The value of the black fiber sign on T1-weighted images for predicting stability of desmoid fibromatosis managed conserv
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MAGNETIC RESONANCE
The value of the black fiber sign on T1-weighted images for predicting stability of desmoid fibromatosis managed conservatively Yasutaka Murahashi 1 & Makoto Emori 1 & Junya Shimizu 1 & Ken Anzai 1 & Takaaki Tanaka 2 & Norifumi Naka 2 & Hiroyuki Tsuchie 3 & Hiroyuki Nagasawa 3 & Naohisa Miyakoshi 3 & Yoichi Shimada 3 & Toshihiko Yamashita 1 Received: 7 January 2020 / Revised: 23 March 2020 / Accepted: 12 May 2020 # European Society of Radiology 2020
Abstract Objectives It is challenging to know at the first which patients with desmoid fibromatosis (DF) are better suited to conservative or aggressive treatment. To investigate whether the low signal intensity bundles on T1- or T2-weighted images (WI), termed the “black fiber sign (BFS),” can predict non-progressive behavior in the conservative approach. Methods This retrospective study included 59 patients with primary DF managed with wait-and-see approach from 2005 to 2018 and serial MR images were analyzed. Three observers blinded to the patient information verified the presence or absence of BFS on baseline T1 or T2WI. The likelihood of progression-free survival (PFS) after ascertaining the presence or absence of the BFS was estimated using the Kaplan–Meier method and analyzed with the log-rank test. Results PFS was significantly higher in cases with BFS than without BFS on T1WI (p < 0.01), but there was no significant difference in PFS between cases with and without BFS on T2WI. Multivariable Cox proportional hazards analysis revealed that the absence of BFS on T1WI was a high-risk factor for progression (hazard ratio, 14.9; p < 0.01). Drastic tumor regression was apparent with significantly increased low-signal area in cases with BFS on T1WI. Intra- and interobserver reliabilities of BFS on T1WI were in almost-perfect agreement (κ > 0.8). Conclusion Our retrospective observational data support that presence of BFS in baseline MRI may be a predictor for progression-free survival of DF. BFS on T1WI is easily identifiable and can be utilized clinically in patients with DF. Key Points • We proposed a new imaging marker for prediction of desmoid fibromatosis progression. • The absence of black fiber sign predicted a high risk of disease progression. Keywords Desmoid . Magnetic resonance imaging . Prognostic factors . Observation
Abbreviations BFS Black fiber sign CR Complete response DF Desmoid fibromatosis FAP Familial adenomatous polyposis HR Hazard ratio MRI Magnetic resonance images NSAIDs Non-steroidal anti-inflammatory drugs
PD PFS PR RECIST ROI SD WI
* Yasutaka Murahashi [email protected]
2
Musculoskeletal Oncology Service, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, Osaka 541-8567, Japan
3
Department of Orthopaedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, Akita 010-8543, Japan
1
Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-ku, Sapporo, Hokkaido 060-8543, Japan
Progressive disease Progression-free survival Partia
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