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Osteogenic and Ewing sarcomas: estimation of necrotic fraction during induction chemotherapy with dynamic contrast-enhanced MR imaging.

Dynamic contrast material-enhanced magnetic resonance (MR) images of primary osteogenic sarcoma (n = 19) and Ewing sarcoma (n = 10) were reviewed in 29 patients undergoing induction chemotherapy before surgery. Histogram distributions containing the initial slope and pharmacokinetic model parameters from individual voxels within each tumor were fitted for each patient. The histogram analysis of initial slope from the tumor correlated well with percentage necrosis as determined at pathologic examination (r = 0.60, P <.001), as did a two-compartment pharmacokinetic model (r = 0.64, P <.001). Both methods predicted tumors with clinically important degrees of necrosis (ie, > or =90%) in a large majority of cases. The ability to determine response to induction chemotherapy by means of noninvasive monitoring of necrotic fraction with perfusion MR imaging methods may provide useful prognostic information and help surgical planning.