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Multiparametric MRI for the Assessment of Treatment Effect and Tumor Recurrence in Soft-tissue Sarcoma of the Extremities
Raul F Valenzuela*, Behrang Amini, Elvis Duran-Sierra, MA Canjirathinkal, John E Madewell, Colleen M Costelloe and William A Murphy
Published: 20 September, 2023 | Volume 7 - Issue 3 | Pages: 058-065
Soft-tissue sarcomas are a rare and complex group of malignant tumors. Advanced MRI sequences such as diffusion-weighted imaging (DWI) and perfusion-weighted imaging/dynamic contrast enhancement (PWI/DCE) can provide valuable tumor characterization and treatment response assessment. In the case of archetypical cellular tumors such as Pleomorphic Undifferentiated sarcoma (UPS), Good responders often display right-side displacement of the ADC intensity histogram, resulting in increased ADC-mean and decreased kurtosis and Skewness compared with Baseline and poor responders’ more left-sided curve. The PWI/DCE pattern most often associated with a good response is the presence of a “capsular-like” enhancement and a TIC type 2. Sarcoma hemorrhage patterns on SWI emerge during treatment, including “interstitial,” globular,” “luminal,” and incomplete and complete “peripheral ring-like” tumor wall hemosiderin impregnation. Treatment-induced bleeding is typically associated with low SWI-mean values and a left-sided intensity histogram with positive Skewness.
During post-surgical surveillance, DCE MR imaging can reliably distinguish recurrent sarcoma from post-surgical scarring. TICs III, IV, and V raise the suspicion of local tumor recurrence, while TIC type II usually represents benign post-operative change such as granulation tissue. Advanced MRI is an essential tool for assessing sarcomas during and after therapy.
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DOI: 10.29328/journal.jro.1001055
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Keywords:
Soft-Tissue Sarcoma (STS); Multiparametric MRI; Treatment Induced Necrosis (TIN); Susceptibility-Imaging (SWI); Perfusion-Imaging (PWI); Diffusion-Imaging (DWI)
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