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Mosher TJ, Kransdorf MJ, Adler R, Appel M, Beaman FD, Bernard SA, Bruno MA, Dempsey ME, Fries IB, Khoury V, Khurana B, Roberts CC, Tuite MJ, Ward RJ, Zoga AC, Weissman BN. ACR Appropriateness Criteria acute trauma to the ankle. J Am Coll Radiol 2016; 12:221-7. [PMID: 25743919 DOI: 10.1016/j.jacr.2014.11.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 11/20/2014] [Indexed: 12/26/2022]
Abstract
Acute ankle injuries are frequently diagnosed and treated in emergency departments and outpatient clinics. Recent evidence-based clinical treatment guidelines and systematic review of economic analyses support the use of 3-view (anteroposterior, lateral, and mortise) radiographic evaluation of patients meeting the criteria of the Ottawa ankle rules. Cross-sectional imaging has a limited secondary role primarily as a tool for preoperative planning and as a problem-solving technique in patients with persistent symptoms and suspected of having occult fractures. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
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Roberts CC, Kransdorf MJ, Beaman FD, Adler RS, Amini B, Appel M, Bernard SA, Fries IB, Germano IM, Greenspan BS, Holly LT, Kubicky CD, Lo SSM, Mosher TJ, Sloan AE, Tuite MJ, Walker EA, Ward RJ, Wessell DE, Weissman BN. ACR Appropriateness Criteria Follow-Up of Malignant or Aggressive Musculoskeletal Tumors. J Am Coll Radiol 2016; 13:389-400. [PMID: 26922595 DOI: 10.1016/j.jacr.2015.12.019] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 12/16/2015] [Indexed: 02/07/2023]
Abstract
Appropriate imaging modalities for the follow-up of malignant or aggressive musculoskeletal tumors include radiography, MRI, CT, (18)F-2-fluoro-2-deoxy-D-glucose PET/CT, (99m)Tc bone scan, and ultrasound. Clinical scenarios reviewed include evaluation for metastatic disease to the lung in low- and high-risk patients, for osseous metastatic disease in asymptomatic and symptomatic patients, for local recurrence of osseous tumors with and without significant hardware present, and for local recurrence of soft tissue tumors. The timing for follow-up of pulmonary metastasis surveillance is also reviewed. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
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Garner HW, Kransdorf MJ. Musculoskeletal Sarcoma: Update on Imaging of the Post-treatment Patient. Can Assoc Radiol J 2016; 67:12-20. [DOI: 10.1016/j.carj.2014.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 11/18/2014] [Indexed: 12/30/2022] Open
Abstract
Post-treatment imaging of musculoskeletal sarcoma remains challenging, but newer imaging techniques are improving our ability to recognize both local and distant recurrence and accurately distinguish local recurrence from post-treatment change. We review recent advances in dynamic contrast-enhanced magnetic resonance imaging, diffusion-weighted magnetic resonance imaging with apparent diffusion coefficient mapping and positron emission tomography/computed tomography in the post-treatment follow-up of musculoskeletal sarcoma. We also describe our multidisciplinary sarcoma team approach to patient care and the essential role of the radiologist in the clinical follow-up scheme.
