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Fertitta L, Jannic A, Zehou O, Bergqvist C, Ferkal S, Moryousef S, Lerman L, Mulé S, Luciani A, Bapst B, Ezzedine K, Ortonne N, Itti E, Wolkenstein P. Whole-Body Positron Emission Tomography with 18F-Fluorodeoxyglucose/Magnetic Resonance Imaging as a Screening Tool for the Detection of Malignant Transformation in Individuals with Neurofibromatosis Type 1. J Invest Dermatol 2024; 144:1754-1761.e1. [PMID: 38368929 DOI: 10.1016/j.jid.2024.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 01/23/2024] [Accepted: 01/30/2024] [Indexed: 02/20/2024]
Abstract
Malignant peripheral nerve sheath tumors (MPNSTs) are the leading cause of death in patients with neurofibromatosis type 1. They can result from premalignant neurofibromas, including neurofibromas with atypia and atypical neurofibromatous neoplasms of uncertain biologic potential. Some phenotypic characteristics have been described as associated with their development. The aim of this study was to outline our use of whole-body positron emission tomography with 18F-fluorodeoxyglucose/magnetic resonance imaging in adults with neurofibromatosis type 1, especially in the screening of asymptomatic individuals with a higher risk of developing an MPNST, and to study its impact on neurofibroma classification (malignant vs premalignant) and MPNST staging over time. Individuals with neurofibromatosis type 1 who underwent a positron emission tomography with 18F-fluorodeoxyglucose/magnetic resonance imaging between 2017 and 2021 were included, analyzing separately the screened population. Maximum standard uptake value and diffusion-weighted imaging were assessed. Biopsy/surgery confirmed the diagnosis. In all, 345 positron emission tomography with 18F-fluorodeoxyglucose/magnetic resonance imaging were performed in 241 patients, including 149 asymptomatic (62%) but at-risk patients. Eight MPNSTs in 8 screened individuals (5%), 6 neurofibromas with atypia in 4 individuals (3%), and 29 atypical neurofibromatous neoplasms of uncertain biologic potential in 23 individuals (15%) were diagnosed. Over time, the proportion of grade 3 MPNST and the malignant/premalignant ratio in screened individuals significantly decreased (P = .03 and P < .001, respectively). This study emphasizes the diagnostic and screening performances of whole-body positron emission tomography with 18F-fluorodeoxyglucose/magnetic resonance imaging in adults with neurofibromatosis type 1.
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Affiliation(s)
- Laura Fertitta
- Department of Dermatology, National Referral Center for Neurofibromatoses (CERENEF), Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Créteil, France; INSERM U955, Créteil, France; INSERM, Centre d'Investigation Clinique 1430, Henri-Mondor Hospital, Assistance Publique-Hôpitaux Paris (AP-HP), Créteil, France
| | - Arnaud Jannic
- Department of Dermatology, National Referral Center for Neurofibromatoses (CERENEF), Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Créteil, France; INSERM, Centre d'Investigation Clinique 1430, Henri-Mondor Hospital, Assistance Publique-Hôpitaux Paris (AP-HP), Créteil, France
| | - Ouidad Zehou
- Department of Dermatology, National Referral Center for Neurofibromatoses (CERENEF), Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Créteil, France
| | - Christina Bergqvist
- Department of Dermatology, National Referral Center for Neurofibromatoses (CERENEF), Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Créteil, France
| | - Salah Ferkal
- Department of Dermatology, National Referral Center for Neurofibromatoses (CERENEF), Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Créteil, France; INSERM, Centre d'Investigation Clinique 1430, Henri-Mondor Hospital, Assistance Publique-Hôpitaux Paris (AP-HP), Créteil, France
| | - Sabine Moryousef
- Department of Dermatology, National Referral Center for Neurofibromatoses (CERENEF), Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Créteil, France
| | - Lionel Lerman
- Department of Nuclear Medicine, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Créteil, France
| | - Sébastien Mulé
- Department of Radiology, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Créteil, France; Université Paris-Est Créteil (UPEC), Créteil, France
| | - Alain Luciani
- Department of Radiology, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Créteil, France; Université Paris-Est Créteil (UPEC), Créteil, France
| | - Blanche Bapst
- Department of Neuro-radiology, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Créteil, France
| | - Khaled Ezzedine
- Department of Dermatology, National Referral Center for Neurofibromatoses (CERENEF), Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Créteil, France; INSERM, Centre d'Investigation Clinique 1430, Henri-Mondor Hospital, Assistance Publique-Hôpitaux Paris (AP-HP), Créteil, France; Université Paris-Est Créteil (UPEC), Créteil, France
| | - Nicolas Ortonne
- INSERM U955, Créteil, France; Université Paris-Est Créteil (UPEC), Créteil, France; Department of Pathology, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Créteil, France
| | - Emmanuel Itti
- Department of Nuclear Medicine, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Créteil, France; Université Paris-Est Créteil (UPEC), Créteil, France
| | - Pierre Wolkenstein
- Department of Dermatology, National Referral Center for Neurofibromatoses (CERENEF), Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Créteil, France; INSERM U955, Créteil, France; INSERM, Centre d'Investigation Clinique 1430, Henri-Mondor Hospital, Assistance Publique-Hôpitaux Paris (AP-HP), Créteil, France; Université Paris-Est Créteil (UPEC), Créteil, France.
