Correlation Of DKI And ~1H-MRS Parameters With VEGF And MVD Expression In Soft Tissue Sarcoma Based On MRI-Pathology

Objective:To explore the correlation of DKI and ~1H-MRS parameters with the expression of VEGF and MVD in soft tissue sarcoma by MR-pathological control method.Materials and methods:1.Case dataA total of 26 patients with soft tissue sarcoma who underwent MRI examination from September 2020 to December 2022 were collected continuously.All the patients signed informed consent and did not receive any clinical treatment before MRI examination,including 17 males and 9 females aged 14-82 years.There were 7liposarcoma,5 neurofibrosarcoma,4 fibrosarcoma,3 leiomyosarcoma,1 angiosarcoma,1 cutaneous fibrosarcoma protuberance,1 pleomorphic rhabdomyosarcoma,1 malignant giant cell tumor of tendon sheath,1 spindle cell sarcoma and 2 undifferentiated pleomorphic cell sarcoma in 26 cases of soft tissue tumors.2.MRI technologyRoutine MRI and DKI and ~1H-MRS examinations were performed with 16-channel phased array abdominal coil of GE Discovery 750 3.0 T superconducting MRI scanner.DKI was performed with 3 b values(0 1000 1500 s/mm~2)and 15 diffusion directions.~1H-MRS was performed with multi-voxel acquisition method of point-resolved spin echo spectrum sequence(PRESS)and the region of interest was selected to avoid bone,blood vessel,nerve and tumor necrosis Ensure that DKI and ~1H-MRS are performed before enhanced examinations.3.Post-processing and data collectionThe DKI and ~1H-MRS images were transferred to ADW 4.7 workstation,and the original DKI and ~1H-MRS images were post-processed by Functool and Read Yview software package.The regions with the highest signal on the tumor enhancement and diffusion images were selected as the ROI,and the ROI were copied to the corresponding DKI and ~1H-MRS images to obtain various parameter values.4.Comparison method between MRI and PathologyUsing the original imaging pathology"point-to-point,slice-to-slice"pathological sampling method developed by our research group,we jointly completed it in collaboration with radiologists and pathologists.Immunohistochemical detection and expression analysis(1)Immunohistochemical detection:According to the MRI-pathological comparison method,the pathological layer corresponding to the tumor image layer was selected as the sampling point to make wax blocks,cut into 3μm thickness for immunohistochemical detection.(2)Immunohistochemical index expression analysis:Evaluation of VEGF score was performed by using method of Xu Liang zhong,and MVD count was according to method of Weidner.5.Observation indicators(1)Conventional MRI features:the location of tumor,morphology,size,boundary,signal and enhancement.(2)Pseudo-color graphs of DKI parameters and ~1H-MRS spectral line graphs.(3)DKI quantitative parameters:MD,MK,KA values.(4)~1H-MRS quantitative parameters:LL/Cho values.(5)Histopathological characteristics:cell morphology,nuclear atypia,mitosis,necrotic area.(6)VEGF and MVD expression score.6.Statistical analysisAll data were analyzed by using SPSS 22.0.Intraclass correlation coefficient was tested to assess inter-reader reliability between the two observers.Pearson correlation method was preformed for normal distribution data to analysis the correlation between VEGF with MVD,the quantitative parameters of DKI and ~1H-MRS with VEGF and MVD,and the quantitative parameters of DKI with those of ~1H-MRS,Spearman correlation method was used for non-normally distributed data.Results:1.The MRI findings of 26 cases of STSs:(1)Conventional MRI manifestations:a Size:10 cases of tumor diameter<5cm,16 cases of≥5cm;b Location:16 cases of limb,3 cases of buttock,7 cases of trunk;c Morphology:22 cases are round or oval shape,4 cases are irregularity;d Boundary:clear in 19 cases,fuzzy in 7 cases;e Signal:26 cases display uniform or hypointense on T1WI,6 cases display homogeneous hyperintense on T2WI,20 cases appearance mixed signal;f Enhancement:8 cases are contrasted evenly and obviously,14 cases are contrasted obviously but heterogeneous,3 cases showed moderate and homogeneous enhancement,1 case showed moderate but heterogeneous enhancement.(2)DKI quantitative parameters:The average values of MD,MK and KA were1.62±0.89、0.75±0.40、0.81±0.45.(3)~1H-MRS quantitative parameters:The average values of LL and Cho were235.33±188.45、12.12±16.39.2.The pathological observation of 26 cases of STSs:(1)Histopathological features.(2)The expression of pathological indexs:VEGF expression score was 3.49±2.42,and MVD expression score was 139.78±80.59.(3)The correlation among pathological indexes:VEGF expression score was positively correlated with MVD expression score(r=0.971,p<0.05).3.The consistency test of the evaluation results of pathological indicators and imaging parameters between observers:The pathological indicators and imaging parameters of the two observers showed good repeatability(ICC>0.75,p<0.05).4.The correlation between imaging parameters and pathological indicators:(1)The correlation between the quantitative parameters of DKI and the expression of VEGF and MVD.KA value was positively correlated with VEGF and MVD expression(r=0.581、0.572,p<0.05).(2)The correlation between the quantitative parameters of ~1H-MRS and the expression of VEGF and MVD.Cho value was positively correlated with VEGF and MVD expression(r=0.899、0.934,p<0.05).5.The correlation between DKI and ~1H-MRS quantitative parameters.KA value was positively correlated with Cho value(r=0.678,p<0.05).Conclusions:Based on the MRI-pathological control method,26 cases of STSs DKI and ~1H-MRS quantitative parameters with pathological indicators VEGF and MVD expression correlation analysis,we draw the following conclusions:1.The DKI quantitative parameter KA value of soft tissue sarcoma is positively correlated with the expression of VEGF and MVD,so that the DKI quantitative parameter KA can be used to evaluate the angiogenesis of STSs tumors.2.The quantitative parameter Cho value of ~1H-MRS in soft tissue sarcoma is positively correlated with the expression of VEGF and MVD,so that the Cho value can reflect the angiogenesis of STSs,further indicating the high metabolism level of STSs.3.There is a positive correlation between KA value and Cho value in soft tissue sarcoma,therefore both MRI diffusion imaging sequence DKI and MRI metabolic imaging sequence ~1H-MRS can be used to reflect STS angiogenesis and tissue metabolism.