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Murphey MD, Foreman KL, Klassen-Fischer MK, Fox MG, Chung EM, Kransdorf MJ. From the radiologic pathology archives imaging of osteonecrosis: radiologic-pathologic correlation. Radiographics 2015; 34:1003-28. [PMID: 25019438 DOI: 10.1148/rg.344140019] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Osteonecrosis is common and represents loss of blood supply to a region of bone. Common sites affected include the femoral head, humeral head, knee, femoral/tibial metadiaphysis, scaphoid, lunate, and talus. Symptomatic femoral head osteonecrosis accounts for 10,000-20,000 new cases annually in the United States. In contradistinction, metadiaphyseal osteonecrosis is often occult and asymptomatic. There are numerous causes of osteonecrosis most commonly related to trauma, corticosteroids, and idiopathic. Imaging of osteonecrosis is frequently diagnostic with a serpentine rim of sclerosis on radiographs, photopenia in early disease at bone scintigraphy, and maintained yellow marrow at MR imaging with a serpentine rim of high signal intensity (double-line sign) on images obtained with long repetition time sequences. These radiologic features correspond to the underlying pathology of osseous response to wall off the osteonecrotic process and attempts at repair with vascularized granulation tissue at the reactive interface. The long-term clinical importance of epiphyseal osteonecrosis is almost exclusively based on the likelihood of overlying articular collapse. MR imaging is generally considered the most sensitive and specific imaging modality both for early diagnosis and identifying features that increase the possibility of this complication. Treatment subsequent to articular collapse and development of secondary osteoarthritis typically requires reconstructive surgery. Malignant transformation of osteonecrosis is rare and almost exclusively associated with metadiaphyseal lesions. Imaging features of this dire sequela include aggressive bone destruction about the lesion margin, cortical involvement, and an associated soft-tissue mass. Recognizing the appearance of osteonecrosis, which reflects the underlying pathology, improves radiologic assessment and is important to guide optimal patient management.
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Tuite MJ, Kransdorf MJ, Beaman FD, Adler RS, Amini B, Appel M, Bernard SA, Dempsey ME, Fries IB, Greenspan BS, Khurana B, Mosher TJ, Walker EA, Ward RJ, Wessell DE, Weissman BN. ACR Appropriateness Criteria Acute Trauma to the Knee. J Am Coll Radiol 2015; 12:1164-72. [DOI: 10.1016/j.jacr.2015.08.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 08/16/2015] [Indexed: 01/03/2023]
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Bancroft LW, Kransdorf MJ, Adler R, Appel M, Beaman FD, Bernard SA, Bruno MA, Dempsey ME, Fries IB, Khoury V, Khurana B, Mosher TJ, Roberts CC, Tuite MJ, Ward RJ, Zoga AC, Weissman BN. ACR Appropriateness Criteria Acute Trauma to the Foot. J Am Coll Radiol 2015; 12:575-81. [DOI: 10.1016/j.jacr.2015.02.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 02/18/2015] [Indexed: 12/23/2022]
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Kohl CA, Chivers FS, Lorans R, Roberts CC, Kransdorf MJ. Accuracy of chemical shift MR imaging in diagnosing indeterminate bone marrow lesions in the pelvis: review of a single institution's experience. Skeletal Radiol 2014; 43:1079-84. [PMID: 24781818 DOI: 10.1007/s00256-014-1886-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 03/28/2014] [Accepted: 03/30/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To re-assess the accuracy of chemical shift imaging in diagnosing indeterminate bone marrow lesions as benign or malignant. MATERIALS AND METHODS We retrospectively reviewed our experience with MR imaging of the pelvis to assess the accuracy of chemical shift imaging in distinguishing benign from malignant bone lesions. Two musculoskeletal radiologists retrospectively reviewed all osseous lesions biopsied since 2006, when chemical shift imaging was added to our routine pelvic imaging protocol. Study inclusion criteria required (1) MR imaging of an indeterminate bone marrow lesion about the pelvis and (2) subsequent histologic confirmation. The study group included 50 patients (29 male, 21 female) with an average age of 67 years (range, 41-89 years). MR imaging results were evaluated using biopsy results as the "gold standard." RESULTS There were 27 malignant and 23 benign lesions. Chemical shift imaging using an opposed-phase signal loss criteria of less than 20 % to indicate a malignant lesion, correctly diagnosed 27/27 malignant lesions and 14/23 benign lesions, yielding a 100 % sensitivity, 61 % specificity, 75 % PPV, 100 % NPV, and 82 % accuracy. The area under the receiver operator characteristic (ROC) curve was 0.88. The inter-rater and intra-rater agreement K values were both 1.0. CONCLUSIONS Chemical shift imaging is a useful adjunct MR technique to characterize focal and diffuse marrow abnormalities on routine non-contrast pelvic imaging. It is highly sensitive in identifying malignant disease. Despite its lower specificity, the need for biopsy could be eliminated in more than 60 % of patients with benign disease.
