Intravoxel Incoherent Motion and Dynamic Contrast-Enhanced Magnetic Resonance Imaging Can Differentiate Between Atypical Cartilaginous Tumors and High-Grade Chondrosarcoma: Correlation With Histological Vessel Characteristics

Objective : To differentiate between atypical cartilaginous tumors and high-grade chondrosarcoma of the major long bones using intravoxel incoherent motion (IVIM) and Dynamic Contrast-Enhanced magnetic resonance imaging (DCE-MRI), and explore the correlation of quantitative parameters with hypoxia inducible factor-1 alpha (HIF-1 alpha), vascular endothelial growth factor (VEGF) and microvessel density (MVD).Method : Between September 2016 and March 2022, 35 patients (17 atypical cartilaginous tumors, 18 high-grade chondrosarcoma) underwent MRI examination and pathological confirmation at our hospital. First, IVIM-derived parameters (D, D*, and f), and DCE-MRI parameters (K-trans, K-ep, and V-e) were measured, and intraclass correlation efficient (ICC) and Mann-Whitney U test were performed. Second, receiver-operating characteristic curve analysis was performed to evaluate the diagnostic performance. Finally, Spearman's correlation analysis was performed between the quantitative parameters of IVIM-DWI and DCE-MRI and the immunohistochemical factors HIF-1 alpha, VEGF, and MVD in chondrosarcoma tissue.Results : D in atypical cartilaginous tumors was significantly higher than that in high-grade chondrosarcoma (P = 0.003), whereas D*, K-trans, and K-ep in atypical cartilaginous tumors were significantly lower than those in high-grade chondrosarcoma (all P < 0.001). K-trans demonstrated the highest area under the curve (AUC) of 0.979. The D*, K-trans, and K-ep were positively correlated with HIF-1 alpha, VEGF, and MVD (all P < 0.001), whereas D had no correlation with HIF-1 alpha, VEGF, and MVD (P = 0.113, 0.077, 0.058, respectively).Conclusion : The IVIM-DWI quantitative parameters (D, D*) and DCE-MRI quantitative parameters (K-trans, K-ep) are helpful to differentiate between atypical cartilaginous tumors and high-grade chondrosarcoma and could be imaging biomarkers to reflect the expressions of HIF-1 alpha, VEGF, and angiogenesis of chondrosarcoma.