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The value of the black fiber sign on T1-weighted images for predicting stability of desmoid fibromatosis managed conservatively

European Radiology volume 30, pages 5768–5776 (2020)Cite this article

Abstract

Objectives

It is challenging to know at the first which patients with desmoid fibromatosis (DF) are better suited to conservative or aggressive treatment. To investigate whether the low signal intensity bundles on T1- or T2-weighted images (WI), termed the “black fiber sign (BFS),” can predict non-progressive behavior in the conservative approach.

Methods

This retrospective study included 59 patients with primary DF managed with wait-and-see approach from 2005 to 2018 and serial MR images were analyzed. Three observers blinded to the patient information verified the presence or absence of BFS on baseline T1 or T2WI. The likelihood of progression-free survival (PFS) after ascertaining the presence or absence of the BFS was estimated using the Kaplan–Meier method and analyzed with the log-rank test.

Results

PFS was significantly higher in cases with BFS than without BFS on T1WI (p < 0.01), but there was no significant difference in PFS between cases with and without BFS on T2WI. Multivariable Cox proportional hazards analysis revealed that the absence of BFS on T1WI was a high-risk factor for progression (hazard ratio, 14.9; p < 0.01). Drastic tumor regression was apparent with significantly increased low-signal area in cases with BFS on T1WI. Intra- and interobserver reliabilities of BFS on T1WI were in almost-perfect agreement (κ > 0.8).

Conclusion

Our retrospective observational data support that presence of BFS in baseline MRI may be a predictor for progression-free survival of DF. BFS on T1WI is easily identifiable and can be utilized clinically in patients with DF.

Key Points

• We proposed a new imaging marker for prediction of desmoid fibromatosis progression.

• The absence of black fiber sign predicted a high risk of disease progression.

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Abbreviations

BFS:

Black fiber sign

CR:

Complete response

DF:

Desmoid fibromatosis

FAP:

Familial adenomatous polyposis

HR:

Hazard ratio

MRI:

Magnetic resonance images

NSAIDs:

Non-steroidal anti-inflammatory drugs

PD:

Progressive disease

PFS:

Progression-free survival

PR:

Partial response

RECIST:

Response Evaluation Criteria in Solid Tumors

ROI:

Region of interest

SD:

Stable disease

WI:

Weighted imaging

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Acknowledgments

We thank M Naka for technical assistance.

Funding

This study has received funding by JSPS KAKENHI Grant Number 17K10974.

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Affiliations

  1. Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan

    Yasutaka Murahashi, Makoto Emori, Junya Shimizu, Ken Anzai & Toshihiko Yamashita

  2. Musculoskeletal Oncology Service, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, Osaka, 541-8567, Japan

    Takaaki Tanaka & Norifumi Naka

  3. Department of Orthopaedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, Akita, 010-8543, Japan

    Hiroyuki Tsuchie, Hiroyuki Nagasawa, Naohisa Miyakoshi & Yoichi Shimada

Authors
  1. Yasutaka Murahashi
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  2. Makoto Emori
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  7. Hiroyuki Tsuchie
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  9. Naohisa Miyakoshi
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  11. Toshihiko Yamashita
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Corresponding author

Correspondence to Yasutaka Murahashi.

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Guarantor

The scientific guarantor of this publication is Toshihiko Yamashita.

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

Hirofumi Ohnishi kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

Methodology

• retrospective

• prognostic study

• multicenter study

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Murahashi, Y., Emori, M., Shimizu, J. et al. The value of the black fiber sign on T1-weighted images for predicting stability of desmoid fibromatosis managed conservatively. Eur Radiol 30, 5768–5776 (2020). https://doi.org/10.1007/s00330-020-06953-z

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  • DOI: https://doi.org/10.1007/s00330-020-06953-z

Keywords

  • Desmoid
  • Magnetic resonance imaging
  • Prognostic factors
  • Observation