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2
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Sabeghi P, Katal S, Chen M, Taravat F, Werner TJ, Saboury B, Gholamrezanezhad A, Alavi A. Update on Positron Emission Tomography/Magnetic Resonance Imaging: Cancer and Inflammation Imaging in the Clinic. Magn Reson Imaging Clin N Am 2023; 31:517-538. [PMID: 37741639 DOI: 10.1016/j.mric.2023.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2023]
Abstract
Hybrid PET/MRI is highly valuable, having made significant strides in overcoming technical challenges and offering unique advantages such as reduced radiation, precise data coregistration, and motion correction. Growing evidence highlights the value of PET/MRI in broad clinical aspects, including inflammatory and oncological imaging in adults, pregnant women, and pediatrics, potentially surpassing PET/CT. This newly integrated solution may be preferred over PET/CT in many clinical conditions. However, further technological advancements are required to facilitate its broader adoption as a routine diagnostic modality.
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Affiliation(s)
- Paniz Sabeghi
- Department of Radiology, Keck School of Medicine of University of Southern California, Health Science Campus, 1500 San Pablo Street, Los Angeles, CA 90033, USA
| | - Sanaz Katal
- Medical Imaging Department of St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Michelle Chen
- Department of Radiology, Keck School of Medicine of University of Southern California, Health Science Campus, 1500 San Pablo Street, Los Angeles, CA 90033, USA
| | - Farzaneh Taravat
- Department of Radiology, Keck School of Medicine of University of Southern California, Health Science Campus, 1500 San Pablo Street, Los Angeles, CA 90033, USA
| | - Thomas J Werner
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Babak Saboury
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA; Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA
| | - Ali Gholamrezanezhad
- Department of Radiology, Keck School of Medicine of University of Southern California, Health Science Campus, 1500 San Pablo Street, Los Angeles, CA 90033, USA
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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3
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Goller SS, Reidler P, Rudolph J, Rückel J, Hesse N, Schmidt VF, Dürr HR, Klein A, Lindner LH, Di Gioia D, Kuhn I, Ricke J, Erber B. Impact of postoperative baseline MRI on diagnostic confidence and performance in detecting local recurrence of soft-tissue sarcoma of the limb. Skeletal Radiol 2023; 52:1987-1995. [PMID: 37129611 PMCID: PMC10449988 DOI: 10.1007/s00256-023-04341-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 03/31/2023] [Accepted: 04/09/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVE To evaluate the impact of a postoperative baseline (PB) MRI on diagnostic confidence and performance in detecting local recurrence (LR) of soft-tissue sarcoma (STS) of the limb. MATERIALS AND METHODS A total of 72 patients (8 with LR, 64 without LR) with primary STS of the limb were included. Routine follow-up MRI (1.5 T) at 6 and approximately 36 months (meanLR: 39.7 months; meanno LR: 34.9 months) after multimodal therapy or at time of LR were assessed by three independent readers using a 5-point Likert scale. Furthermore, the following imaging parameters were evaluated: presence of a mass, signal characteristics at T2- and T1-weighted imaging, contrast enhancement (CE), and in some of the cases signal intensity on the apparent diffusion coefficient (ADC). U-test, McNemar test, and ROC-analysis were applied. Interobserver reliability was calculated using Fleiss kappa statistics. A p value of 0.05 was considered statistically significant. RESULTS The presence of a PB MRI significantly improved diagnostic confidence in detecting LR of STS (p < 0.001) and slightly increased specificity (mean specificity without PE 74.1% and with presence of PB MRI 81.2%); however, not to a significant level. The presence of a mass showed highest diagnostic performance and highest interreader agreement (AUC [%]; κ: 73.1-83.6; 0.34) followed by T2-hyperintensity (50.8-66.7; 0.08), CE (52.4-62.5; 0.13), and T1-hypointensity (54.7-77.3; 0.23). ADC showed an AUC of 65.6-96.6% and a κ of 0.55. CONCLUSION The presence of a PB MRI increases diagnostic confidence in detecting LR of STS of the limb.
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Affiliation(s)
| | - Paul Reidler
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Jan Rudolph
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Johannes Rückel
- Institute of Neuroradiology, University Hospital, LMU Munich, Munich, Germany
| | - Nina Hesse
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | | | - Hans Roland Dürr
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Alexander Klein
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | | | - Dorit Di Gioia
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Isabella Kuhn
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Bernd Erber
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
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4
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Song EH, Lee SY, Lee S, Jung JY, Shin SH, Chung YG, Jung CK. Diagnosis of Local Recurrence of Malignant Soft Tissue Tumors after Reconstructive Surgery on MRI. J Clin Med 2023; 12:4369. [PMID: 37445404 DOI: 10.3390/jcm12134369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 06/21/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
PURPOSE Magnetic resonance imaging (MRI) is useful in the diagnosis of local recurrence, but few studies have explored recurrence in MRI in patients after reconstructive surgery. The purpose of this study was to analyze MRI findings of locoregional recurrence following reconstructive surgery after malignant soft tissue tumor resection. METHOD Fifty-three postoperative MRIs from 37 patients who underwent reconstructive surgery after malignant soft tissue tumor resection were retrospectively reviewed. A total of 76 enhancing lesions, including 40 locoregional recurrences and 36 postoperative changes, were analyzed regarding morphology (location on the transplanted tissue, border, and shape) and the signals on T1- and T2-weighted imaging (T1WI, T2WI), fat-suppressed (FS) T2WI, and contrast-enhanced FS T1WI. Diffusion-weighted imaging with an apparent diffusion coefficient was assessed. A chi-squared test and Fisher's exact test were used for statistical analysis. RESULTS The most common site of recurrent tumors and postoperative changes was the peripheral margin on transplanted tissue (63% and 61%, respectively p = 0.907). Recurrent tumors commonly appeared with well-defined borders (75%) as well as nodular appearance (98%), hyperintensity on T2WI (85%) and FS-T2WI (95%), isointensity on T1WI (65%), impeded water diffusion (55%), and intense (50%) or moderate (45%) enhancement. Postoperative changes showed ill-defined borders (75%), nodular appearance (56%), facilitated water diffusion (69%), and moderate (86%) enhancement, which were significantly different from those of recurrent tumors (p ≤ 0.020). CONCLUSIONS Common and partitioning MRI features of locoregional recurrence were well-defined borders, nodular shape, impeded water diffusion, and intense enhancement. Peripheral margins on transplanted tissue were common sites in both recurrent tumors and postoperative changes.
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Affiliation(s)
- Eun-Hee Song
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea
| | - So-Yeon Lee
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
| | - Seungeun Lee
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
| | - Joon-Yong Jung
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
| | - Seung-Han Shin
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
| | - Yang-Guk Chung
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
| | - Chan-Kwon Jung
- Department of Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
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5
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Stanborough R, Demertzis JL, Wessell DE, Lenchik L, Ahlawat S, Baker JC, Banks J, Caracciolo JT, Garner HW, Hentz C, Lewis VO, Lu Y, Maynard JR, Pierce JL, Scott JA, Sharma A, Beaman FD. ACR Appropriateness Criteria® Malignant or Aggressive Primary Musculoskeletal Tumor-Staging and Surveillance: 2022 Update. J Am Coll Radiol 2022; 19:S374-S389. [PMID: 36436964 DOI: 10.1016/j.jacr.2022.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/27/2022]
Abstract
Malignant or aggressive primary musculoskeletal tumors are rare and encompass a wide variety of bone and soft tissue tumors. Given the most common site for metastasis from these primary musculoskeletal tumors is to the lung, chest imaging is integral in both staging and surveillance. Extrapulmonary metastases are rarely encountered with only a few exceptions. Following primary tumor resection, surveillance of the primary tumor site is generally recommended. Local surveillance imaging recommendations differ between primary tumors of bone origin versus soft tissue origin. This document consolidates the current evidence and expert opinion for the imaging staging and surveillance of these tumors into five clinical scenarios. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer-reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer-reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | - Jennifer L Demertzis
- Diagnostic Imaging Associates, Chesterfield, Missouri; Partner, ProSight Radiology.
