title: Multiparametric Assessment of Treatment Response in High-Grade Soft-Tissue Sarcomas with Anatomic and Functional MR Imaging Sequences.
abstract: OBJECTIVE
  To determine the added value of quantitative diffusion-weighted and dynamic contrast material-enhanced imaging to conventional magnetic resonance (MR) imaging for assessment of the response of soft-tissue sarcomas to neoadjuvant therapy.
  
  
  METHODS
  MR imaging examinations in 23 patients with soft-tissue sarcomas who had undergone neoadjuvant therapy were reviewed by two readers during three sessions: conventional imaging (T1-weighted, fluid-sensitive, static postcontrast T1-weighted), conventional with diffusion-weighted imaging, and conventional with diffusion-weighted and dynamic contrast-enhanced imaging. For each session, readers recorded imaging features and determined treatment response. Interobserver agreement was assessed and receiver operating characteristic analysis was performed to evaluate the accuracy of each session for determining response by using results of the histologic analysis as the reference standard. Good response was defined as less than or equal to 5% residual viable tumor.
  
  
  RESULTS
  Of the 23 sarcomas, four (17.4%) showed good histologic response (three of four with >95% granulation tissue and <5% necrosis, one of four with 95% necrosis and <5% viable tumor) and 19 (82.6%) showed poor response (viable tumor range, 10%-100%). Interobserver agreement was substantial or excellent for imaging features in all sequences (k = 0.789-1.000). Receiver operating characteristic analysis showed an increase in diagnostic performance with the addition of diffusion-weighted and dynamic contrast-enhanced MR imaging for prediction of response compared with that for conventional imaging alone (areas under the curve, 0.500, 0.676, 0.821 [reader 1] and 0.506, 0.704, 0.833 [reader 2], respectively).
  
  
  CONCLUSIONS
  Adding functional sequences to the conventional MR imaging protocol increases the sensitivity of MR imaging for determining treatment response in soft-tissue sarcomas.
authors.affiliation: From the Department of Radiology and Medical Imaging, Victoria Hospital, NHS Fife, Kirkcaldy, United Kingdom (T.S.); Russell H. Morgan Department of Radiology and Radiological Science (S.A., M.C., M.A.J., L.M.F.), Sidney Kimmel Comprehensive Cancer Center (E.M., M.A.J., L.M.F.), and Department of Pathology (E.M.), Johns Hopkins University Hospital, 601 N Wolfe St, Baltimore, MD 21287.
authors.forename: Theodoros
authors.initials: T
authors.lastname: Soldatos
authors.affiliation: From the Department of Radiology and Medical Imaging, Victoria Hospital, NHS Fife, Kirkcaldy, United Kingdom (T.S.); Russell H. Morgan Department of Radiology and Radiological Science (S.A., M.C., M.A.J., L.M.F.), Sidney Kimmel Comprehensive Cancer Center (E.M., M.A.J., L.M.F.), and Department of Pathology (E.M.), Johns Hopkins University Hospital, 601 N Wolfe St, Baltimore, MD 21287.
authors.forename: Shivani
authors.initials: S
authors.lastname: Ahlawat
authors.affiliation: From the Department of Radiology and Medical Imaging, Victoria Hospital, NHS Fife, Kirkcaldy, United Kingdom (T.S.); Russell H. Morgan Department of Radiology and Radiological Science (S.A., M.C., M.A.J., L.M.F.), Sidney Kimmel Comprehensive Cancer Center (E.M., M.A.J., L.M.F.), and Department of Pathology (E.M.), Johns Hopkins University Hospital, 601 N Wolfe St, Baltimore, MD 21287.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Montgomery
authors.affiliation: From the Department of Radiology and Medical Imaging, Victoria Hospital, NHS Fife, Kirkcaldy, United Kingdom (T.S.); Russell H. Morgan Department of Radiology and Radiological Science (S.A., M.C., M.A.J., L.M.F.), Sidney Kimmel Comprehensive Cancer Center (E.M., M.A.J., L.M.F.), and Department of Pathology (E.M.), Johns Hopkins University Hospital, 601 N Wolfe St, Baltimore, MD 21287.
authors.forename: Majid
authors.initials: M
authors.lastname: Chalian
authors.affiliation: From the Department of Radiology and Medical Imaging, Victoria Hospital, NHS Fife, Kirkcaldy, United Kingdom (T.S.); Russell H. Morgan Department of Radiology and Radiological Science (S.A., M.C., M.A.J., L.M.F.), Sidney Kimmel Comprehensive Cancer Center (E.M., M.A.J., L.M.F.), and Department of Pathology (E.M.), Johns Hopkins University Hospital, 601 N Wolfe St, Baltimore, MD 21287.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Jacobs
authors.affiliation: From the Department of Radiology and Medical Imaging, Victoria Hospital, NHS Fife, Kirkcaldy, United Kingdom (T.S.); Russell H. Morgan Department of Radiology and Radiological Science (S.A., M.C., M.A.J., L.M.F.), Sidney Kimmel Comprehensive Cancer Center (E.M., M.A.J., L.M.F.), and Department of Pathology (E.M.), Johns Hopkins University Hospital, 601 N Wolfe St, Baltimore, MD 21287.
authors.forename: Laura M
authors.initials: LM
authors.lastname: Fayad
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007223:Infant; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D060787:Neoplasm Grading; D012509:Sarcoma / Q000473:pathology* / Q000628:therapy*; D012983:Soft Tissue Neoplasms / Q000473:pathology* / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA