Valenzuela Raul F, Duran Sierra Elvis de Jesus, Canjirathinkal Mathew A, Amini Behrang, Hwang Ken-Pin, Ma Jingfei, Torres Keila E, Stafford R Jason, Wang Wei-Lien, Benjamin Robert S, Bishop Andrew J, Madewell John E, Murphy William A, Costelloe Colleen M
University of Texas MD Anderson Cancer Center, Houston, TX.
JCO Clin Cancer Inform. 2025 Jan;9:e2400042. doi: 10.1200/CCI.24.00042. Epub 2025 Jan 22.
Undifferentiated pleomorphic sarcomas (UPSs) demonstrate therapy-induced hemosiderin deposition, granulation tissue formation, fibrosis, and calcification. We aimed to determine the treatment-assessment value of morphologic tumoral hemorrhage patterns and first- and high-order radiomic features extracted from contrast-enhanced susceptibility-weighted imaging (CE-SWI).
This retrospective institutional review board-authorized study included 33 patients with extremity UPS with magnetic resonance imaging and resection performed from February 2021 to May 2023. Volumetric tumor segmentation was obtained at baseline, postsystemic chemotherapy (PC), and postradiation therapy (PRT). The pathology-assessed treatment effect (PATE) in surgical specimens separated patients into responders (R; ≥90%, n = 16), partial responders (PR; 89%-31%, n = 10), and nonresponders (NR; ≤30%, n = 7). RECIST, WHO, and volume were assessed for all time points. CE-SWI T2* morphologic patterns and 107 radiomic features were analyzed.
A Complete-Ring (CR) pattern was observed in PRT in 71.4% of R ( = 7.71 × 10), an Incomplete-Ring pattern in 33.3% of PR ( = .2751), and a Globular pattern in 50% of NR ( = .1562). The first-order radiomic analysis from the CE-SWI intensity histogram outlined the values of the 10th and 90th percentiles and their skewness. R showed a 280% increase in 10th percentile voxels ( = .061) and a 241% increase in skewness ( = .0449) at PC. PR/NR showed a 690% increase in the 90th percentile voxels ( = .03) at PC. Multiple high-order radiomic texture features observed at PRT discriminated better R versus PR/NR than the first-order features.
CE-SWI morphologic patterns strongly correlate with PATE. The CR morphology pattern was the most frequent in R and had the highest statistical association predicting response at PRT, easily recognized by a radiologist not requiring postprocessing software. It can potentially outperform size-based metrics, such as RECIST. The first- and high-order radiomic analysis found several features separating R versus PR/NR.
未分化多形性肉瘤（UPSs）表现出治疗诱导的含铁血黄素沉积、肉芽组织形成、纤维化和钙化。我们旨在确定从对比增强 susceptibility-weighted 成像（CE-SWI）中提取的肿瘤形态学出血模式以及一阶和高阶影像组学特征的治疗评估价值。
这项经机构审查委员会批准的回顾性研究纳入了 33 例 2021 年 2 月至 2023 年 5 月期间接受磁共振成像检查并进行手术切除的四肢 UPS 患者。在基线、全身化疗后（PC）和放射治疗后（PRT）进行肿瘤体积分割。手术标本中经病理评估的治疗效果（PATE）将患者分为反应者（R；≥90%，n = 16）、部分反应者（PR；89%-31%，n = 10）和无反应者（NR；≤30%，n = 7）。在所有时间点评估 RECIST、WHO 和体积。分析 CE-SWI T2*形态学模式和 107 个影像组学特征。
在 PRT 中，71.4%的 R 患者观察到完整环（CR）模式（P = 7.71×10），33.3%的 PR 患者观察到不完整环模式（P =.2751），50%的 NR 患者观察到球状模式（P =.1562）。从 CE-SWI 强度直方图进行的一阶影像组学分析勾勒出第 10 和第 90 百分位数的值及其偏度。R 患者在 PC 时第 10 百分位数体素增加 280%（P =.061），偏度增加 241%（P =.0449）。PR/NR 患者在 PC 时第 90 百分位数体素增加 690%（P =.03）。在 PRT 时观察到的多个高阶影像组学纹理特征在区分 R 与 PR/NR 方面比一阶特征表现更好。
CE-SWI 形态学模式与 PATE 密切相关。CR 形态学模式在 R 患者中最常见，并且在预测 PRT 反应方面具有最高的统计关联性，放射科医生无需后处理软件即可轻松识别。它可能优于基于大小的指标，如 RECIST。一阶和高阶影像组学分析发现了几个区分 R 与 PR/NR 的特征。
