Department of Radiology, University Hospital, LMU Munich, Munich, Germany.
Institute of Neuroradiology, University Hospital, LMU Munich, Munich, Germany.
Skeletal Radiol. 2023 Oct;52(10):1987-1995. doi: 10.1007/s00256-023-04341-4. Epub 2023 May 2.
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.
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 (mean: 39.7 months; mean: 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.
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.
The presence of a PB MRI increases diagnostic confidence in detecting LR of STS of the limb.
评估术后基线（PB）MRI 对检测肢体软组织肉瘤（STS）局部复发（LR）的诊断信心和性能的影响。
共纳入 72 例肢体原发性 STS 患者（8 例 LR，64 例无 LR）。采用 5 分李克特量表，由 3 位独立观察者对多模态治疗后 6 个月和大约 36 个月（平均：39.7 个月；平均：34.9 个月）的常规随访 MRI（1.5 T）以及 LR 时的 MRI 进行评估。此外，还评估了以下影像学参数：肿块的存在、T2 和 T1 加权成像的信号特征、对比增强（CE），以及在某些情况下表观扩散系数（ADC）的信号强度。采用 U 检验、McNemar 检验和 ROC 分析。采用 Fleiss kappa 统计计算观察者间的可靠性。P 值<0.05 被认为具有统计学意义。
存在 PB MRI 可显著提高检测 STS LR 的诊断信心（p<0.001），并略微提高特异性（无 PB MRI 时的平均特异性为 74.1%，存在 PB MRI 时为 81.2%）；但未达到显著水平。肿块的存在显示出最高的诊断性能和最高的观察者间一致性（AUC [%]；κ：73.1-83.6；0.34），其次是 T2 高信号（50.8-66.7；0.08）、CE（52.4-62.5；0.13）和 T1 低信号（54.7-77.3；0.23）。ADC 的 AUC 为 65.6-96.6%，κ 值为 0.55。
存在 PB MRI 可提高检测肢体 STS LR 的诊断信心。
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