Soft Tissue Sarcoma: Correlation of Dynamic Contrast-enhanced Magnetic Resonance Imaging Features with HIF-1α Expression and Patient Outcomes

Background: To investigate the value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) features for predicting hypoxia-inducible factor 1-alpha (HIF-1α) expression and patient outcomes in soft tissue sarcoma (STS).

Methods: We enrolled 71 patients with STS who underwent 3.0 Tesla (3.0T) MRI, including conventional MRI and DCE-MRI sequencing. The location, maximum tumor diameter, envelope, T2-weighted tumor heterogeneity, peritumoral edema, peritumoral enhancement, necrosis, configuration, tail-like pattern, bone invasion, and vessel/nerve invasion and/or encasement of the STSs were determined using conventional MRI images. The DCE-MRI parameters, including the volume transfer constant ( ), reflux rate ( ), volume fraction of extravascular extracellular matrix ( ), and time-signal intensity curve (TIC) type, of each lesion were independently analyzed by two observers. Independent samples -test, chi-square test, and Mann-Whitney U-test were performed to evaluate the differences in the MRI features between the two groups. The relationships between the DCE-MRI parameters and HIF-1α expression were analyzed using Spearman's correlation analysis. The Cox proportional hazards model and Kaplan-Meier method were used for survival analysis.

Results: Of the conventional MRI features, high heterogeneity, peritumoral enhancement, necrosis, and multilobulation of the T2-weighted tumor were prone to occur in the high-expression group. Of the DCE-MRI parameters, the high-expression group showed significantly higher (0.311±0.091 0.210±0.058 min), and values (0.896±0.656 0.444±0.300 min) than the low-expression group. No significant differences in TIC types and values were observed between the low- and high-expression groups (P>0.05). There were positive correlations between and values with HIF-1α expression (r=0.705, P<0.001; r=0.123, P<0.001, respectively). Receiver operating characteristic (ROC) analysis indicated high specificity (93.9%) of the value for predicting high expression of HIF-1α. The value provided the best performance in diagnostic sensitivity (84.2%). Survival analyses revealed that more than 50% necrosis, multilobulation, and values greater than 0.262 min were strongly associated with a higher risk of death.

Conclusions: Conventional MRI features and DCE-MRI parameters were significantly helpful in determining HIF-1α expression levels and predicting the overall survival (OS) of patients with STS.