Correlation Of DCE-MRI And IVIM-DWI With VEGF And MVD Expression In Soft Tissue Sarcomas Based On MRI-Pathology

Objective:To explore the correlation between the quantitative parameters of DCE-MRI and IVIM-DWI with VEGF and MVD expression in soft tissue sarcoma based on the MRI-pathology.Materials and Methods:1.Case dataTwenty-two patients with pathologically confirmed soft tissue sarcomas who underwent MRI examination from February 2019 to December 2019 were collected consecutively,with a total of 24 lesions（1 patient contained 3 independent lesions）.All patients signed the informed consent and did not receive pathological biopsy and any clinical treatment before MRI examination,including 11 females and 11 males,aged12-85 years,with an average age of 55±19.68 years.2.MRI technologyUsing American GE Discovery 750W 3.0T MRI scanner,16-channel phased array abdominal coil or large flexible coil were selected according to the location of the tumor.22 patients with soft tissue sarcoma were examined by Conventional MRI,IVIM-DWI,DCE-MRI,and enhanced MRI respectively.3.MRI post-processingDCE-MRI and IVIM-DWI raw data were imported into GE ADW4.7 workstation.The Gen IQ General software was used to process the DCE-MRI data,and the MADC software in Functool was used to process the IVIM-DWI data.The region of interest was selected where the signal of tumor DWI map（b=800s/mm²）was the highest and the enhancement was most obvious,then the quantitative parameters were obtained.4.Comparison method between MRI and PathologyWith the help of pathologists,the imaging region of interest and pathological sampling points were compared according to the imaging-pathological comparison method.5.Immunohistochemical detection and expression analysis.（1）Immunohistochemical detection:With the assistance of pathologists,the solid part of the tumor was selected to make wax blocks according to the MRI-pathological comparison method,and the sections with a thickness of 3μm were cut into sections.（2）Immunohistochemical index expression analysis:Evaluation of VEGF score was performed by using method of Xu Liang zhong,and MVD count was according to method of Weidner.6.Observation indicators（1）Conventional MRI features.（2）Characteristics of DCE-MRI and IVIM-DWI pseudo-color graphs.（3）DCE-MRI quantitative parameters.（4）IVIM-DWI quantitative parameters.（5）Histopathological features.（6）VEGF expression score,MVD value.7.Statistical analysisAll data were analyzed by using SPSS 22.0.Intraclass correlation coefficient was tested to assess inter-reader reliability between the two observers.Pearson correlation method was preformed for normal distribution data to analysis the correlation between VEGF with MVD,the quantitative parameters of DCE-MRI and IVIM-DWI with VEGF and MVD,and the quantitative parameters of DCE-MRI with those of IVIM-DWI,Spearman correlation method was used for non-normally distributed data.Results:1.MRI manifestations of STS.（1）Conventional MRI manifestations:position,boundary,size,shape,signal intensity,enhancement（2）DCE-MRI findings:the solid components of 24 cases of soft tissue sarcoma showed obvious progressive enhancement.（3）IVIM-DWI findings:18 cases showed hyperintense,6 cases showed isointense or slightly hyperintense.2.Quantitative parameter values of DCE-MRI and IVIM-DWI.The average values of Ktrans,Kep,and Ve were 1.00±0.49/min,1.42±0.70/min,0.77±0.14,and the average values of D,D^*,and f were 1.17±0.32×10^-3mm²/s,31.60±17.43×10^-3mm²/s,0.24±0.13.3.Pathological observation.（1）histopathological features.（2）The expression of pathological indexs:VEGF expression score was 4.58±2.44,and MVD value was 46.42±22.21.（3）The correlation among pathological indexes:VEGF expression score was positively correlated with MVD value（r=0.702,p<0.05）.4.The consistency test of the evaluation results of pathological indicators and imaging parameters between observers.The pathological indicators and imaging parameters of the two observers showed good repeatability（ICC>0.75,p<0.05）.5.The correlation between imaging parameters and pathological indicators.（1）The correlation between the quantitative parameters of DCE-MRI and the expression of VEGF and MVD.Ktrans value was positively correlated with VEGF and MVD expression（r=0.788,0.901,p<0.05）,Kep value was positively correlated with VEGF and MVD expression（r=0.683,0.792,p<0.05）,and there was no significant correlation between Ve value with VEGF and MVD expression.（2）The correlation between the quantitative parameters of IVIM-DWI and the expression of VEGF and MVD.D^*value was positively correlated with VEGF and MVD expression（r=0.691,0.749,p<0.05）,f value was positively correlated with VEGF and MVD expression（r=0.520,0.441,p<0.05）,and there was no significant correlation between D value with VEGF and MVD expression.6.The correlation between DCE-MRI and IVIM-DWI perfusion parameters.Ktrans value was positively correlated with D^*,f value（r=0.681,0.547,p<0.05）,Kep value was positively correlated with D^*,f value（r=0.595,0.467,p<0.05）,and there was no significant correlation between Ve value with D^*and f values.Conclusions:Based on the contrast between the MRI and pathology,24 cases of STS DCE-MRI and IVIM-DWI quantitative parameters with pathological indicators VEGF and MVD expression correlation analysis,we draw the following conclusions:1.The quantitative parameters Ktrans and Kep of DCE-MRI are positively correlated with the expression of VEGF and MVD in STS.The higher the Ktrans and Kep values,the higher the expression of VEGF and MVD.The Ktrans and Kep values may be used to evaluate angiogenesis of STS by reflecting VEGF and MVD.2.The quantitative parameters D^*and f of IVIM-DWI are positively correlated with the expression of VEGF and MVD in STS.The higher the D^*and f values,the higher the expression of VEGF and MVD.The D^*and f values may be used to evaluate angiogenesis of STS by reflecting VEGF and MVD.3.The quantitative parameters Ktrans and Kep of DCE-MRI are positively correlated with the quantitative parameters D^*and f of IVIM-DWI,respectively.