Quantitative magnetic resonance imaging (q-MRI) for the assessment of soft-tissue sarcoma treatment response: a narrative case review of technique development

Soft-tissue sarcomas are a heterogeneous class of tumors that exhibit varying degrees of cellularity and cystic degeneration in response to neoadjuvant chemotherapy. This creates unique challenges in the radiographic assessment of treatment response when relying on conventional markers such as tumor diameter (RECIST criteria). In this case series, we provide a narrative discussion of technique development for whole tumor volume quantitative magnetic resonance imaging (q-MRI), highlighting cases from a small pilot study of 8 patients (9 tumors) pre- and post-neoadjuvant chemotherapy. One of the methods of q-MRI analysis (the “constant-cutoff” technique) was able to predict responders versus non-responders based on percent necrosis and viable tumor volume calculations (p = 0.05), respectively. Our results suggest that q-MRI of whole tumor volume contrast enhancement may have a role in tumor response assessment, although further validation is needed. •Soft-tissue sarcomas may not shrink in response to chemotherapy despite adequate treatment.•Decreased attenuation or contrast enhancement more accurately predicts sarcoma treatment response.•Quantitative MRI of sarcomas can estimate necrosis and viable tumor volume to assess treatment response.