The Role of Quantitative DCE-MRI and Diffusion-Weighted Imaging in Differentiating the Grade of Soft Tissue Sarcomas

Abstract

Objective: Tumor grade is critical for prognosis, metastatic risk, and treatment planning in soft tissue sarcomas (STSs). This study evaluated the role of quantitative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) parameters and diffusion-weighted imaging (DWI) in predicting STS grade.

Methods: Between March 2022 and February 2023, patients with histopathologically confirmed STS who underwent DCE-MRI and DWI were retrospectively included; those with prior therapy or liposarcoma were excluded. Two musculoskeletal radiologists (3 and 4 years of experience) reviewed the exams. Age, gender, and tumor diameter (LD) were recorded. Dynamic contrast-enhanced magnetic resonance imaging measurements were obtained from Ktrans maps, avoiding hemorrhagic, necrotic, and cystic areas. Regions of interest were placed over the most perfused region (max) and a broader area (mean). Parameters (Ktrans, area under the curve [AUC], Kep, Ve) and enhancement curves were documented. Apparent diffusion coefficient (ADC)_min and ADC_mean were measured from ADC maps. Soft tissue sarcomas were grouped by pathological grade (1-3) and as low (1-2) vs. high (3).

Results: Fourteen patients (3 females, 11 males) were included: 4 grade 1, 2 grade 2, and 8 grade 3. Mean age was 58.07 ± 16.35 years; mean LD 113.36 ± 36.87 mm. Inter-observer agreement was excellent for perfusion max values and ADCmin, and good for perfusion mean and ADC_mean. No significant differences were found in age or LD. Apparent diffusion coefficient (ADC)_mean (P = .026), ADC_min (P = .029), and AUC_max (P = .047) differed among grades. In low- vs. high-grade comparison, ADC_mean, ADC_min, Ktrans_max, AUC_max, and Ktrans_mean were significant.

Conclusion: Apparent diffusion coefficient (ADC)_min, ADC_mean, AUC_max, Ktrans_max, and Ktrans_mean may support STS grading.

Cite this article as: Peker A, Çeliksöz AH, Özen Atalay H, Canturk EM, Şentürk YE. The role of quantitative DCE-MRI and diffusion-weighted imaging in differentiating the grade of soft tissue sarcomas. Cerrahpaşa Med J. 2026, 50, 0074, doi: 10.5152/ cjm.2026.25074.