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. 2023 Oct;52(10):1987-1995.
doi: 10.1007/s00256-023-04341-4. Epub 2023 May 2.

Impact of postoperative baseline MRI on diagnostic confidence and performance in detecting local recurrence of soft-tissue sarcoma of the limb

Sophia Samira Goller  1 , Paul Reidler  2 , Jan Rudolph  2 , Johannes Rückel  3 , Nina Hesse  2 , Vanessa Franziska Schmidt  2 , Hans Roland Dürr  4 , Alexander Klein  4 , Lars Hartwin Lindner  5 , Dorit Di Gioia  5 , Isabella Kuhn  4 , Jens Ricke  2 , Bernd Erber  2
Affiliations

Impact of postoperative baseline MRI on diagnostic confidence and performance in detecting local recurrence of soft-tissue sarcoma of the limb

Sophia Samira Goller et al. Skeletal Radiol. 2023 Oct.

Abstract

Objective: To evaluate the impact of a postoperative baseline (PB) MRI on diagnostic confidence and performance in detecting local recurrence (LR) of soft-tissue sarcoma (STS) of the limb.

Materials and methods: A total of 72 patients (8 with LR, 64 without LR) with primary STS of the limb were included. Routine follow-up MRI (1.5 T) at 6 and approximately 36 months (meanLR: 39.7 months; meanno LR: 34.9 months) after multimodal therapy or at time of LR were assessed by three independent readers using a 5-point Likert scale. Furthermore, the following imaging parameters were evaluated: presence of a mass, signal characteristics at T2- and T1-weighted imaging, contrast enhancement (CE), and in some of the cases signal intensity on the apparent diffusion coefficient (ADC). U-test, McNemar test, and ROC-analysis were applied. Interobserver reliability was calculated using Fleiss kappa statistics. A p value of 0.05 was considered statistically significant.

Results: The presence of a PB MRI significantly improved diagnostic confidence in detecting LR of STS (p < 0.001) and slightly increased specificity (mean specificity without PE 74.1% and with presence of PB MRI 81.2%); however, not to a significant level. The presence of a mass showed highest diagnostic performance and highest interreader agreement (AUC [%]; κ: 73.1-83.6; 0.34) followed by T2-hyperintensity (50.8-66.7; 0.08), CE (52.4-62.5; 0.13), and T1-hypointensity (54.7-77.3; 0.23). ADC showed an AUC of 65.6-96.6% and a κ of 0.55.

Conclusion: The presence of a PB MRI increases diagnostic confidence in detecting LR of STS of the limb.

Keywords: Local recurrence; Magnetic resonance imaging; Postoperative baseline MRI; Soft-tissue sarcoma.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Patient example without LR in synovial sarcoma of the right thigh after multimodal therapy. Images of a 45-year-old female patient six (a–c) and 31 months (d–f) after multimodal therapy for a synovial sarcoma of the right thigh without signs of LR in further follow-up. a T2-weighted image shows slight diffuse increased signal intensity in the area of resection (arrow) while slight T1-hypointensity in subcutaneous fat was evaluated (b). Also, marked diffuse contrast uptake is shown in the area of resection (c). In a T2-weighted image 36 months after therapy (d), slight diffuse edema is present, while marked contrast uptake (arrow) in the area of resection is present (f). Minimal T1-hypointensity was detected in the area of resection (e)
Fig. 2
Fig. 2
Patient example with LR in synovial sarcoma of the left hip after multimodal therapy. Images of a 62-year-old female patient six (a–c) and 37 months (d–f) after multimodal therapy for a synovial sarcoma of the left hip with histologically proven LR. a T2-weighted image shows slight diffuse increased signal intensity in the area of resection (arrow), while slight T1-hypointensity was evaluated (b). Also, slight diffuse contrast uptake is shown in the area of resection (c). Imaging 37 months after therapy revealed a mass. A nodular-shaped T2-hyperintensity (d), T1-hypointensity (e), and contrast uptake were evaluated (arrows) (f)
Fig. 3
Fig. 3
Diagnostic confidence. Barplots showing mean ratings of Likert scale for the readers for evaluation of MRI 36 months after multimodal therapy for STS without and with availability of a PB MRI. Differences were significant for all readers
Fig. 4
Fig. 4
Diagnostic performance of imaging characteristics. AUCs with confidence intervals (in brackets) for all imaging characteristics for each reader: Presence of a mass in all sequences, increased signal intensity in T2-weighted sequences, reduced signal intensity in T1-weighted sequences, enhanced uptake of contrast in T1-weighted fat saturated images, and signal intensity in ADC sequences
Fig. 5
Fig. 5
Progression of imaging characteristics. Line plots showing the frequency of the presence of each imaging sign at 6-month follow-up and at 36 months and the time of local recurrence of STS
See this image and copyright information in PMC

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