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. 2024 Jul 23;12(8):1640.
doi: 10.3390/biomedicines12081640.

Beyond Clinical Examination: Utilizing MRI Surveillance to Detect Recurrence of Soft Tissue Sarcomas and Differentiate from Posttherapeutic Changes

Felix R M Koenig  1 , Alfred H Kielburg  1 , Snehansh Roy Chaudhary  2 , Christian Wassipaul  1 , Akash Ganguly  3 , Raoul Varga  1 , Martin L Watzenboeck  1 , Iris-Melanie Noebauer-Huhmann  1
Affiliations

Beyond Clinical Examination: Utilizing MRI Surveillance to Detect Recurrence of Soft Tissue Sarcomas and Differentiate from Posttherapeutic Changes

Felix R M Koenig et al. Biomedicines. .

Abstract

Background: Early detection of soft tissue sarcoma (STS) recurrence is essential; however, the role and timeline of Magnetic resonance imaging (MRI) surveillance are still under debate. The aim of this study was to determine whether local recurrence (LR) could be identified via clinical examination alone and to assess the MRI morphology of primary STS and LR.

Methods: This retrospective study included all patients with STS recurrence after surveillance for at least five years from the tumor database of the Medical University of Vienna from 2000 until December 2023. The characteristics of primary STS and LR and the time interval to recurrence and clinical detectability were assessed. The MRIs of LR and posttherapeutic changes (PTC) were compared with the initial MRIs.

Results: A total of 57 patients (60% male; mean age 58.5 ± 18.0 years) with STS and histologically confirmed LR were included. The mean time interval to LR was 2.3 ± 1.8 years (range 108 to 3037 days). The clinically detectable recurrences were significantly larger than the inapparent ones (71.9 cm3 vs. 7.0 cm3; p < 0.01). The MRI morphology of all LRs (26/26) closely resembled the initial STS. For comparison, nine patients were included with clinically suspected LRs, which were histologically proven to be PTC. None of these resembled the primary STS.

Conclusion: Based on clinical symptoms alone, especially small and early recurrences can be missed, which supports the importance of MRI surveillance.

Keywords: locoregional neoplasm recurrence; magnetic resonance imaging; sarcoma; soft tissue neoplasms; surveillance.

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Conflict of interest statement

The Department of Biomedical Imaging and Image-guided Therapy of Medical University of Vienna has grants/grants pending and contracts with more than 100 partners (organizational, academic, industry), independent of this study and all through official contracts with the Medical University of Vienna. However, this study has not received any funding. Felix R. M. Koenig—nothing to disclose. Alfred H. Kielburg—nothing to disclose. Snehansh Roy Chaudhary—nothing to disclose. Akash Ganguly—nothing to disclose. Christian Wassipaul—nothing to disclose. Raoul Varga—nothing to disclose. Martin L. Watzenboeck—nothing to disclose. Iris-M. Noebauer-Huhmann—nothing to disclose.

Figures

Figure 1
Figure 1
This flowchart depicts the patient selection process for this retrospective study on STS, detailing the inclusion of patients with histologically verified LR and PTC; LR, Local Recurrence; PTC, Posttherapeutic Changes.
Figure 2
Figure 2
Clinical detectability and volume of LR. Significant difference in mean volume of clinically detectable (71.9 cm3) and not clinically detectable LR (7.0 cm3). LR, Local Recurrence. * indicates that the result is significant with a p-value of less than 0.01.3.3. Period between Primary STS and LR.
Figure 3
Figure 3
Recurrence-free survival: 50% of LR happened within 2.02 years; the last LR took place after 8.5 years.
Figure 4
Figure 4
Histologically verified STS showing the same T1-weighted (w) signal intensity, T2-weighted signal intensity, homogeneity, and contrast enhancement as the histologically verified LR that occurred during the course of the disease. Using these four features allows MR tomographic differentiation of LR and PTC. A newly occurring hematoma can be distinguished from an LR on the basis of the different contrast agent uptake and on the basis of the different homogeneity. (A) STS, from left to right: HASTE coronal, T2w axial, KM flooding of the primary tumor; (B) LR and HA, from left to right: T1 fat suppression post contrast coronal, upper row: LR: T2w axial, subtraction of the LR; lower row: T2w axial, subtraction of the HA. HA, hematoma; LR, local recurrence; STS, soft tissue sarcoma.
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