Prognostic value of clinical and MRI features in the screening of lipomatous lesions

Background and objectives: Differentiation of lipomatous tumors mostly requires diagnostic biopsy but is essential to decide for the most adequate therapy. This study aims to investigate the prognostic value of available clinical and radiological features with regard to malignancy of the lesion, recurrence and survival.Methods: In this retrospective cohort study, 104 patients with a biopsy-proven lipomatous tumor between 2010 and 2015 and a minimum clinical follow-up of two years were enrolled. Next to clinical features (age, gender, location of the lesion, histopathologic diagnosis, stage of disease, time to recurrence and death), MRI parameters were recorded retrospectively and blinded to the histological diagnosis.Results: Malignant lipomatous tumors were associated with location in the lower extremities and MRI features like thick septation (>2 mm), presence of a non-adipose mass, foci of high T2/STIR signal and contrast agent enhancement. A non-adipose mass was a predictor for recurrence and inferior overall survival, while lesions with high T2/STIR signal showed higher risk of recurrence only. In combination, clinical and radiological features (lower extremities, septation > 2 mm, existence of non-adipose mass, contrast enhancement, and foci of high T2/ STIR signal) predicted a malignant lipomatous tumor with an accuracy of 0.941 (95% CI of 0.899-0.983; 87% sensitivity, 86% specificity).Conclusion: Localization and characteristic MR features predict malignancy in most lipomatous lesions. Non adipose masses are a poor prognostic factor, being associated with tumor recurrence and disease-related death.