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Ward RJ, Weissman BN, Kransdorf MJ, Adler R, Appel M, Bancroft LW, Bernard SA, Bruno MA, Fries IB, Morrison WB, Mosher TJ, Roberts CC, Scharf SC, Tuite MJ, Zoga AC. ACR Appropriateness Criteria Acute Hip Pain—Suspected Fracture. J Am Coll Radiol 2014; 11:114-20. [DOI: 10.1016/j.jacr.2013.10.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 10/25/2013] [Indexed: 10/25/2022]
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Foreman KL, Kransdorf MJ, O'Connor MI, Krishna M. AIRP Best Cases in Radiologic-Pathologic Correlation: Maffucci Syndrome. Radiographics 2014; 33:861-8. [PMID: 23674779 DOI: 10.1148/rg.333125155] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Murphey MD, Senchak LT, Mambalam PK, Logie CI, Klassen-Fischer MK, Kransdorf MJ. From the Radiologic Pathology Archives: Ewing Sarcoma Family of Tumors: Radiologic-Pathologic Correlation. Radiographics 2013; 33:803-31. [DOI: 10.1148/rg.333135005] [Citation(s) in RCA: 170] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Ginzel AW, Kransdorf MJ, Peterson JJ, Garner HW, Murphey MD. Mass-like extramedullary hematopoiesis: imaging features. Skeletal Radiol 2012; 41:911-6. [PMID: 22101909 DOI: 10.1007/s00256-011-1323-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 10/27/2011] [Accepted: 10/30/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE To report the imaging appearances of mass-like extramedullary hematopoiesis (EMH), to identify those features that are sufficiently characteristic to allow a confident diagnosis, and to recognize the clinical conditions associated with EMH and the relative incidence of mass-like disease. MATERIALS AND METHODS We retrospectively identified 44 patients with EMH; 12 of which (27%) had focal mass-like lesions and formed the study group. The study group consisted of 6 male and 6 female subjects with a mean age of 58 years (range 13-80 years). All 12 patients underwent CT imaging and 3 of the 12 patients had undergone additional MR imaging. The imaging characteristics of the extramedullary hematopoiesis lesions in the study group were analyzed and recorded. The patient's clinical presentation, including any condition associated with extramedullary hematopoiesis, was also recorded. RESULTS Ten of the 12 (83%) patients had one or more masses located along the axial skeleton. Of the 10 patients with axial masses, 9 (90%) had multiple masses and 7 (70%) demonstrated internal fat. Eight patients (80%) had paraspinal masses and 4 patients (40%) had presacral masses. Seven patients (70%) had splenomegaly. Eleven of the 12 patients had a clinical history available for review. A predisposing condition for extramedullary hematopoiesis was present in 10 patients and included various anemias (5 cases; 45%), myelofibrosis/myelodysplastic syndrome (4 cases; 36%), and marrow proliferative disorder (1 case; 9%). One patient had no known predisposing condition. CONCLUSION Mass-like extramedullary hematopoiesis most commonly presents as multiple, fat-containing lesions localized to the axial skeleton. When these imaging features are identified, extramedullary hematopoiesis should be strongly considered, particularly when occurring in the setting of a predisposing medical condition.