| | | | - Leon Lenchik
- Panel Vice-Chair, Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - Shivani Ahlawat
- The Johns Hopkins University School of Medicine, Baltimore, Maryland; member
| | - Jonathan C Baker
- MSK Imaging and Interventions Fellowship Director, Mallinckrodt Institute of Radiology Washington University School of Medicine, Saint Louis, Missouri
| | - James Banks
- Nova Southeastern University, Fort Lauderdale, Florida; FRS 2023 Program Chair; ACR alternate counselor from Florida; MSK Section Chair for group; Medical student radiology rotation clerkship director for HCA Florida Aventura and Kendall Hospitals
| | - Jamie T Caracciolo
- Section Head, MSK Imaging, Moffitt Cancer Center and University of South Florida Morsani College of Medicine, Tampa, Florida; MSK-RADS (Bone) Committee; Chairman
| | - Hillary W Garner
- Mayo Clinic Florida, Jacksonville, Florida; Committee Chair, Society of Skeletal Radiology and International Skeletal Society
| | - Courtney Hentz
- Stritch School of Medicine Loyola University Chicago, Maywood, Illinois; Commission on Radiation Oncology
| | - Valerae O Lewis
- University of Texas Health Science Center, Houston, Texas; American Academy of Orthopaedic Surgeons; Chair, Department of Orthopaedic Surgery
| | - Yi Lu
- Brigham & Women's Hospital & Harvard Medical School, Boston, Massachusetts; American Association of Neurological Surgeons/Congress of Neurological Surgeons; Director, Neurosurgical Trauma; Codirector, Spinal Deformity and Scoliosis Surgery Brigham and Women's Hospital; Cochair, Spinal Cord Injury Section, North American Spine Society; Chair, Payor Response
| | - Jennifer R Maynard
- Mayo Clinic Florida, Jacksonville, Florida; Primary care physician; Jacksonville Sports Medicine Program, Chair of the Governing Board; Program Director Sports Medicine Fellowship, Mayo Clinic Florida
| | - Jennifer L Pierce
- University of Virginia, Charlottesville, Virginia; Associate Division Chair, Musculoskeletal Radiology, University of Virginia; Radiology Residency Global Health Leadership Track Program Director, University of Virginia
| | - Jinel A Scott
- Chief Quality Officer, SUNY Downstate Health Sciences University, Brooklyn, New York
| | - Akash Sharma
- Mayo Clinic, Jacksonville, Florida; Commission on Nuclear Medicine and Molecular Imaging; Chair, Research Committee, Radiology, Mayo Clinic Florida; Chair, PET-MRI Workgroup, Mayo Clinic Florida
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6
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Arthur A, Johnston EW, Winfield JM, Blackledge MD, Jones RL, Huang PH, Messiou C. Virtual Biopsy in Soft Tissue Sarcoma. How Close Are We? Front Oncol 2022; 12:892620. [PMID: 35847882 PMCID: PMC9286756 DOI: 10.3389/fonc.2022.892620] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/31/2022] [Indexed: 12/13/2022] Open
Abstract
A shift in radiology to a data-driven specialty has been unlocked by synergistic developments in imaging biomarkers (IB) and computational science. This is advancing the capability to deliver “virtual biopsies” within oncology. The ability to non-invasively probe tumour biology both spatially and temporally would fulfil the potential of imaging to inform management of complex tumours; improving diagnostic accuracy, providing new insights into inter- and intra-tumoral heterogeneity and individualised treatment planning and monitoring. Soft tissue sarcomas (STS) are rare tumours of mesenchymal origin with over 150 histological subtypes and notorious heterogeneity. The combination of inter- and intra-tumoural heterogeneity and the rarity of the disease remain major barriers to effective treatments. We provide an overview of the process of successful IB development, the key imaging and computational advancements in STS including quantitative magnetic resonance imaging, radiomics and artificial intelligence, and the studies to date that have explored the potential biological surrogates to imaging metrics. We discuss the promising future directions of IBs in STS and illustrate how the routine clinical implementation of a virtual biopsy has the potential to revolutionise the management of this group of complex cancers and improve clinical outcomes.
