Conventional size-based criteria have limitations in accurately assessing neoadjuvant therapy (NAT) response in soft tissue sarcomas (STS).This systematic review evaluated the association between dynamic contrast-enhanced MRI (DCE-MRI) parameters and histopathology-based response to NAT in STS and summarized which DCE-MRI parameters show the most consistent associations across diverse clinical contexts.Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive search was conducted to identify studies evaluating treatment response to NAT in STS using DCE-MRI.Thirteen studies comprising 234 patients were included.Quantitative DCE-MRI parameters, particularly K trans , showed a strong predictive performance for treatment response and demonstrated high discriminatory ability in several cohorts during both early and late post-treatment phases.Related measures such as K trans , Kep, and Ve also correlated significantly with histopathologic necrosis.Semi-quantitative markers, including the integrated area under the curve in the first 60 seconds after injection (iAUC60), wash-in rate, and time-to-peak, showed consistent associations with tumor perfusion and hypoxia.Qualitative features, including time-intensity curve patterns, effectively differentiated responders from non-responders, with type II curves most strongly associated with favorable outcomes.In conclusion, DCE-MRI, particularly quantitative pharmacokinetic parameters such as K trans , shows promise for assessing treatment response in STS and demonstrates generally concordant associations with histopathology-based response.However, protocol and endpoint heterogeneity and small cohort sizes limit the ability to establish definitive cutoffs and reduce generalizability, highlighting the need for standardized prospective validation.
Mirghaderi et al. (Thu,) studied this question.
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