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Tuite MJ, Daffner RH, Weissman BN, Bancroft L, Bennett DL, Blebea JS, Bruno MA, Fries IB, Hayes CW, Kransdorf MJ, Luchs JS, Morrison WB, Roberts CC, Scharf SC, Stoller DW, Taljanovic MS, Ward RJ, Wise JN, Zoga AC. ACR appropriateness criteria(®) acute trauma to the knee. J Am Coll Radiol 2012; 9:96-103. [PMID: 22305695 DOI: 10.1016/j.jacr.2011.10.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 10/24/2011] [Indexed: 01/03/2023]
Abstract
There are more than 1 million visits to the ER annually in the United States for acute knee trauma. Many of these are twisting injuries in young patients who can walk and bear weight, and emergent radiography is not required. Several clinical decision rules have been devised that can considerably reduce the number of radiographic studies ordered without missing a clinically significant fracture. Although fractures are seen on only 5% of emergency department knee radiographs, 86% of knee fractures result from blunt trauma. In patients with falls or twisting injuries who have focal tenderness, effusion, or inability to bear weight, radiography should be the first imaging study performed. If radiography shows no fracture, MRI is best for evaluating for a suspected meniscal or ligament tear or patellar dislocation. Patients with knee dislocation should undergo radiography and MRI, as well as fluoroscopic angiography, CT angiography, or MR angiography. The ACR Appropriateness Criteria(®) are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
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Desai MA, Peterson JJ, Garner HW, Kransdorf MJ. Clinical utility of dual-energy CT for evaluation of tophaceous gout. Radiographics 2012; 31:1365-75; discussion 1376-7. [PMID: 21918049 DOI: 10.1148/rg.315115510] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Although diagnosing gout generally is straightforward, atypical disease may present a challenge if it is associated with unusual symptoms or sites, discordant serum urate level, or mimics of gout. Dual-energy computed tomography (CT) may be used to differentiate urate crystals from calcium by using specific attenuation characteristics, which may help diagnose gout. In patients with known tophaceous gout, dual-energy CT may be used for serial volumetric quantification of subclinical tophi to evaluate response to treatment. Given the utility of dual-energy CT in challenging cases and its ability to provide an objective outcomes measure in patients with tophaceous gout, dual-energy CT promises to be a unique and clinically relevant modality in the diagnosis and management of gout.
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Garner HW, Kransdorf MJ, Peterson JJ. Posttherapy Imaging of Musculoskeletal Neoplasms. Radiol Clin North Am 2011; 49:1307-23, vii. [DOI: 10.1016/j.rcl.2011.07.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Desai MA, Peterson JJ, Garner HW, Kransdorf MJ. Authors’ Response. Radiographics 2011. [DOI: 10.1148/radiographics.31.5.3151377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Khanna M, Naraghi AM, Salonen D, Bhumbra R, Dickson BC, Kransdorf MJ, White LM. Massive localised lymphoedema: clinical presentation and MR imaging characteristics. Skeletal Radiol 2011; 40:647-52. [PMID: 21249496 DOI: 10.1007/s00256-010-1080-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 12/02/2010] [Accepted: 12/05/2010] [Indexed: 02/02/2023]
Abstract
Three morbidly obese women were referred to us with suspected soft-tissue sarcomas. All lesions arose from the medial subcutaneous tissues of the thigh, and were shown to represent massive localised lymphoedema (MLL), a rare condition occurring in morbidly obese adults. MR imaging typically demonstrates a sharply demarcated, pedunculated mass consisting of fat partitioned by fibrous septae surrounded by a thickened dermis. There is oedema both within the mass and tracking along the subcutaneous septae in a "lace-like" fashion outwards from the pedicle, outlining large lobules of fat. Minimal enhancement is observed within the dermis of the lesion following intravenous gadolinium administration. Obesity is a growing problem that is likely to result in an increase in the prevalence of this condition; therefore, familiarity with the radiological appearance is important in establishing a correct diagnosis in this condition that may mimic a soft-tissue sarcoma.
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Bernard SA, Murphey MD, Flemming DJ, Kransdorf MJ. Improved differentiation of benign osteochondromas from secondary chondrosarcomas with standardized measurement of cartilage cap at CT and MR imaging. Radiology 2010; 255:857-65. [PMID: 20392983 DOI: 10.1148/radiol.10082120] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE To validate a technique for reproducible measurement of the osteochondroma cartilage cap with computed tomography (CT) and magnetic resonance (MR) imaging and to reevaluate the correlation of the thickness of the cartilage cap with pathologic findings to improve noninvasive differentiation of benign osteochondromas from secondary chondrosarcomas. MATERIALS AND METHODS The institutional review board approved the study and waived the need for informed consent. HIPAA compliance was maintained. After validation of the measurement technique, 101 pathologically confirmed osteochondromas were retrospectively reviewed. Patient demographic data, histologic diagnosis, and chondrosarcoma grade were recorded. Two musculoskeletal radiologists used a standardized technique to independently measure the thicknesses of the cartilage caps on CT and MR images; these measurements were compared for interobserver agreement. Agreement between measurements with CT and MR imaging was also evaluated, as were the sensitivity and specificity of both modalities for differentiation of osteochondromas from chondrosarcomas. RESULTS Evaluated were 67 benign osteochondromas (from 49 male patients and 18 female patients; mean age, 23.4 years) and 34 secondary chondrosarcomas (from 27 male patients and seven female patients; mean age, 33.2 years). On the basis of the proposed measuring technique, there was 88% interobserver measurement agreement with MR imaging (95% confidence interval [CI]: 80%, 94%) and 93% with CT (95% CI: 84%, 98%). The median difference between measurements of cap thickness at CT and MR imaging was 0 cm (25th and 75th percentiles, -3 mm and 1 mm, respectively). With 2 cm used as a cutoff for distinguishing benign osteochondromas from chondrosarcomas, the sensitivities and specificities were 100% and 98% for MR imaging and 100% and 95% for CT, respectively. CONCLUSION The proposed measuring technique allows accurate and reproducible measurement of cartilage cap thickness with both CT and MR imaging. Cap thickness of 2 cm or greater strongly indicated secondary chondrosarcomas.
