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Can we use MRI to detect clinically silent recurrent soft-tissue sarcoma?

  • Musculoskeletal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Purpose

The impact of MRI on early detection of local recurrence (LR) in high-grade soft-tissue sarcomas (STS) is unsubstantiated. To identify the contribution of MRI criteria including dynamic contrast-enhanced (DCE) MRI and knowledge of surgical margins that can be used in detecting recurrence prior to obvious proven presence of LR in soft-tissue sarcomas. The secondary aim was to determine causes for misdiagnosing LR.

Methods

MRI of 23 patients (12 men; mean age, 59.7 years ± 16.5 years) with LR of STS and that of 22 age- and histology-matched controls with STS but without LR were retrospectively analyzed by two musculoskeletal radiologists. Preoperative MRI characteristics (conventional and DCE) were compared to those of MRIs made after treatment, but before LR was proven. Likelihood of recurrence was rated on a 5-point Likert scale for morphological and dynamic assessment separately, before and after adding knowledge of surgical margins. Descriptive statistics and receiver operating characteristic analysis were performed.

Results

Differentiation of LR from post-therapeutic changes was the highest combining result of conventional MRI, DCE-MRI, and knowledge of surgical margins (area under the curve (AUC) 0.779), followed by DCE-MRI (AUC 0.706) and conventional MRI (AUC 0.648). Suboptimal MRI technique and overcalling post-therapeutic changes in microscopic positive margins were the main reasons for false negative and false positive results, respectively.

Conclusion

MRI including DCE improves the detection of recurrent, clinically silent soft-tissue sarcoma when combined with knowledge of achieved surgical margins. LR may be missed on inadequate MRI protocols.

Key Points

• Dynamic contrast-enhanced MRI is useful in the differentiation of recurrent soft-tissue sarcoma and post-therapeutic fibrosis.

• Knowledge of surgical margins substantially increases the value of MRI in detecting recurrent soft-tissue sarcoma.

• MR with all three image orientations, covering the entire part of the extremity in at least one sequence and comparison to initial tumor characteristics and location, is beneficial.

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Abbreviations

AUC:

Area under the curve

DCE:

Dynamic contrast-enhanced

FNCLCC:

Fédération Nationale des Centres de Lutte Contre le Cancer

FS:

Fat-saturated

LR:

Local recurrence

MRI:

Magnetic resonance imaging

ROC:

Receiver operating characteristic

SI:

Signal intensity

STS:

Soft-tissue sarcomas

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Funding

This study received funding from Uniscientia Foundation and Gottfried und Julia Bangerter-Rhyner-Stiftung (received by Anna Hirschmann).

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Author notes

  1. Anna Hirschmann and Veroniek M. van Praag contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands

    Anna Hirschmann & Johan L. Bloem

  2. Clinic of Radiology and Nuclear Medicine, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland

    Anna Hirschmann

  3. Department of Orthopedics, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands

    Veroniek M. van Praag & Michiel A. J. van de Sande

  4. Department of Radiotherapy, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands

    Rick L. Haas

  5. Department of Radiation Oncology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands

    Rick L. Haas

Authors
  1. Anna Hirschmann
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  2. Veroniek M. van Praag
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  4. Michiel A. J. van de Sande
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  5. Johan L. Bloem
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Corresponding author

Correspondence to Anna Hirschmann.

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The scientific guarantor of this publication is J.L. Bloem.

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The authors declare that they have no conflict of interest.

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One of the authors has significant statistical expertise.

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Written informed consent was waived by the institutional review board.

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• Retrospective

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• Multicenter study

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Hirschmann, A., van Praag, V.M., Haas, R.L. et al. Can we use MRI to detect clinically silent recurrent soft-tissue sarcoma?. Eur Radiol 30, 4724–4733 (2020). https://doi.org/10.1007/s00330-020-06810-z

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  • DOI: https://doi.org/10.1007/s00330-020-06810-z

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