Soft tissue sarcoma: correlation of dynamic contrast-enhanced magnetic resonance imaging features with HIF-1a expression and patient outcomes

Background: To investigate the value of dynamic contrast-enhanced magnetic resonance imaging (DCEMRI) features for predicting hypoxia-inducible factor 1-alpha (HIF-1 alpha) expression and patient outcomes in soft tissue sarcoma (STS). Methods: We enrolled 71 patients with STS who underwent 3.0 Tesla (3.0T) MRI, including conventional MRI and DCE-MRI sequencing. The location, maximum tumor diameter, envelope, T2-weighted tumor heterogeneity, peritumoral edema, peritumoral enhancement, necrosis, configuration, tail-like pattern, bone invasion, and vessel/nerve invasion and/or encasement of the STSs were determined using conventional MRI images. The DCE-MRI parameters, including the volume transfer constant (Ktrans), reflux rate (Kep), volume fraction of extravascular extracellular matrix (Ve), and time-signal intensity curve (TIC) type, of each lesion were independently analyzed by two observers. Independent samples t-test, chi-square test, and Mann-Whitney U-test were performed to evaluate the differences in the MRI features between the two groups. The relationships between the DCE-MRI parameters and HIF-1 alpha expression were analyzed using Spearman's correlation analysis. The Cox proportional hazards model and Kaplan-Meier method were used for survival analysis. Results: Of the conventional MRI features, high heterogeneity, peritumoral enhancement, necrosis, and multilobulation of the T2-weighted tumor were prone to occur in the high-expression group. Of the DCE-MRI parameters, the high-expression group showed significantly higher K-rans (0.311 +/- 0.091 vs. 0.210 +/- 0.058 min-1), and Kep values (0.896 +/- 0.656 vs. 0.444 +/-.300 min-1) than the low-expression group. No significant differences in TIC types and Ve values were observed between the low-and high-expression groups (P > 0.05). There were positive correlations between Kt(rans) and Kep values with HIF-1 alpha expression (r=0.705, P < 0.001; r=0.123, P < 0.001, respectively). Receiver operating characteristic (ROC) analysis indicated high specificity (93.9%) of the K-rans value for predicting high expression of HIF-1 alpha. The K-ep value provided the best performance in diagnostic sensitivity (84.2%). Survival analyses revealed that more than 50% necrosis, multilobulation, and K-rans values greater than 0.262 min-1 were strongly associated with a higher risk of death. Conclusions: Conventional MRI features and DCE-MRI parameters were significantly helpful in determining HIF-1 alpha expression levels and predicting the overall survival (OS) of patients with STS.