Valenzuela Raul F, Duran-Sierra Elvis, Antony Mathew, Amini Behrang, Lo Sam, Torres Keila E, Benjamin Robert S, Ma Jingfei, Hwang Ken-Pin, Stafford R Jason, Araujo Dejka, Bishop Andrew J, Ratan Ravin, Wang Wei-Lien, Espinoza Jossue, Valenzuela Pia V, Wu Chengyue, Madewell John E, Murphy William A, Costelloe Colleen M
The University of Texas MD Anderson Cancer Center, Houston, United States.
Texas A and M University, College Station, United States.
Cancer Imaging. 2025 Apr 26;25(1):56. doi: 10.1186/s40644-025-00873-1.
Undifferentiated pleomorphic sarcoma (UPS) is the largest subgroup of soft-tissue sarcomas. It demonstrates post-therapeutic hemosiderin deposition, granulation tissue formation, fibrosis, and calcification. Our research aims to establish the multiparametric MRI (mp-MRI) value for predicting UPS treatment response.
An IRB-approved retrospective study included 33 extremity UPS patients with pre-operative mp-MRI, including diffusion-weighted imaging (DWI), contrast-enhanced susceptibility-weighted imaging (CE-SWI), and perfusion-weighted imaging with dynamic contrast-enhancement (PWI/DCE), and surgical resection between February 2021 and May 2023. Lesions were visually classified on CE-SWI into one of 6 morphology patterns. On PWI/DCE, lesions were classified into one of 6 patterns, and time-intensity curves (TICs) were classified as types I-V. Patients were categorized into three groups based on the percentage of pathology-assessed treatment effect (PATE) in the surgical specimen: Responders (> = 90% PATE, n = 16), partial-responders (31-89% PATE, n = 10), and non-responders (< = 30% PATE, n = 7).
At post-radiation therapy (PRT), a CE-SWI Complete-Ring pattern was observed in 71% of responders (p = 7.71 × 10). On PWI/DCE images, 79% of responders displayed a Capsular pattern (p = 1.49 × 10), and 100% demonstrated a TIC-type II (p = 8.32 × 10). ROC analysis comparing responders (n = 14) vs. partial/non-responders (n = 16) at PRT showed that the model combining PWI/DCE TIC-type II, PWI/DCE Capsular pattern, and CE-SWI Complete-Ring pattern yielded the highest classification performance (AUC = 0.99), outperforming PWI/DCE Capsular + TIC-type II (AUC = 0.97), PWI/DCE Capsular (AUC = 0.89), PWI/DCE TIC-type II (AUC = 0.88), and CE-SWI Complete Ring (AUC = 0.79). Contrary to prior reports, DWI/ADC played a secondary role in predicting response: ADC mean & skewness (AUC = 0.63). RECIST demonstrated 100% stability at PRT and 100% pseudo-progression at PC in responders and partial/non-responders (AUC = 0.47).
Mp-MRI-derived features are valuable in assessing UPS treatment response. A pre-operative model that combines PWI/DCE TIC-type II, PWI/DCE Capsular pattern, and CE-SWI Complete Ring pattern can reliably predict successfully treated UPS with > = 90% PATE, outperforming RECIST, which was proven unreliable in separating responders from partial/non-responders. Institutions that have not yet implemented CE-SWI can rely on a single-sequence approach based on PWI/DCE, combining the presence of TIC II and Capsular enhancement as criteria for response prediction.
未分化多形性肉瘤（UPS）是软组织肉瘤中最大的亚组。它表现出治疗后含铁血黄素沉积、肉芽组织形成、纤维化和钙化。我们的研究旨在建立多参数MRI（mp-MRI）预测UPS治疗反应的价值。
一项经机构审查委员会批准的回顾性研究纳入了33例接受术前mp-MRI检查的四肢UPS患者，包括扩散加权成像（DWI）、对比增强磁敏感加权成像（CE-SWI）和动态对比增强灌注加权成像（PWI/DCE），这些患者于2021年2月至2023年5月期间接受了手术切除。在CE-SWI上，病变在视觉上被分类为6种形态模式之一。在PWI/DCE上，病变被分类为6种模式之一，时间-强度曲线（TIC）被分类为I-V型。根据手术标本中病理评估的治疗效果（PATE）百分比，将患者分为三组：反应者（PATE≥90%，n = 16）、部分反应者（PATE 31-89%，n = 10）和无反应者（PATE≤30%，n = 7）。
在放射治疗后（PRT），71%的反应者观察到CE-SWI完全环形模式（p = 7.71×10）。在PWI/DCE图像上，79%的反应者表现为包膜模式（p = 1.49×10），100%表现为TIC-II型（p = 8.32×10）。PRT时比较反应者（n = 14）与部分/无反应者（n = 16）的ROC分析表明，结合PWI/DCE TIC-II型、PWI/DCE包膜模式和CE-SWI完全环形模式的模型具有最高的分类性能（AUC = 0.99），优于PWI/DCE包膜+TIC-II型（AUC = 0.97）、PWI/DCE包膜（AUC = 0.89）、PWI/DCE TIC-II型（AUC = 0.88）和CE-SWI完全环形（AUC = 0.79）。与先前的报道相反，DWI/ADC在预测反应中起次要作用：ADC平均值和偏度（AUC = 0.63）。RECIST在PRT时显示100%的稳定性，在反应者和部分/无反应者的PC时显示100%的假进展（AUC = 0.47）。
mp-MRI衍生特征在评估UPS治疗反应方面具有价值。一种结合PWI/DCE TIC-II型、PWI/DCE包膜模式和CE-SWI完全环形模式的术前模型能够可靠地预测PATE≥90%的成功治疗的UPS，优于RECIST，后者在区分反应者与部分/无反应者方面已被证明不可靠。尚未实施CE-SWI的机构可以依赖基于PWI/DCE的单序列方法，将TIC II的存在和包膜强化作为反应预测标准。
