Building a Pre-Surgical Multiparametric-MRI-Based Morphologic, Qualitative, Semiquantitative, First and High-Order Radiomic Predictive Treatment Response Model for Undifferentiated Pleomorphic Sarcoma To Replace RECIST

Authors

Raul F Valenzuela
Elvis Duran-Sierra
Mathew Antony
Behrang Amini
Sam Lo
Keila E Torres
Robert S Benjamin
Jingfei Ma
Ken-Pin Hwang
R Jason Stafford
Dejka Araujo
Andrew J Bishop
Ravin Ratan
Wei-Lien Wang
Jossue Espinoza
Pia V Valenzuela
Chengyue Wu
John E Madewell
William A Murphy
Colleen M Costelloe

Publication Date

4-26-2025

Journal

Cancer Imaging

Abstract

Background: Undifferentiated pleomorphic sarcoma (UPS) is the largest subgroup of soft-tissue sarcomas. It demonstrates post-therapeutic hemosiderin deposition, granulation tissue formation, fibrosis, and calcification. Our research aims to establish the multiparametric MRI (mp-MRI) value for predicting UPS treatment response.

Methods: An IRB-approved retrospective study included 33 extremity UPS patients with pre-operative mp-MRI, including diffusion-weighted imaging (DWI), contrast-enhanced susceptibility-weighted imaging (CE-SWI), and perfusion-weighted imaging with dynamic contrast-enhancement (PWI/DCE), and surgical resection between February 2021 and May 2023. Lesions were visually classified on CE-SWI into one of 6 morphology patterns. On PWI/DCE, lesions were classified into one of 6 patterns, and time-intensity curves (TICs) were classified as types I-V. Patients were categorized into three groups based on the percentage of pathology-assessed treatment effect (PATE) in the surgical specimen: Responders (> = 90% PATE, n = 16), partial-responders (31-89% PATE, n = 10), and non-responders (< = 30% PATE, n = 7).

Results: At post-radiation therapy (PRT), a CE-SWI Complete-Ring pattern was observed in 71% of responders (p = 7.71 × 10-6). On PWI/DCE images, 79% of responders displayed a Capsular pattern (p = 1.49 × 10-7), and 100% demonstrated a TIC-type II (p = 8.32 × 10-7). ROC analysis comparing responders (n = 14) vs. partial/non-responders (n = 16) at PRT showed that the model combining PWI/DCE TIC-type II, PWI/DCE Capsular pattern, and CE-SWI Complete-Ring pattern yielded the highest classification performance (AUC = 0.99), outperforming PWI/DCE Capsular + TIC-type II (AUC = 0.97), PWI/DCE Capsular (AUC = 0.89), PWI/DCE TIC-type II (AUC = 0.88), and CE-SWI Complete Ring (AUC = 0.79). Contrary to prior reports, DWI/ADC played a secondary role in predicting response: ADC mean & skewness (AUC = 0.63). RECIST demonstrated 100% stability at PRT and 100% pseudo-progression at PC in responders and partial/non-responders (AUC = 0.47).

Conclusion: Mp-MRI-derived features are valuable in assessing UPS treatment response. A pre-operative model that combines PWI/DCE TIC-type II, PWI/DCE Capsular pattern, and CE-SWI Complete Ring pattern can reliably predict successfully treated UPS with > = 90% PATE, outperforming RECIST, which was proven unreliable in separating responders from partial/non-responders. Institutions that have not yet implemented CE-SWI can rely on a single-sequence approach based on PWI/DCE, combining the presence of TIC II and Capsular enhancement as criteria for response prediction.

Keywords

Humans, Retrospective Studies, Middle Aged, Male, Female, Sarcoma, Multiparametric Magnetic Resonance Imaging, Aged, Adult, Response Evaluation Criteria in Solid Tumors, Diffusion Magnetic Resonance Imaging, Soft Tissue Neoplasms, Treatment Outcome, Radiomics, Soft tissue sarcoma (STS), Undifferentiated pleomorphic sarcoma (UPS), Pathology-assessed treatment effect (PATE), Multiparametric MRI, Radiomics

DOI

10.1186/s40644-025-00873-1

PMID

40281609

PMCID

PMC12032704

PubMedCentral® Posted Date

4-26-2025

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes