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Role of MRI in osteosarcoma for evaluation and prediction of chemotherapy response: correlation with histological necrosis

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Abstract

Background

Histological necrosis, the current standard for response evaluation in osteosarcoma, is attainable after neoadjuvant chemotherapy.

Objective

To establish the role of surrogate markers of response prediction and evaluation using MRI in the early phases of the disease.

Materials and methods

Thirty-one treatment-naïve osteosarcoma patients received three cycles of neoadjuvant chemotherapy followed by surgery during 2006–2008. All patients underwent baseline and post-chemotherapy conventional, diffusion-weighted and dynamic contrast-enhanced MRI. Taking histological response (good response ≥90% necrosis) as the reference standard, various parameters of MRI were compared to it. A tumor was considered ellipsoidal; volume, average tumor plane and its relative value (average tumor plane relative/body surface area) was calculated using the standard formula for ellipse. Receiver operating characteristic curves were generated to assess best threshold and predictability. After deriving thresholds for each parameter in univariable analysis, multivariable analysis was carried out.

Results

Both pre-and post-chemotherapy absolute and relative-size parameters correlated well with necrosis. Apparent diffusion coefficient did not correlate with necrosis; however, on adjusting for volume, significant correlation was found. Thus, we could derive a new parameter: diffusion per unit volume.

Conclusion

In osteosarcoma, chemotherapy response can be predicted and evaluated by conventional and diffusion-weighted MRI early in the disease course and it correlates well with necrosis. Further, newly derived parameter diffusion per unit volume appears to be a sensitive substitute for response evaluation in osteosarcoma.

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Authors and Affiliations

  1. Department of Medical Oncology, All India Institute of Medical Sciences, Dr. B. R. A. Institute Rotary Cancer Hospital, New Delhi, 110029, India

    Jyoti Bajpai & Sameer Bakhshi

  2. Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India

    Shivanand Gamnagatti

  3. Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India

    Rakesh Kumar & Arun Malhotra

  4. Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India

    Vishnubhatla Sreenivas

  5. Department of Pathology, All India Institute of Medical Sciences, New Delhi, India

    Mehar Chand Sharma & Rajni Safaya

  6. Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India

    Shah Alam Khan & Shishir Rastogi

Authors
  1. Jyoti Bajpai
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  2. Shivanand Gamnagatti
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  3. Rakesh Kumar
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  4. Vishnubhatla Sreenivas
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  6. Shah Alam Khan
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  8. Arun Malhotra
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  9. Rajni Safaya
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  10. Sameer Bakhshi
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Corresponding author

Correspondence to Sameer Bakhshi.

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Bajpai, J., Gamnagatti, S., Kumar, R. et al. Role of MRI in osteosarcoma for evaluation and prediction of chemotherapy response: correlation with histological necrosis. Pediatr Radiol 41, 441–450 (2011). https://doi.org/10.1007/s00247-010-1876-3

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  • DOI: https://doi.org/10.1007/s00247-010-1876-3

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