Abstract
Objectives
This study was conducted to evaluate the added value of diffusion-weighted imaging (DWI) to conventional magnetic resonance imaging (MRI) for predicting fascial involvement of soft tissue sarcomas located in close proximity to fascial boundaries.
Methods
This retrospective study included 29 patients with surgically resected soft tissue sarcomas located in proximity to deep fascia and with a curvilinear tail-like hyperintensity in the adjacent fascia on T2-weighted images. All patients underwent conventional MRI and DWI at 3.0 T and had detailed histologic reports on involvement of fascia. Two musculoskeletal radiologists with 21 and 1 year of experience independently reviewed conventional MRI and conventional imaging with added DWI. Readers scored their confidence for tumor involvement of fascia using a three-point scale. Diagnostic performance (area under the curve [Az]) of the two MRI sets was assessed with receiver-operating characteristic curve analysis.
Result
Fascial involvement was present in 22/29 patients (75.9%). Both readers showed improvement in diagnostic performance with the addition of DWI (Az, from 0.545 to 0.792 and from 0.646 to 0.792 for reader 1 and reader 2, respectively). Adding DWI did not improve sensitivity or specificity for either reader (p > 0.05). Interobserver agreement for the confidence scores improved from fair to moderate with the addition of DWI (κ, from 0.390 to 0.560).
Conclusions
Adding DWI to conventional MRI improved diagnostic performance on prediction of fascial involvement of soft tissue sarcomas located in proximity to fascia, without significant improvement in sensitivity or specificity.
Key Points
• Adding DWI to conventional MRI improved readers’ confidence level for the prediction of fascial involvement of soft tissue sarcomas that are close to the deep fascia.
• Addition of DWI also improved interobserver agreement.
• Conversely, compared with conventional MRI, adding DWI did not significantly improve the sensitivity or specificity for the detection of fascial involvement.
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Abbreviations
- ADC:
-
Apparent diffusion coefficient
- DWI:
-
Diffusion-weighted imaging
- MPNST:
-
Malignant peripheral nerve sheath tumor
- MRI:
-
Magnetic resonance imaging
- NPV:
-
Negative predictive value
- PPV:
-
Positive predictive value
- ROC:
-
Receiver-operating characteristic
- UPS:
-
Undifferentiated pleomorphic sarcoma
References
Jo VY, Fletcher CD (2014) WHO classification of soft tissue tumours: an update based on the 2013 (4th) edition. Pathology 46:95–104
Ahmad R, Jacobson A, Hornicek F et al (2016) The width of the surgical margin does not influence outcomes in extremity and truncal soft tissue sarcoma treated with radiotherapy. Oncologist 21:1269–1276
Robinson E, Bleakney RR, Ferguson PC, O’Sullivan B (2008) Oncodiagnosis panel: 2007: multidisciplinary management of soft-tissue sarcoma. Radiographics 28:2069–2086
O’Donnell PW, Manivel JC, Cheng EY, Clohisy DR (2014) Chemotherapy influences the pseudocapsule composition in soft tissue sarcoma. Clin Orthop Relat Res 472:849–855
Grabellus F, Podleska LE, Sheu SY et al (2013) Neoadjuvant treatment improves capsular integrity and the width of the fibrous capsule of high-grade soft-tissue sarcomas. Eur J Surg Oncol 39:61–67
Chenevert TL, Brunberg JA, Pipe JG (1990) Anisotropic diffusion in human white matter: demonstration with MR techniques in vivo. Radiology 177:401–405
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
Moore WA, Khatri G, Madhuranthakam AJ, Sims RD, Pedrosa I (2014) Added value of diffusion-weighted acquisitions in MRI of the abdomen and pelvis. AJR Am J Roentgenol 202:995–1006
Dwyer AJ (1991) Matchmaking and McNemar in the comparison of diagnostic modalities. Radiology 178:328–330
Cohen J (1968) Weighted kappa: nominal scale agreement with provision for scaled disagreement or partial credit. Psychol Bull 70:213–220
Amin MB, Edge S, Greene F et al (2017) AJCC cancer staging manual, 8th edn. Springer, Berlin
Noebauer-Huhmann IM, Weber MA, Lalam RK et al (2015) Soft tissue tumors in adults: ESSR-approved guidelines for diagnostic imaging. Semin Musculoskelet Radiol 19:475–482
Enneking WF, Spanier SS, Malawer MM (1981) The effect of the anatomic setting on the results of surgical procedures for soft parts sarcoma of the thigh. Cancer 47:1005–1022
Tanabe KK, Pollock RE, Ellis LM, Murphy A, Sherman N, Romsdahl MM (1994) Influence of surgical margins on outcome in patients with preoperatively irradiated extremity soft tissue sarcomas. Cancer 73:1652–1659
Lee SY, Jee WH, Jung JY et al (2016) Differentiation of malignant from benign soft tissue tumours: use of additive qualitative and quantitative diffusion-weighted MR imaging to standard MR imaging at 3.0 T. Eur Radiol 26:743–754
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
Koh DM, Collins DJ (2007) Diffusion-weighted MRI in the body: applications and challenges in oncology. AJR Am J Roentgenol 188:1622–1635
Fernebro J (2007) Soft tissue sarcoma patterns multiplicity, heterogeneity and growth characteristics. Department of Clinical Sciences, Lund University, Lund
Weiss SW, Enzinger FM (1978) Malignant fibrous histiocytoma: an analysis of 200 cases. Cancer 41:2250–2266
Yoo HJ, Hong SH, Kang Y et al (2014) MR imaging of myxofibrosarcoma and undifferentiated sarcoma with emphasis on tail sign; diagnostic and prognostic value. Eur Radiol 24:1749–1757
Kaya M, Wada T, Nagoya S et al (2008) MRI and histological evaluation of the infiltrative growth pattern of myxofibrosarcoma. Skeletal Radiol 37:1085–1090
Lefkowitz RA, Landa J, Hwang S et al (2013) Myxofibrosarcoma: prevalence and diagnostic value of the “tail sign” on magnetic resonance imaging. Skeletal Radiol 42:809–818
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The scientific guarantor of this publication is Hye Won Chung.
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Methodology
• Retrospective
• Diagnostic or prognostic study
• Performed at one institution
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Yoon, M.A., Chee, C.G., Chung, H.W. et al. Added value of diffusion-weighted imaging to conventional MRI for predicting fascial involvement of soft tissue sarcomas. Eur Radiol 29, 1863–1873 (2019). https://doi.org/10.1007/s00330-018-5786-3
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DOI: https://doi.org/10.1007/s00330-018-5786-3