Abstract
BACKGROUND: Soft-tissue sarcomas are rare tumors of the soft tissue. Recent diagnostic studies mainly dealt with conventional image analysis and included only a few cases. This study investigated whether low- and high-proliferative soft tissue sarcomas can be differentiated using conventional imaging and radiomics features on MRI. METHODS: In this retrospective study, soft tissue sarcomas were separated into two groups according to their proliferative activity: high-proliferative (Ki-67 ≥ 20%) and low-proliferative soft tissue sarcomas (Ki-67 < 20%). Several radiomics features, and various conventional imaging features on MRI like tumor heterogeneity, peritumoral edema, peritumoral contrast-enhancement, percentage of ill-defined tumor margins, Apparent Diffusion Coefficient (ADC) values, and area under the curve (AUC) in contrast dynamics were collected. These imaging features were independently compared with the two mentioned groups. RESULTS: 118 sarcoma cases were included in this study. Metastases were more prevalent in high-proliferative soft tissue sarcomas (p < 0.001), and time till metastasis negatively correlated with the Ki-67 proliferation index (k -0.43, p = 0.021). Several radiomics features representing intratumoral heterogeneity differed significantly between both groups, especially in T2-weighted (T2w) and contrast-enhanced T1-weighted (CE-T1w) sequences. Peritumoral contrast enhancement and edema were significantly more common in soft tissue sarcomas with a high Ki-67 index (p < 0.001). Tumor configuration, heterogeneity, and ill-defined margins were commonly seen in high-proliferative soft tissue sarcomas (p = 0.001-0.008). Diffusion restriction (ADC values) and contrast dynamics (AUC values) did not present significant differences between low- and high-proliferative soft tissue sarcomas. CONCLUSIONS: Several radiomics and conventional imaging features indicate a higher Ki-67 proliferation index in soft tissue sarcomas and can therefore be used to distinguish between low- and high-proliferative soft tissue sarcomas.