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The Desmoid Tumor Research Foundation

July 2025

A follow-up study on the novel use of contrast-enhanced susceptibility-weighted imaging for extremity desmoid fibromatosis response assessment

Author Information

Raul F Valenzuela 1, Elvis Duran-Sierra 2, Mathew Antony 2, Behrang Amini 2, Sam Lo 2, Keila E Torres 3, Ken-Pin Hwang 4, Jingfei Ma 4, R Jasson Stafford 4, Ravin Ratan 5, John E Madewell 2, Dejka Araujo 5, William A Murphy Jr 2, Colleen M Costelloe 2

1Department of Musculoskeletal Radiology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA. rfvalenzuela@mdanderson.org. 2Department of Musculoskeletal Radiology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA. 3Department of Surgical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA. 4Department of Imaging Physics, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA. 5Department of Sarcoma Medical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA.

Publication

Sci Rep

Summary

Desmoid tumors are rare mesenchymal neoplasms characterized by a clonal proliferation of fibroblasts and myofibroblasts. Using the novel contrast-enhanced susceptibility-weighted imaging (CE-SWI) for characterizing desmoid tumors can enhance the separation between fibrous T2-hypointense and cellular T1-enhancing components. We aim to evaluate the effectiveness of the CE-SWI signal, volumetric, and radiomics-derived features in assessing desmoid treatment response. This IRB-approved study included 17 single-lesion extremity desmoid fibromatosis patients who underwent standard-of-care MRI, including CE-SWI, from March 2021 to February 2024. Measurements of maximum diameter, volume, and the modified Choi (m-Choi: tumor/muscle T2 ratio) were computed based on CE-SWI and T2-STIR volumetric tumor segmentations. 107 shape, first-order, and textural radiomic features were calculated. Patient response was assessed using conventional RECIST as a reference standard and compared against T2-STIR and CE-SWI volumetric, m-Choi, and radiomics features. RECIST-progression (n = 3): In two patients, CE-SWI volume detected progression 10 months earlier than T2-STIR-based RECIST. Only 33% were characterized as progression by the routine radiologic report (RRR). RECIST-stability (n = 14): 5% exhibited at least one expected first-order response/progression-related change in the mean, skewness, 10th percentile, or 90th percentile, with all four changes present in 33% of cases. In RECIST-progression, CE-SWI showed an average of 15% more voxels at the 90th percentile than T2-STIR. Volume and CE-SWI/T2-STIR shape-derived size dimensional features demonstrated the highest separation between progressive and responding patients. CE-SWI has a higher sensitivity than T2-WI in detecting the active/progressive enhancing component. Volume and Shape-derived and, to a lesser extent, textural radiomic features and m-Choi effectively distinguish between progressive and responding cases, outperforming first-order radiomics, RRR, and RECIST. Particularly, progression prediction by CE-SWI/T2-STIR-volume and response prediction by CE-SWI-m-Choi outperform and precede RRR and RECIST. The novel CE-SWI enhances tumor insight and desmoid treatment-response prediction by effectively separating responding T2-hypointense-collagenized-mature components from potentially progressive T1-shortened/enhancing T2-hyperintense-immature components.

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