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. 2015 Jul-Sep;25(3):269-75.
doi: 10.4103/0971-3026.161452.

Evaluation of static and dynamic MRI for assessing response of bone sarcomas to preoperative chemotherapy: Correlation with histological necrosis

Priyadarshi Amit  1 , Atul Malhotra  2 , Rahul Kumar  2 , Lokesh Kumar  3 , Dilip Kumar Patro  4 , Sundar Elangovan  5
Affiliations

Evaluation of static and dynamic MRI for assessing response of bone sarcomas to preoperative chemotherapy: Correlation with histological necrosis

Priyadarshi Amit et al. Indian J Radiol Imaging. 2015 Jul-Sep.

Abstract

Objectives: Preoperative chemotherapy plays a key role in management of bone sarcomas. Postoperative evaluation of histological necrosis has been the gold standard method of assessing response to preoperative chemotherapy. This study was done to evaluate the efficacy of static and dynamic magnetic resonance imaging (MRI) for assessing response preoperatively.

Materials and methods: Our study included 14 patients (12 osteosarcomas and 2 malignant fibrous histiocytomas) with mean age of 21.8 years, treated with preoperative chemotherapy followed by surgery. They were evaluated with static and dynamic MRI twice, before starting chemotherapy and again prior to surgery. Change in tumor volume and slope of signal intensity - time curve were calculated and correlated with percentage of histological necrosis using Pearson correlation test.

Results: The change in dynamic MRI slope was significant (P = 0.001). Also, ≥60% reduction in slope of the curve proved to be an indicator of good histological response [positive predictive value (PPV) =80%]. Change in tumor volume failed to show significant correlation (P = 0.071). Although it showed high negative predictive value (NPV = 85.7%), PPV was too low (PPV = 57.14%).

Conclusions: Dynamic MRI correctly predicts histological necrosis after administration of preoperative chemotherapy to bone sarcomas. Hence, it can be used as a preoperative indicator of response to neoadjuvant chemotherapy. On the other hand, volumetric assessment by static MRI is not an effective predictor of histological necrosis. This study proves the superiority of dynamic contrast-enhanced study over volumetric study by MRI.

Keywords: Dynamic MR; MR; histological necrosis; malignant fibrous histiocytoma; osteosarcoma; preoperative chemotherapy.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Correlation of tumor volume change with histological necrosis
Figure 2
Figure 2
(A and B): (A) Pre-chemotherapy dynamic MR image of osteosarcoma of distal femur in a 15-year-old girl showing greater enhancement (B) Post-chemotherapy dynamic MR image showing reduced enhancement following chemotherapy
Figure 3 (A and B)
Figure 3 (A and B)
(A) Pre-chemotherapy signal intensity–time curve [signal intensity on the x-axis and time (minute) on the y-axis] showing dynamic MRI slope value of 67.09% (B) Post-chemotherapy signal intensity–time curve [signal intensity on the x-axis and time (minute) on the y-axis] showing dynamic MRI slope value of 34.13% (49.13% reduction in slope value following chemotherapy)
Figure 4 (A and B)
Figure 4 (A and B)
(A) Pre-chemotherapy dynamic MR image of telangiectatic osteosarcoma of proximal tibia in a 15-year-old boy showing greater enhancement (B) Post-chemotherapy dynamic MR image showing reduced enhancement following chemotherapy
Figure 5 (A and B)
Figure 5 (A and B)
(A) Pre-chemotherapy signal intensity–time curve [signal intensity on the x-axis and time (minute) on the y-axis] showing dynamic MRI slope value of 36.7% (B) Post-chemotherapy signal intensity–time curve [signal intensity on the x-axis and time (minute) on the y-axis] showing dynamic MRI slope value of 21.9% (40.3% reduction in slope value following chemotherapy)
Figure 6
Figure 6
Correlation of change in dynamic MRI slope with histological necrosis
See this image and copyright information in PMC

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