多参数MRI评价四肢软组织肉瘤治疗效果及肿瘤复发

Valenzuela Raul F, Amini Behrang, Duran-Sierra Elvis, Canjirathinkal MA, Madewell John E, Costelloe Colleen M, Murphy William A
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引用次数: 0

摘要

软组织肉瘤是一种罕见而复杂的恶性肿瘤。高级MRI序列如弥散加权成像(DWI)和灌注加权成像/动态对比增强(PWI/DCE)可以提供有价值的肿瘤特征和治疗反应评估。对于典型的细胞肿瘤,如多形性未分化肉瘤(UPS),良好应答者通常显示ADC强度直方图的右侧移位,导致ADC平均值升高,峰度和偏度降低,与基线相比,不良应答者的曲线更左侧。PWI/DCE模式最常与良好反应相关的是“囊状”增强和2型TIC。SWI上出现的肉瘤出血类型包括“间质性”、“球状”、“管腔性”以及不完全和完全的“外周环状”肿瘤壁含铁血黄素浸渍。治疗性出血通常与低swi平均值和左侧强度直方图呈正偏性相关。在术后监测中,DCE磁共振成像可以可靠地区分复发性肉瘤和术后瘢痕。III型、IV型、V型常提示肿瘤局部复发,II型多为术后良性改变,如肉芽组织。高级MRI是在治疗期间和治疗后评估肉瘤的重要工具。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Multiparametric MRI for the Assessment of Treatment Effect and Tumor Recurrence in Soft-tissue Sarcoma of the Extremities
Soft-tissue sarcomas are a rare and complex group of malignant tumors. Advanced MRI sequences such as diffusion-weighted imaging (DWI) and perfusion-weighted imaging/dynamic contrast enhancement (PWI/DCE) can provide valuable tumor characterization and treatment response assessment. In the case of archetypical cellular tumors such as Pleomorphic Undifferentiated sarcoma (UPS), Good responders often display right-side displacement of the ADC intensity histogram, resulting in increased ADC-mean and decreased kurtosis and Skewness compared with Baseline and poor responders’ more left-sided curve. The PWI/DCE pattern most often associated with a good response is the presence of a “capsular-like” enhancement and a TIC type 2. Sarcoma hemorrhage patterns on SWI emerge during treatment, including “interstitial,” globular,” “luminal,” and incomplete and complete “peripheral ring-like” tumor wall hemosiderin impregnation. Treatment-induced bleeding is typically associated with low SWI-mean values and a left-sided intensity histogram with positive Skewness. During post-surgical surveillance, DCE MR imaging can reliably distinguish recurrent sarcoma from post-surgical scarring. TICs III, IV, and V raise the suspicion of local tumor recurrence, while TIC type II usually represents benign post-operative change such as granulation tissue. Advanced MRI is an essential tool for assessing sarcomas during and after therapy.
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