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Dixon TL, Kransdorf MJ, Krishna M, O’Connor MI. Thigh pain in a 73-year-old man. Clin Orthop Relat Res 2009; 467:3040-5. [PMID: 19184261 PMCID: PMC2758964 DOI: 10.1007/s11999-009-0710-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Accepted: 01/08/2009] [Indexed: 02/09/2023]
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Potter BK, Adams SC, Kransdorf MJ, Thomas Temple H. A 38-year-old man with left knee pain. Clin Orthop Relat Res 2009; 467:2755-9. [PMID: 19184259 PMCID: PMC2745443 DOI: 10.1007/s11999-009-0716-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2008] [Accepted: 01/12/2009] [Indexed: 01/31/2023]
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Moore LF, Kransdorf MJ, Buskirk SJ, O'Connor MI, Menke DM. Radiation-induced pseudotumor following therapy for soft tissue sarcoma. Skeletal Radiol 2009; 38:579-84. [PMID: 19221738 DOI: 10.1007/s00256-009-0653-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2008] [Revised: 01/10/2009] [Accepted: 01/12/2009] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to describe the prevalence and imaging appearance of radiation induced pseudotumors in patients following radiation therapy for extremity soft tissue sarcomas. MATERIALS AND METHODS We retrospectively reviewed the serial magnetic resonance (MR) images of 24 patients following radiation therapy for extremity soft tissue sarcomas. A total of 208 exams were reviewed (mean, 8.7 exams per patient) and included all available studies following the start of radiation therapy. Exams were analyzed for the identification of focal signal abnormalities within the surgical bed suggesting local tumor recurrence. Histopathologic correlation was available in nine patients suspected of having local tumor recurrence. Additional information recorded included patient demographics, tumor type and location, radiation type, and dose. RESULTS The study group consisted of 12 men and 12 women, having an average age of 63 years (range, 39-88 years). Primary tumors were malignant fibrous histiocytoma (n = 13), leiomyosarcoma (n = 6), liposarcoma (n = 3), synovial sarcoma (n = 1), and extraskeletal chondrosarcoma (n = 1). All lesions were high-grade sarcomas, except for two myxoid liposarcomas. Average patient radiation dose was 5,658 cGy (range, 4,500-8,040 cGy). Average follow-up time was 63 months (range, 3-204 months). Focal signal abnormalities suggesting local recurrence were seen in nine (38%) patients. Three of the nine patients with these signal abnormalities were surgically proven to have radiation-induced pseudotumor. The pseudotumors developed between 11 and 61 months following the initiation of radiation therapy (mean, 38 months), with an average radiation dose of 5,527 cGy (range, 5,040-6,500 cGy). MR imaging demonstrated a relatively ill-defined ovoid focus of abnormal signal and intense heterogeneous enhancement with little or no associated mass effect. CONCLUSION MR imaging of radiation-induced pseudotumor typically demonstrates a relatively ill-defined ovoid mass-like focus of intense heterogeneous enhancement with little or no associated mass effect. Imaging follow-up or biopsy may be an alternative course of action to surgical re-exploration if this diagnosis is considered. The study revealed radiation-induced pseudotumor in 12.5% of patients in our extremity study group, suggesting that radiation-induced pseudotumor may be more prevalent than previously reported.
