Evaluation of Static and Dynamic MRI for Assessing Response of Bone Sarcomas to Preoperative Chemotherapy: Correlation with Histological Necrosis

Overview

Journal Indian J Radiol Imaging

Publisher Thieme

Specialty Radiology

Date 2015 Aug 20

PMID 26288521

Citations 8

Authors

Priyadarshi Amit

Atul Malhotra

Rahul Kumar

Lokesh Kumar

Dilip Kumar Patro

Sundar Elangovan

Affiliations

Soon will be listed here.

Abstract

Objectives: Preoperative chemotherapy plays a key role in management of bone sarcomas. Postoperative evaluation of histological necrosis has been the gold standard method of assessing response to preoperative chemotherapy. This study was done to evaluate the efficacy of static and dynamic magnetic resonance imaging (MRI) for assessing response preoperatively.

Materials And Methods: Our study included 14 patients (12 osteosarcomas and 2 malignant fibrous histiocytomas) with mean age of 21.8 years, treated with preoperative chemotherapy followed by surgery. They were evaluated with static and dynamic MRI twice, before starting chemotherapy and again prior to surgery. Change in tumor volume and slope of signal intensity - time curve were calculated and correlated with percentage of histological necrosis using Pearson correlation test.

Results: The change in dynamic MRI slope was significant (P = 0.001). Also, ≥60% reduction in slope of the curve proved to be an indicator of good histological response [positive predictive value (PPV) =80%]. Change in tumor volume failed to show significant correlation (P = 0.071). Although it showed high negative predictive value (NPV = 85.7%), PPV was too low (PPV = 57.14%).

Conclusions: Dynamic MRI correctly predicts histological necrosis after administration of preoperative chemotherapy to bone sarcomas. Hence, it can be used as a preoperative indicator of response to neoadjuvant chemotherapy. On the other hand, volumetric assessment by static MRI is not an effective predictor of histological necrosis. This study proves the superiority of dynamic contrast-enhanced study over volumetric study by MRI.

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References

Hendershot E, Pappo A, Malkin D, Sung L . Tumor necrosis in pediatric osteosarcoma: impact of modern therapies. J Pediatr Oncol Nurs. 2006; 23(4):176-81. DOI: 10.1177/1043454206289786. View

Cheon G, Kim M, Lee J, Lee S, Cho W, Song W . Prediction model of chemotherapy response in osteosarcoma by 18F-FDG PET and MRI. J Nucl Med. 2009; 50(9):1435-40. DOI: 10.2967/jnumed.109.063602. View

Huvos A, Rosen G, Marcove R . Primary osteogenic sarcoma: pathologic aspects in 20 patients after treatment with chemotherapy en bloc resection, and prosthetic bone replacement. Arch Pathol Lab Med. 1977; 101(1):14-8. View

Holscher H, Bloem J, Vanel D, Hermans J, Nooy M, Taminiau A . Osteosarcoma: chemotherapy-induced changes at MR imaging. Radiology. 1992; 182(3):839-44. DOI: 10.1148/radiology.182.3.1535905. View

Hayashida Y, Yakushiji T, Awai K, Katahira K, Nakayama Y, Shimomura O . Monitoring therapeutic responses of primary bone tumors by diffusion-weighted image: Initial results. Eur Radiol. 2006; 16(12):2637-43. DOI: 10.1007/s00330-006-0342-y. View

Holscher H, Bloem J, Nooy M, Taminiau A, Eulderink F, Hermans J . The value of MR imaging in monitoring the effect of chemotherapy on bone sarcomas. AJR Am J Roentgenol. 1990; 154(4):763-9. DOI: 10.2214/ajr.154.4.2107673. View

Glasser D, Lane J, Huvos A, Marcove R, Rosen G . Survival, prognosis, and therapeutic response in osteogenic sarcoma. The Memorial Hospital experience. Cancer. 1992; 69(3):698-708. DOI: 10.1002/1097-0142(19920201)69:3<698::aid-cncr2820690317>3.0.co;2-g. View

Moon S, Shin K, Suh J, Yang W, Noh J, Hahn S . Tumor volume change after chemotheraphy as a predictive factor of disease free survival for osteosarcoma. Yonsei Med J. 2005; 46(1):119-24. PMC: 2823037. DOI: 10.3349/ymj.2005.46.1.119. View

de Baere T, Vanel D, Shapeero L, Charpentier A, Terrier P, Di Paola M . Osteosarcoma after chemotherapy: evaluation with contrast material-enhanced subtraction MR imaging. Radiology. 1992; 185(2):587-92. DOI: 10.1148/radiology.185.2.1410378. View

10.

