Shinnhuey Shirley Chou MD, Presenter: Nothing to Disclose

Kurt Friedrich Scherer MD, Abstract Co-Author: Nothing to Disclose

Daniel S. Hippe MS, Abstract Co-Author: Research Grant, Koninklijke Philips NV Research Grant, General Electric Company

Amie Yoo Youn Lee MD, Abstract Co-Author: Nothing to Disclose

Jack Anthony Porrino MD, Abstract Co-Author: Nothing to Disclose

Darin J. Davidson, Abstract Co-Author: Nothing to Disclose

Felix Sze-Kway Chew MD, Abstract Co-Author: Nothing to Disclose

Alice S. Ha MD, Abstract Co-Author: Nothing to Disclose

MRI with gadolinium-based contrast (Gd) is used to screen for recurrence after soft tissue sarcoma (STS) treatment. Previously, we failed to demonstrate that Gd improved the detection of recurrent STS in our population, although Gd-enhancing recurrences were more conspicuous. We hypothesized that Gd could improve diagnostic performance, especially for readers without high levels of expertise. 

This prospective reader study was IRB-approved and HIPAA compliant. From patients undergoing MRI for possible STS recurrence, we selected 26 (13 with recurrence, 13 without) who had MRI without and with Gd (52 total scans). 4 readers of differing expertise (radiology resident, fellow, and attending; and tumor surgeon), blinded to the diagnosis, rated each MRI for recurrence on a 7-point scale to create receiver operating characteristic (ROC) curves. Net reclassification index (NRI) was used to evaluate changes in confidence.

All readers discriminated recurrence from non-recurrence; areas under the ROC curves ranged from 0.976 to 1.0 without Gd and from 0.997 to 1.0 with Gd (p>0.1 for improvement for each reader). However, NRI showed that with Gd, diagnostic confidence improved for resident (p<0.001), fellow (p=0.001), and surgeon (p=0.001), but not attending (p=0.17). The resident showed more confidence for both assigning and excluding recurrence; the fellow showed more confidence assigning recurrence only; and the surgeon showed more confidence in excluding recurrence only.

Gd does not improve the detection of recurrent soft tissue sarcoma by MRI, but may improve the confidence level depending on the reader’s expertise.

Gd is not necessary in the detection of local STS recurrence, but may be helpful in improving confidence depending on the reader’s expertise. Costs and potential morbidity associated with Gd could be eliminated, with the same diagnostic results.

Chou, S, Scherer, K, Hippe, D, Lee, A, Porrino, J, Davidson, D, Chew, F, Ha, A, MRI with Gadolinium-based Contrast for Locally Recurrent Soft Tissue Sarcoma: A Prospective Reader Study.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14005909.html