yong Jung
  • Seung Han Shin
  • Yang-Guk Chung



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.


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).


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.


MRI Diffusion Sarcoma Neoplasm staging 



Apparent diffusion coefficient


Diffusion-weighted imaging



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

Compliance with ethical standards


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.


• retrospective

• diagnostic or prognostic study

• performed at one institution


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Department of Radiology, Seoul St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaSeoulSouth Korea
  2. 2.Department of Radiology, Kangdong Seong-Sim Hospital, College of MedicineHallym UniversitySeoulSouth Korea
  3. 3.Department of Pathology, Seoul St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaSeoulSouth Korea
  4. 4.Orthopedic Surgery, Seoul St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaSeoulSouth Korea

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