A Comparative Study Between Quantitative DCE-MRI And Histopathology Grading Of Soft Tissue Sarcomas

Objective: To explore the value of quantitative Dynamic contrast enhanced-MRI?DCE-MRI?to assess the histopathology grading of STSs.Materials and methods: 1.Case data: Collected in our hospital Patient from September 2015 to January 2017,the quantitative analysis of DCE-MRI examination of 17 cases of STSs,all patients with MRI examination were agreed..Aged 44-79,with an average age of 57.4 years.All cases were confirmed by operation and pathology.Among them,3 cases of undifferentiated pleomorphic sarcoma i,1.cases of angiosarcoma,1 leiomyosarcoma,2 cases of malignant peripheral nerve sheath tumors,1 cases of epithelioid sarcoma,6 cases of liposarcoma,1 cases of malignant myofibroblastic tumor,2 cases of fibrosarcoma.2.MRI scanning technology and image post-processing?1?scanning method All cases were treated with conventional MR enhanced scan and dynamic enhanced MR scan with Siemens 3 T MR.The first routine MR scan,and then use the 3D FSPGRE series for small flip angle T1 WI scan and 3D-VIBE sequence for dynamic enhanced MR scanning,40 continuous scanning period,finally performed MR T1 WI scan.?2?DCE-MRI image post-processing The DCE-MRI multi turn angle data and dynamic enhancement data were transmitted to the hemodynamic software Omni Kinetics?GE healthcare?for image post-processing.Processing software interface in Omni Kinetics,AIF Type choice Population,click Curving,obtain the population percapita AIF,select the ETL blood flow dynamics model,control K^trans pseudo color lesions,tumor enhancement to manually select the most obvious place to take a picture of the region of-interest?ROI?,the fitting calculation of quantitative parameters(volume transfer constant volume transfer constant(K^trans),flux rate constant between extravascular extracellular space and plasma,(K_ep)andvolume of extravascular extracellular space per unit volume of tissue,?V_e?.?3?Conventional MR performance observationthe maximum tumor diameter: maximum diameter of <5cm or ? 5cm;cystic degree: no cystic and cystic?cystic area of more than 5%?;signal homogeneity: signal,signal inequality;clear outline: edge?edge contour is not clear,less than 10%?contour clear?edge unclear >10%?;strengthening methods?uniform or non-uniform strengthening?.3.specimen acquisition,the location of the general pathological specimens and the corresponding image level and the production of pathological specimens?1?specimen acquisitionpreoperative: MR examination suspected STSs patients,with reference to the MR image,assisted clinicians,the nature of the tumor,morphology and the scope of the evaluation.during the operation: by the operation room doctors do longitudinal incision,probe mass,expand the tumor and surrounding muscles,do the direction of the mark on mass.?2?the location of the gross specimen corresponds to the image level?3?preparation of tissue sections and pathological changes under microscopeBy the image-pathologist closely cooperate,corresponding to the DCE-MR image,select the mass position where MR image to strengthen the most obvious,then material and slice the mass.4.observation index:?1?the performance of STSs on conventional MR the maximum diameter of the tumor;cystic change degree;signal heterogeneity the edge;strengthen the way?2?the quantitative parameters of DCE-MRI in17 cases of STSs: K^trans;V_e;K_ep.?3?Histopathology grading:Using the French Federation of Cancer Centre grading;according to the pathological grading of French Federation Cancer Center?FNCLCC?STSs in the diagnosis of pathological grading standards,pathological tissue sections observed under microscope,the cell differentiation degree,tumor necrosis area and nuclear fission phenomenon were counting scores,the 17 cases of STSs were divided into? ?5.Statistical analysis: all data were analyzed by SPSS statistical software?version 17?.?1?the x² test was used for compara the performance of STSs on conventional MR?tumor size;cystic;heterogeneity;edge enhancement;?to its histopathological grading;?2?the Newman-Keuls by single factor analysis of variance and Q test,was used for compara the differences of DCE-MRI parameters K^trans,V_e and K_ep parameters of the STSs were compared with the histopathological grading;?3?the Spearman correlation test used for compara to correlation between the DCE-MRI parameters of STSs and the pathological grading;?4?ROC curve was used for analyzing the cut-off value,diagnostic sensitivity and specificity of the pharmacokinetics parameters,which can be used for?dentification of STSs pathological grade.Result: 1.17 cases of STSs conventional MR performance5 cases of tumor maximum diameter of <5cm,12 cases of ?5cm;no obvious cyst in 5,cystic changes in 12 cases;3 cases of homogeneous signal,signal heterogeneity in 14 cases;7 cases of clear edge,the edge is not clear in 10 cases;homogeneous enhancement in 3 cases,14 cases were heterogeneous enhancement.2.Quantitative parameters of STSs,K^trans,V_e and K_ep in 17 cases3.The pathological grading of STSs in 17 cases17 cases of STSs pathological grade was? grade in 7 cases,grade ? in 4 cases,grade ? in 6 cases.4.The conventional MR manifestations of 17 cases of STSs were compared with the histopathological grading.Depending on the degree of tumor necrosis,I-? STSs?P<0.0167?can be identified,and?-? and ?-? can not be identified.By the maximum diameter of the tumor,the heterogeneity of the signal,the edge of the tumor and the way of enhancement.,I-? ?I-? and ?-? could not be distinguished.5.The DCE-MRI of quantitative parameters in 17 cases STSs were compared with the pathological grading.?1?DCE-MRI quantitative parameters of STSs compared with the histopathological grading.17 cases of STSs K^trans,high K_ep value,high grade of the histopathology,there was?-? STSs K^trans,K_ep level difference?P<0.05?,Grade? and grade ?,grade ? and grade ? STSs can be identified?P<0.05?,however grade ? and grade ? can not be identified?P>0.05?.according to V_e,All the STSs can not be identified the histopathology?P>0.05??2?K^trans,K_ep and histopathology grade had positive correlation?P<0.05?,the correlation between K^trans and pathological grading are better?r=0.7168?;V_e and histopathology have no correlation with STSs grading of STSs?P>0.05?.?3?17 cases of STSs,pathological grade of K^trans and K_ep for the area of quantitative parameters of?,? and ? between STSs histopathology under the curve were 0.939,0.894,K^trans and K_ep in the differential diagnosis of pathological grade?,? threshold STSs and ? level were 0.1032983min-1,0.3427705,differential diagnosis of? ?,? and STSs are on the threshold between the sensitivity were 100% and 83.33%,the specificity was 81.82%,81.82% respectively.Conclusion: 1.DCE-MRI quantitative parameters of K^trans K_ep have correlation with its histological grade of STSs,they can reflect STSs histopathological grading.2.when the quantitative analysis of STSs DCE-MRI data in the ETL model with Avg-AIF,,according to K^trans and K_ep Grade? and ?,grade ? and ? can be identified according to K^trans ?K_ep.K^trans value is greater than 0.1032983min-1 or K_ep is greater than 0.3427705 will be considered the STSs pathological grade ?,the diagnostic sensitivity was 100% and 83.33% respectively,the specificity were 81.82%,81.82% respectively.