Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany.
Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany.
Eur J Radiol. 2024 Aug;177:111548. doi: 10.1016/j.ejrad.2024.111548. Epub 2024 Jun 3.
Systematic reviews on the grading of STS using MRI are lacking. This review analyses the role of different MRI features in inferring the histological grade of STS.
A systematic review was conducted and is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) checklist. The electronic databases of PubMed/MEDLINE were systematically searched for literature addressing the correlation of MRI findings in soft tissue sarcoma with tumor grade. As keywords "MRI", "magnetic resonance imaging", "sarcoma", "grade", "grading", and "FNCLCC" have been selected.
14 studies have been included in this systematic review. Tumor size (p = 0.015 (51 patients) to p = 0.81 (36 patients)), tumor margin (p < 0.001 (95 patients) to 0.93 (36 patients)), necrosis (p = 0.004 (50 patients) to p = 0.65 (95 patients)), peritumoral edema (p = 0.002 (130 patients) to p = 0.337 (40 patients)), contrast enhancement (p < 0.01 (50 patients) to 0.019 (51 patients)) and polycyclic/multilobulated tumor configuration (p = 0.008 (71 patients)) were significantly associated with STS malignancy grade in most of the included studies. Heterogeneity in T2w images (p = 0.003 (130 patients) to 0.202 (40 patients)), signal intensity in T1w images/ hemorrhage (p = 0.02 (130 patients) to 0.5 (31 patients)), peritumoral contrast enhancement (p < 0.001 (95 patients) to 0.253 (51 patients)) and tumoral diffusion restriction (p = 0.01 (51 patients) to 0.53 (52 patients)) were regarded as significantly associated with FNCLCC grade in some of the studies which investigated these features. Most other MRI features were not significant.
Several MRI features, such as tumor size, necrosis, peritumoral edema, peritumoral contrast enhancement, intratumoral contrast enhancement, and polycyclic/multilobulated tumor configuration may indicate the malignancy grade of STS. However, further studies are needed to gain consensus.
目前缺乏使用 MRI 对 STS 进行分级的系统评价。本研究分析了不同 MRI 特征在推断 STS 组织学分级中的作用。
系统检索了 PubMed/MEDLINE 电子数据库中有关软组织肉瘤 MRI 表现与肿瘤分级相关性的文献，并按照系统评价和荟萃分析的 Preferred Reporting Items（PRISMA）清单进行报告。选择了“MRI”、“磁共振成像”、“肉瘤”、“分级”、“grading”和“FNCLCC”作为关键词。
本系统评价纳入了 14 项研究。肿瘤大小（51 例患者中 p=0.015 至 p=0.81，36 例患者）、肿瘤边界（95 例患者中 p<0.001 至 p=0.93，36 例患者）、坏死（50 例患者中 p=0.004 至 p=0.65，95 例患者）、肿瘤周围水肿（130 例患者中 p=0.002 至 p=0.337，40 例患者）、对比增强（50 例患者中 p<0.01 至 p=0.019，51 例患者）和多形性/多叶状肿瘤形态（71 例患者中 p=0.008）与 STS 恶性程度分级显著相关。在大多数纳入的研究中，T2w 图像的异质性（130 例患者中 p=0.003 至 p=0.202，40 例患者）、T1w 图像/出血的信号强度（130 例患者中 p=0.02 至 p=0.5，31 例患者）、肿瘤周围对比增强（95 例患者中 p<0.001 至 p=0.253，51 例患者）和肿瘤弥散受限（51 例患者中 p=0.01 至 p=0.53，52 例患者）与 FNCLCC 分级显著相关。其他一些 MRI 特征则没有显著意义。
多项 MRI 特征，如肿瘤大小、坏死、肿瘤周围水肿、肿瘤周围增强、肿瘤内增强以及多形性/多叶状肿瘤形态，可能提示 STS 的恶性程度。然而，还需要进一步的研究来达成共识。
