Wortman Jeremy R, Tirumani Sree Harsha, Tirumani Harika, Shinagare Atul B, Jagannathan Jyothi P, Hornick Jason L, Ramaiya Nikhil H
Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA.
Eur Radiol. 2016 May;26(5):1226-34. doi: 10.1007/s00330-015-3953-3. Epub 2015 Aug 28.
To evaluate MRI features of response of primary extremity liposarcoma (LPS) to neoadjuvant radiation therapy (RT) with histopathologic correlation.
In this IRB-approved study including 125 patients with extremity LPS treated with neoadjuvant RT from 2000 to 2013, MRI of the primary tumour in 18 patients (5 pleomorphic LPS, 13 myxoid LPS) before and after RT were reviewed by two radiologists by consensus. Histopathology of the surgical specimens was reviewed by a pathologist with expertise in sarcomas.
In the pleomorphic LPS cohort, 3/5 tumours increased in size; 3/5 decreased in enhancing component; and 3/5 increased in peritumoral oedema, intratumoral haemorrhage, and necrosis. In the myxoid LPS cohort, 12/13 tumours decreased in size, 8/13 decreased in enhancing component, and 5/13 increased in internal fat following RT. Histopathology showed ≥50% residual tumour in 1/5 pleomorphic LPS and 2/13 myxoid LPS. Hyalinization/necrosis of ≥75% was noted in 4/5 pleomorphic LPS and 11/13 myxoid LPS. Cytodifferentiation was noted in 1/5 pleomorphic and 9/13 myxoid LPS.
While pleomorphic LPS showed an increase in size, peritumoral oedema, intratumoral haemorrhage, and necrosis on MRI following neoadjuvant RT, myxoid LPS showed a decrease in size and enhancement with an increase in internal fat.
• Pleomorphic LPS commonly increase in size and necrosis on MRI following RT. • Myxoid LPS commonly decrease in size and enhancement on MRI following RT. • Myxoid LPS often increase in fatty component on MRI following RT.
通过组织病理学相关性评估原发性肢体脂肪肉瘤（LPS）对新辅助放射治疗（RT）反应的MRI特征。
在这项经机构审查委员会批准的研究中，纳入了2000年至2013年接受新辅助RT治疗的125例肢体LPS患者，由两名放射科医生共同对18例患者（5例多形性LPS，13例黏液样LPS）放疗前后的原发性肿瘤MRI进行回顾。手术标本的组织病理学由一名肉瘤专家病理学家进行审查。
在多形性LPS队列中，3/5的肿瘤体积增大；3/5的强化成分减少；3/5的瘤周水肿、瘤内出血和坏死增加。在黏液样LPS队列中，12/13的肿瘤体积减小，8/13的强化成分减少，5/13的内部脂肪在放疗后增加。组织病理学显示，1/5的多形性LPS和2/13的黏液样LPS存在≥50%的残留肿瘤。4/5的多形性LPS和11/13的黏液样LPS出现≥75%的玻璃样变/坏死。1/5的多形性LPS和9/13的黏液样LPS出现细胞分化。
新辅助RT后，多形性LPS在MRI上表现为体积增大、瘤周水肿、瘤内出血和坏死，而黏液样LPS表现为体积减小、强化减弱及内部脂肪增加。
• 多形性LPS放疗后MRI上通常体积增大且坏死。• 黏液样LPS放疗后MRI上通常体积减小且强化减弱。• 黏液样LPS放疗后MRI上脂肪成分常增加。
