Which MRI Features Predict Patients’ Prognosis in Soft Tissue Sarcoma?

Presentation Format: Educational poster presentation.

Purpose or Learning Objective: Soft tissue sarcomas (STS) are a relatively rare group of malignancies. Magnetic resonance imaging (MRI) is considered the best imaging tool to assess STS, offering relevant information to help choose the most useful treatment strategies. Moreover, several MRI features are associated with patients’ prognosis. This educational poster summarizes all the main MRI features related to increased risk of local recurrence and reduced sarcoma-specific survival in patients affected by STS.

Methods or Background: We reviewed the literature on STS MRI and patients’ prognosis. We focused on both general MRI features applicable to all STS subtypes and to features applicable to specific STS subtypes. We checked both original research and review articles. We summarized the most important results, and we described all the MRI features that can provide information for prognosis.

Results or Findings: The size of the lesion is a key element for STS as well as other malignancies. Tumor size seems to be more related to overall survival rather than local recurrence risk in STS.

General MRI features associated with poor prognosis in patients with all types of STS are peritumoral enhancement, signs of necrosis, and signal heterogeneity in T2-weighted sequences. Moreover, some MRI features can predict patient outcome in some specific STS subtypes. Above all, the MRI “tail sign” is a well-known element related to increased risk of local recurrence after excision for undifferentiated pleomorphic sarcoma and myxofibrosarcoma. The tail sign is also linked with an increased risk of metastases at diagnosis in patients affected by myxofibrosarcoma. For synovial sarcoma, the “triple sign” and the absence of intratumoral calcifications are both MRI signs associated with poorer sarcoma-specific survival.

Conclusion: MRI of STS can provide several fundamental elements that may help assess patients’ prognosis. Radiologists must know how to recognize and report all the MRI features useful for the treatment choice and also relevant for prognosis.

Publication History

Article published online:
03 June 2021