Toms A, White L, Kandel R, Bleakney R, Noseworthy M, Lee S . Limitations of single slice dynamic contrast enhanced MR in pharmacokinetic modeling of bone sarcomas. Acta Radiol. 2009; 50(5):512-20. DOI: 10.1080/02841850902922761. View

11.

Lang P, Honda G, Roberts T, Vahlensieck M, Johnston J, Rosenau W . Musculoskeletal neoplasm: perineoplastic edema versus tumor on dynamic postcontrast MR images with spatial mapping of instantaneous enhancement rates. Radiology. 1995; 197(3):831-9. DOI: 10.1148/radiology.197.3.7480764. View

12.

Dyke J, Panicek D, Healey J, Meyers P, Huvos A, Schwartz L . Osteogenic and Ewing sarcomas: estimation of necrotic fraction during induction chemotherapy with dynamic contrast-enhanced MR imaging. Radiology. 2003; 228(1):271-8. DOI: 10.1148/radiol.2281011651. View

13.

Picci P, Rougraff B, Bacci G, Neff J, Sangiorgi L, Cazzola A . Prognostic significance of histopathologic response to chemotherapy in nonmetastatic Ewing's sarcoma of the extremities. J Clin Oncol. 1993; 11(9):1763-9. DOI: 10.1200/JCO.1993.11.9.1763. View

14.

ENNEKING W, Spanier S, Goodman M . A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop Relat Res. 1980; (153):106-20. View

15.

Kawai A, Sugihara S, Kunisada T, Uchida Y, Inoue H . Imaging assessment of the response of bone tumors to preoperative chemotherapy. Clin Orthop Relat Res. 1997; (337):216-25. DOI: 10.1097/00003086-199704000-00024. View

16.

Holscher H, Bloem J, van der Woude H, Hermans J, Nooy M, Taminiau A . Can MRI predict the histopathological response in patients with osteosarcoma after the first cycle of chemotherapy?. Clin Radiol. 1995; 50(6):384-90. DOI: 10.1016/s0009-9260(05)83135-6. View

17.

van der Woude H, Bloem J, Verstraete K, Taminiau A, Nooy M, Hogendoorn P . Osteosarcoma and Ewing's sarcoma after neoadjuvant chemotherapy: value of dynamic MR imaging in detecting viable tumor before surgery. AJR Am J Roentgenol. 1995; 165(3):593-8. DOI: 10.2214/ajr.165.3.7645476. View

18.

Erlemann R, Sciuk J, Bosse A, Ritter J, Peters P, Wuisman P . Response of osteosarcoma and Ewing sarcoma to preoperative chemotherapy: assessment with dynamic and static MR imaging and skeletal scintigraphy. Radiology. 1990; 175(3):791-6. DOI: 10.1148/radiology.175.3.2188300. View

19.

Rosen G, Caparros B, Huvos A, Kosloff C, Nirenberg A, Cacavio A . Preoperative chemotherapy for osteogenic sarcoma: selection of postoperative adjuvant chemotherapy based on the response of the primary tumor to preoperative chemotherapy. Cancer. 1982; 49(6):1221-30. DOI: 10.1002/1097-0142(19820315)49:6<1221::aid-cncr2820490625>3.0.co;2-e. View

20.

Fletcher B, Hanna S, Fairclough D, Gronemeyer S . Pediatric musculoskeletal tumors: use of dynamic, contrast-enhanced MR imaging to monitor response to chemotherapy. Radiology. 1992; 184(1):243-8. DOI: 10.1148/radiology.184.1.1319075. View