Role of Dynamic Contrast-Enhanced MRI in Detecting Post-Treatment Local Recurrence of Soft-Tissue Sarcomas: A Systematic Review and Meta-Analysis

Background: The role of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in detecting soft-tissue sarcoma (STS) local recurrence (LR) following therapeutic intervention was evaluated. Method: PubMed, Embase, and Scopus were systematically searched from January 1990 to 1 February 2024 for studies evaluating DCE-MRI for LR detection in histologically confirmed STS following surgery. Two independent reviewers screened studies and extracted data, and a bivariate diagnostic test accuracy meta-analysis was performed to estimate pooled sensitivity, specificity, and the area under the summary receiver operating characteristic (SROC) curve. Results: Six studies, including 309 patients (110 with LR and 199 without LR), met the inclusion criteria. Across studies, DCE-MRI qualitative features (such as early rapid arterial enhancement and malignant time–intensity curves) and quantitative or semiquantitative parameters (such as volume transfer constants [Ktrans and Kep], initial area under the curve [iAUC], and relative plasma flow [rPF]) consistently differentiated LR from post-treatment change. When DCE-MRI parameters were added to conventional MRI, the pooled sensitivity and specificity for LR detection were 98% and 83%, respectively, with an SROC area under the curve of 0.94, indicating high overall diagnostic accuracy. Conclusions: DCE-MRI increases the accuracy of LR detection when combined with conventional MRI and offers a higher specificity and sensitivity in distinguishing LR from post-surgical changes, which support consideration of adding DCE-MRI when LR is suspected; prospective standardized studies are warranted.