Objective To identify MRI features of desmoid tumors (DTs) that predict the growth of residual disease following ablation. Methods Patients who underwent MRI-guided ablation for DTs between February 2013 and April 2021 were included in this single-center IRB-approved retrospective study. MRI scans assessed three suspicious tissue features: intermediate T2 signal [+iT2], nodular appearance [+NOD], and contrast enhancement [+ENH]. Percent-monthly change in diameter (PMCD) of suspicious foci determined growth (PMCD > 1%), unchanged (PMCD between −1% and +1%), or regression (PMCD < −1%). Statistical tests compared mean PMCD between groups and evaluated sensitivity and specificity. Results Thirty-three patients (32 years ± 13.3; 22 females) with 34 DTs underwent 47 MRI-guided ablations, with a median follow-up of 269 days (IQR 147). Of 93 suspicious foci, 62 (67%) grew (PMCD: +5.6% IQR: 5.8), 13 (14%) remained unchanged (PMCD: −0.1% IQR: 0.6), and 18 (19%) regressed (PMCD: −3.9% IQR: 4.2). Features [+iT2], [+ENH], and [+NOD] were associated with PMCDs of +5.2% IQR: 6.0, +3.4% IQR: 6.0, and +3.4% IQR: 6.5, respectively, compared to −1.5% IQR: 4.7 (p < 0.0001), −0.5% IQR: 0.8 (p = 0.003), and +0.4% IQR: 7.5 (p = 0.0056) for their respective negative counterparts. Sensitivity, specificity, and accuracy for distinguishing growth were [+iT2]: 0.95, 0.71, 0.87, [+ENH]: 1.00, 0.32, 0.77, and [+NOD]: 0.84, 0.42, 0.70. Combining [+iT2 + NOD + ENH] yielded PMCD +5.9% IQR: 6.2 and the best performance for distinguishing growth (sensitivity 0.81, specificity 0.94, accuracy 0.85). Discussion MRI features reliably predict the growth of residual or recurrent DTs post-ablation, with [+iT2] being the most accurate. Adding nodular enhancement to [+iT2] improved specificity without sacrificing accuracy. Key Points <Emphasis Type="BoldItalic">Question</Emphasis> Post-ablation imaging of desmoids is challenging due to tumor heterogeneity and treatment-related inflammation. This study evaluates MRI features for assessing future tumor growth. <Emphasis Type="BoldItalic">Findings</Emphasis> Foci of intermediate T2 signal post-ablation predicted desmoid growth with high sensitivity (0.95), while T2 signal, nodularity, and enhancement combined offer high specificity (0.94). <Emphasis Type="BoldItalic">Clinical relevance</Emphasis> Intermediate T2 signal predicts desmoid tumor growth post-ablation with high sensitivity and accuracy but moderate specificity. Combining nodularity and enhancement improves specificity and predictive value, helping clinicians in managing desmoid tumor patients post-ablation.

MRI features that predict progression of residual disease after ablation of extra-abdominal desmoid fibromatosis

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2025年1月21日

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Daniel M. Düx,
Yosef Chodakiewitz,
Rachelle Bitton,
Sharmila Sewell,
Vipul R. Sheth,
Pejman Ghanouni,
Ryan L. Brunsing

摘要

Objective

To identify MRI features of desmoid tumors (DTs) that predict the growth of residual disease following ablation.

Methods

Patients who underwent MRI-guided ablation for DTs between February 2013 and April 2021 were included in this single-center IRB-approved retrospective study. MRI scans assessed three suspicious tissue features: intermediate T2 signal [+iT2], nodular appearance [+NOD], and contrast enhancement [+ENH]. Percent-monthly change in diameter (PMCD) of suspicious foci determined growth (PMCD > 1%), unchanged (PMCD between −1% and +1%), or regression (PMCD < −1%). Statistical tests compared mean PMCD between groups and evaluated sensitivity and specificity.

Results

Thirty-three patients (32 years ± 13.3; 22 females) with 34 DTs underwent 47 MRI-guided ablations, with a median follow-up of 269 days (IQR 147). Of 93 suspicious foci, 62 (67%) grew (PMCD: +5.6% IQR: 5.8), 13 (14%) remained unchanged (PMCD: −0.1% IQR: 0.6), and 18 (19%) regressed (PMCD: −3.9% IQR: 4.2). Features [+iT2], [+ENH], and [+NOD] were associated with PMCDs of +5.2% IQR: 6.0, +3.4% IQR: 6.0, and +3.4% IQR: 6.5, respectively, compared to −1.5% IQR: 4.7 (p < 0.0001), −0.5% IQR: 0.8 (p = 0.003), and +0.4% IQR: 7.5 (p = 0.0056) for their respective negative counterparts. Sensitivity, specificity, and accuracy for distinguishing growth were [+iT2]: 0.95, 0.71, 0.87, [+ENH]: 1.00, 0.32, 0.77, and [+NOD]: 0.84, 0.42, 0.70. Combining [+iT2 + NOD + ENH] yielded PMCD +5.9% IQR: 6.2 and the best performance for distinguishing growth (sensitivity 0.81, specificity 0.94, accuracy 0.85).

Discussion

MRI features reliably predict the growth of residual or recurrent DTs post-ablation, with [+iT2] being the most accurate. Adding nodular enhancement to [+iT2] improved specificity without sacrificing accuracy.

Key Points

Question Post-ablation imaging of desmoids is challenging due to tumor heterogeneity and treatment-related inflammation. This study evaluates MRI features for assessing future tumor growth.

Findings Foci of intermediate T2 signal post-ablation predicted desmoid growth with high sensitivity (0.95), while T2 signal, nodularity, and enhancement combined offer high specificity (0.94).

Clinical relevance Intermediate T2 signal predicts desmoid tumor growth post-ablation with high sensitivity and accuracy but moderate specificity. Combining nodularity and enhancement improves specificity and predictive value, helping clinicians in managing desmoid tumor patients post-ablation.