Preliminary exploration of diffusion-weighted imaging in pre-surgical planning of dermatofibrosarcoma protuberans

doi:10.3969/j.issn.1674-8115.2022.08.014

Abstract

Abstract:

Objective ·To explore the value of diffusion-weighted imaging (DWI) in pre-surgical planning of dermatofibrosarcoma protuberans (DFSP). Methods ·The cases with DFSP in Shanghai Ninth People 's Hospital, Shanghai Jiao Tong University School of Medicine from May 2018 to March 2022 were enrolled. CT and MRI were conducted before surgery as a routine procedure. All the patients were randomly divided into MRI functional imaging group (CT plain scan and enhanced scan, MRI plain scan and enhanced scan, and DWI) and MRI conventional imaging group (CT plain scan and enhanced scan, and MRI plain scan and enhanced scan). The tumor boundaries of the two groups were outlined respectively by aligning CT with corresponding MRI images with computer- aided design software Medraw [alignment of CT images with DWI images in MRI functional imaging group and alignment of CT images with dynamic contrast-enhanced magnetic resonance imaging (DCE) images in MRI conventional imaging group] in order to complete the DFSP 3D tumor models and the 3D visualization reports, and to design surgical plans. The clinical characteristics of the two groups were completely collected. The recurrence rate and postoperative satisfaction evaluation of the two groups were compared. Results ·A total of 34 cases with DFSP having completed clinical and imaging information were enrolled in this research with an average age of (36.56±13.07) years. The tumor location of occurrence included 10 cases in the abdominal walls, 9 cases in the chest walls, 4 cases in the maxillofacial regions, 3 cases in the thighs, 3 cases in the shoulders, 2 cases in the hips, 2 cases in the waists, and 1 case in the feet. The average tumor diameter was (2.25±0.92) cm. Seventeen patients were included in the MRI functional imaging group and MRI conventional imaging group respectively with an average follow-up of (9.97±7.82) months. There were no significant differences in the basic clinical information between the two groups ( P>0.05). The recurrence rate of the MRI functional imaging group (0) was lower than that of the MRI conventional imaging group (29.4%), and the postoperative aesthetic satisfaction rate in the former group (100%) was higher than that in the latter group (70.6%). There were statistically significant differences in these results between the two groups ( P<0.05). Conclusion ·DWI is more advantageous for tumor boundary determination compared with conventional MRI; DWI-based preoperative image planning can reduce DFSP recurrence rate and improve aesthetics of the operative area to some extent.

Key words: dermatofibrosarcoma protuberans (DFSP), magnetic resonance imaging (MRI), diffusion-weighted imaging (DWI), pre-surgical planning

CLC Number:

R445.2

LIU Siyu, WU Bing, LI Xiaomin, ZHAO Lulu, CHEN Jun, AI Songtao. Preliminary exploration of diffusion-weighted imaging in pre-surgical planning of dermatofibrosarcoma protuberans[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2022, 42(8): 1095-1102.

Figures/Tables 6

TrendMD

References 29

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Clinical characteristic	MRI functional imaging group （ n＝17）	MRI conventional imaging group （ n＝17）	P value
Age/year	38.76±12.63	34.35±13.51	0.333
Gender/ n（%）			1.000
Male	9 （52.9）	9 （52.9）
Female	8 （47.1）	8 （47.1）
Lesion location/ n（%）			0.562
Trunk	12 （70.6）	14 （82.4）
Limbs	3 （17.6）	1 （5.8）
Head and neck	2 （11.8）	2 （11.8）
Diameter/cm	2.37±0.81	2.13±1.02	0.452
Number of episodes/ n（%）			0.080
First onset	7 （41.2）	13 （76.5）
Recurrence	10 （58.8）	4 （23.5）

Clinical characteristic	MRI functional imaging group （ n＝17）	MRI conventional imaging group （ n＝17）	P value
Age/year	38.76±12.63	34.35±13.51	0.333
Gender/ n（%）			1.000
Male	9 （52.9）	9 （52.9）
Female	8 （47.1）	8 （47.1）
Lesion location/ n（%）			0.562
Trunk	12 （70.6）	14 （82.4）
Limbs	3 （17.6）	1 （5.8）
Head and neck	2 （11.8）	2 （11.8）
Diameter/cm	2.37±0.81	2.13±1.02	0.452
Number of episodes/ n（%）			0.080
First onset	7 （41.2）	13 （76.5）
Recurrence	10 （58.8）	4 （23.5）

Radiologist 1	MRI functional imaging group			MRI conventional imaging group
	Radiologist 2		κ value	Radiologist 2		κ value
	Yes/ n	No/ n	κ value	Yes/ n	No/ n	κ value
Yes/ n	5	1	0.866	5	2	0.514
No/ n	0	11		2	8

Radiologist 1	MRI functional imaging group			MRI conventional imaging group
	Radiologist 2		κ value	Radiologist 2		κ value
	Yes/ n	No/ n	κ value	Yes/ n	No/ n	κ value
Yes/ n	5	1	0.866	5	2	0.514
No/ n	0	11		2	8

Radiologist 1	MRI functional imaging group			MRI conventional imaging group
	Radiologist 2		κ value	Radiologist 2		κ value
	Yes/ n	No/ n	κ value	Yes/ n	No/ n	κ value
Yes/ n	5	1	0.742	3	1	0.549
No/ n	1	10		2	11