Table 5.
A summary of the main quantitative features derived from imaging studies associated with a poor prognosis in patients with osteosarcoma.
| Modality, Sequence | Quantitative Imaging Data | Clinical Significance |
|---|---|---|
| DCE-MRI | Lower Ktrans and Vp, change in Kep between inner and outer tumor areas at intermediate evaluation | Good histologic response |
| Lower Ktrans measured inside tumor after NACT | Good histologic response | |
| Decrease in Ktrans from baseline to pre-surgical MRI | Good histologic response | |
| Relative wash-in rate ratio (rWIR) < 2.3 (poor radiological response) | Poor histologic response | |
| Difference between outer and inner values of Ve at baseline | Lower EFS | |
| Lower baseline peritumoral Ve (cut-off = 0.2485) and lower post-chemotherapy intra-tumoral Ktrans (cut-off = 0.2275) | Longer EFS and OS | |
| Lower intra-tumoral Ktrans at baseline and after chemotherapy | Longer OS | |
| DWI | - Mean ADC difference before and after NACT - ADC ratio significantly higher in good responders compared to poor responders |
Higher decrease in good histologic responders |
| - Peritumoral ADC measured in peritumoral area after NACT - Changes in peritumoral ADC from baseline to end of NACT |
Higher decrease in good histologic responders | |
| Higher post-chemotherapy peritumoral ADC | Longer OS | |
| 18F-FDG PET/CT | Low baseline SUVmax (cut-off = 6) | Good histologic response |
| High baseline SUVmax (cut-off = 15) | Lower EFS and PFS | |
| Low post-chemotherapy SUVmax (cut-off = 2–3) | Good histologic response | |
| High post-chemotherapy SUVmax (cut-off = 2.5–5) | Lower EFS and PFS | |
| TBR > 0.46–0.60 | Good histologic response | |
| Decrease in SUVmax between baseline and post-cNACT ≥ 52–60% | Good histologic response | |
| PERCIST criteria | Good histologic response | |
| High baseline MTV (cut-off = 238), | Lower EFS, PFS, and OS | |
| Higher baseline TLG (cut-off = 1022), | Lower OS | |
| Low TLG change (cut-off = 10%) | Lower EFS and PFS |
Abbreviations: ADC: apparent diffusion coefficient, DCE-MRI: dynamic contrast-enhanced MRI, EFS: event-free survival, MTV: metabolic tumor volume, NACT: neoadjuvant chemotherapy, OS: overall survival, PFS: progression-free survival, SUV: standardized uptake value, TBR: tumor-to-background ratio, TLG: total lesion glycolysis.