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Bancroft LW, Peterson JJ, Kransdorf MJ. Imaging of soft tissue lesions of the foot and ankle. Radiol Clin North Am 2009; 46:1093-103, vii. [PMID: 19038615 DOI: 10.1016/j.rcl.2008.08.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Differential diagnosis of soft tissue lesions of the foot can be narrowed with imaging. The cystic nature of ganglia, synovial cysts, and bursitis can be confirmed with MR imaging or sonography. Location and signal characteristics of noncystic lesions can suggest Morton's neuroma, giant cell tumor of tendon sheath, and plantar fibromatosis. Synovial-based lesions of the foot and ankle can be differentiated based on presence or absence of mineralization, lesion density, signal intensity, and enhancement pattern. Knowledge of the incidence of specific neoplasms of the foot and ankle based on patient age aids in providing a limited differential diagnosis.
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Garner HW, Kransdorf MJ, Bancroft LW, Peterson JJ, Berquist TH, Murphey MD. Benign and Malignant Soft-Tissue Tumors: Posttreatment MR Imaging. Radiographics 2009; 29:119-34. [DOI: 10.1148/rg.291085131] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Kransdorf MJ. Society of skeletal radiology 2008 annual meeting. Skeletal Radiol 2009; 38:97-100. [PMID: 18594810 DOI: 10.1007/s00256-008-0531-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2008] [Accepted: 05/22/2008] [Indexed: 02/02/2023]
Abstract
Peer-reviewed abstracts presented at the 2008 Society of Skeletal Radiology (SSR) Annual Meeting were reviewed again following oral presentation. Topics representing new concepts, new or novel imaging techniques and instructive case series involving the musculoskeletal system, felt to be of potential interest to investigators and practicing clinicians, have been highlighted in this compilation and analysis.
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Bestic JM, Bancroft LW, Peterson JJ, Kransdorf MJ. Postoperative Imaging of the Total Ankle Arthroplasty. Radiol Clin North Am 2008; 46:1003-15, v-vi. [DOI: 10.1016/j.rcl.2008.08.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Russell JM, Kransdorf MJ, Bancroft LW, Peterson JJ, Berquist TH, Bridges MD. Magnetic resonance imaging of the sacral plexus and piriformis muscles. Skeletal Radiol 2008; 37:709-13. [PMID: 18521595 DOI: 10.1007/s00256-008-0486-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2008] [Revised: 02/24/2008] [Accepted: 03/03/2008] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The objective was to evaluate the piriformis muscles and their relationship to the sacral nerve roots on T1-weighted MRI in patients with no history or clinical suspicion of piriformis syndrome. PATIENTS AND METHODS Axial oblique and sagittal T1-weighted images of the sacrum were obtained in 100 sequential patients (200 pairs of sacral roots) undergoing routine MRI examinations. The relationship of the sacral nerve roots to the piriformis muscles and piriformis muscle size were evaluated, as were clinical symptoms via a questionnaire. RESULTS The S1 nerve roots were located above the piriformis muscle in 99.5% of cases (n=199). The S2 nerve roots were located above the piriformis muscle in 25% of cases (n=50), and traversed the muscle in 75% (n=150). The S3 nerve roots were located above the piriformis muscle in 0.5% of cases (n=1), below the muscle in 2.5% (n=5), and traversed the muscle in 97% (n=194). The S4 nerve roots were located below the muscle in 95% (n=190). The piriformis muscles ranged in size from 0.8-3.2 cm, with an average size of 1.9 cm. Nineteen percent of patients had greater than 3 mm of asymmetry in the size of the piriformis muscle, with a maximum asymmetry of 8 mm noted. CONCLUSION The S1 nerve roots course above the piriformis muscle in more than 99% of patients. The S2 roots traverse the piriformis muscle in 75% of patients. The S3 nerve roots traverse the piriformis muscle in 97% of patients. Piriformis muscle size asymmetry is common, with muscle asymmetry of up to 8 mm identified.
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