From the Shandong Medical Imaging Research Institute, Shandong University, Jinan, Shandong, China (F.Z.); and Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Medical Institutions, 601 N Caroline St, Baltimore, MD 21287 (S.A., S.J.F., K.L.W., E.A.M., J.A.C., L.M.F.).
Radiology. 2014 Jul;272(1):192-201. doi: 10.1148/radiol.14131871. Epub 2014 Mar 8.
To identify the magnetic resonance (MR) imaging features that can be used to differentiate high-grade from low-grade soft-tissue sarcoma (STS).
Institutional review board approval was obtained, and informed consent was waived. Patients with STS who had undergone MR imaging with T1-weighted, T2-weighted, and contrast material-enhanced sequences prior to neoadjuvant therapy and surgery were included retrospectively. Tumor grade (grades 1-3) was recorded from the histologic specimen for each STS. Images were evaluated by two observers for tumor size and MR features (signal intensity, heterogeneity, margin, and perilesional characteristics) on images obtained with each sequence. Descriptive statistics for low-grade (grade 1) and high-grade (grades 2 and 3) STS were recorded, and the accuracy of individual features was determined. A multivariate logistic regression model was developed to identify features that were independently predictive of a high-grade tumor.
Ninety-five patients (48 female [mean age, 55.8 years; age range, 7-96 years] and 47 male [mean age, 55.3 years; age range, 1-87 years]) with STS (16 patients with grade 1 STS, 34 patients with grade 2 STS, and 45 patients with grade 3 STS) were included. High-grade STS differed from low-grade STS in size (>5 cm, P = .004), tumor margin (partly or poorly defined margin on T1-weighted images, P = .002; with other sequences, P < .001), internal signal intensity composition (heterogeneous signal intensity on T2-weighted images, P = .009), and peritumoral characteristics (peritumoral high signal intensity on T2-weighted images, P = .025; peritumoral enhancement on contrast-enhanced T1-weighted images, P < .001). The logistic regression model showed that peritumoral contrast enhancement is the strongest independent indicator of high-grade status (odds ratio, 13.6; 95% confidence interval: 2.9, 64.6).
Among several MR imaging features that aid in the discrimination of high-grade from low-grade sarcomas, the presence of peritumoral contrast enhancement is a feature that may be solely used to diagnose high-grade STS.
确定磁共振成像（MR）特征，用于区分高级别和低级别软组织肉瘤（STS）。
本研究经机构审查委员会批准，豁免了患者知情同意。回顾性分析了接受新辅助治疗和手术前进行 MR 成像（T1 加权、T2 加权和对比增强序列）的 STS 患者。每例 STS 的组织学标本均记录肿瘤分级（1-3 级）。由两位观察者评估每个序列的图像，记录肿瘤大小和 MR 特征（信号强度、异质性、边缘和瘤周特征）。记录低级别（1 级）和高级别（2 级和 3 级）STS 的描述性统计数据，并确定各特征的准确性。建立多变量逻辑回归模型，以确定可独立预测高级别肿瘤的特征。
95 例患者（48 例女性[平均年龄 55.8 岁；年龄范围 7-96 岁]和 47 例男性[平均年龄 55.3 岁；年龄范围 1-87 岁]）患有 STS（16 例 1 级 STS，34 例 2 级 STS，45 例 3 级 STS）。高级别 STS 与低级别 STS 相比，肿瘤大小更大（>5cm，P=0.004），肿瘤边缘更不规则（T1 加权图像上部分或边界不清，P=0.002；其他序列上，P<0.001），内部信号强度组成更不均匀（T2 加权图像上信号强度不均匀，P=0.009），瘤周特征更明显（T2 加权图像上瘤周高信号强度，P=0.025；对比增强 T1 加权图像上瘤周强化，P<0.001）。逻辑回归模型显示，瘤周对比增强是高级别状态的最强独立指标（比值比，13.6；95%置信区间：2.9，64.6）。
在有助于区分高级别和低级别肉瘤的多种 MR 成像特征中，瘤周对比增强的存在可能是诊断高级别 STS 的唯一特征。