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Affiliation(s)
- Amani Arthur
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, Sutton, United Kingdom
| | - Edward W. Johnston
- Sarcoma Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Jessica M. Winfield
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, Sutton, United Kingdom
- Sarcoma Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Matthew D. Blackledge
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, Sutton, United Kingdom
| | - Robin L. Jones
- Sarcoma Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
| | - Paul H. Huang
- Division of Molecular Pathology, The Institute of Cancer Research, Sutton, United Kingdom
- *Correspondence: Paul H. Huang, ; Christina Messiou,
| | - Christina Messiou
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, Sutton, United Kingdom
- Sarcoma Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
- *Correspondence: Paul H. Huang, ; Christina Messiou,
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7
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Kawai A, Araki N, Ae K, Akiyama T, Ozaki T, Kawano H, Kunisada T, Sumi M, Takahashi S, Tanaka K, Tsukushi S, Naka N, Nishida Y, Miyachi M, Yamamoto N, Yoshida A, Yonemoto T, Yoshida M, Iwata S. Japanese Orthopaedic Association (JOA) clinical practice guidelines on the management of soft tissue tumors 2020 - Secondary publication. J Orthop Sci 2022; 27:533-550. [PMID: 35339316 DOI: 10.1016/j.jos.2021.11.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/05/2021] [Accepted: 11/08/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND These clinical practice guidelines are intended to provide recommendations based on the best evidence obtained to date on key issues in clinical practice to improve the prognosis, diagnostic and therapeutic processes for patients with soft tissue tumors. METHODS The Guidelines Development Committee and Systematic Review Committee were composed of a multidisciplinary team of specialists who play an important role in soft tissue tumor care. Clinical questions (CQs) were determined by choosing key decision-making points based on Algorithms for the diagnosis and treatment of soft tissue tumors. The guidelines were developed according to the "Medical Information Network Distribution Service (Minds) Handbook for Clinical Practice Guideline Development 2014" and "Minds Manual for Clinical Practice Guideline Development 2017." Recommendation strength was rated on two levels and the strength of evidence was rated on four levels. The recommendations were decided based on agreement by 70% or more voters. RESULTS Twenty-two CQs were chosen by the Guidelines Development Committee. The Systematic Review Committee reviewed the evidence concerning each CQ, a clinical value judgment was added by experts, and the text of each recommendation was determined. CONCLUSION We established 22 CQs and recommendations for key decision-making points in the diagnosis and treatment of soft tissue tumors according to the Minds Clinical Practice Guideline development methods. We hope that these guidelines will assist the decision-making of all medical staff engaged in the treatment and diagnosis of soft tissue tumors, and eventually lead to improved soft tissue tumor care in the country.
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Affiliation(s)
- Akira Kawai
- Department of Musculoskeletal Oncology and Rehabilitation Medicine, National Cancer Center Hospital, Tokyo, Japan.
| | - Nobuhito Araki
- Department of Orthopaedic Surgery, Ashiya Municipal Hospital, Hyogo, Japan
| | - Keisuke Ae
- Department of Musculoskeletal Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Japan
| | - Toru Akiyama
- Department of Orthopaedic Surgery, Saitama Medical Center, Jichi Medical University, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Hirotaka Kawano
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Japan
| | - Toshiyuki Kunisada
- Department of Medical Materials for Musculoskeletal Reconstruction, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Minako Sumi
- Radiation Oncology Department, Tokyo Metropolitan Geriatric Hospital, Japan
| | - Shunji Takahashi
- Department of Medical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Japan
| | - Kazuhiro Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Japan
| | | | - Norifumi Naka
- Department of Orthopedic Surgery, NachiKatsuura Town Onsen Hospital, Japan
| | - Yoshihiro Nishida
- Department of Rehabilitation Medicine, Nagoya University Hospital, Japan
| | - Mitsuru Miyachi
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Norio Yamamoto
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Japan
| | - Akihiko Yoshida
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
| | | | - Masahiro Yoshida
- International University of Health and Welfare, Japan Council for Quality Health Care, Japan
| | - Shintaro Iwata
- Department of Musculoskeletal Oncology and Rehabilitation Medicine, National Cancer Center Hospital, Tokyo, Japan
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8
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Gu B, Liu X, Wang S, Xu X, Liu X, Hu S, Yan W, Luo Z, Song S. Head-to-head evaluation of [ 18F]FDG and [ 68 Ga]Ga-DOTA-FAPI-04 PET/CT in recurrent soft tissue sarcoma. Eur J Nucl Med Mol Imaging 2022; 49:2889-2901. [PMID: 35113192 PMCID: PMC9206606 DOI: 10.1007/s00259-022-05700-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 01/20/2022] [Indexed: 02/06/2023]
Abstract
Purpose We aimed to evaluate the value of [68 Ga]Ga-DOTA-FAPI-04 PET/CT for the diagnosis of recurrent soft tissue sarcoma (STS), compared with [18F]FDG PET/CT. Methods A total of 45 patients (21 females and 24 males; median age, 46 years; range, 18–71 years) with 13 subtypes of STS underwent [18F]FDG and [68 Ga]Ga-DOTA-FAPI-04 PET/CT examination within 1 week for assessment local relapse or distant metastasis. Positive lesions on PET/CT images were verified by biopsy or 3-month follow-up. Wilcoxon matched-pairs signed-rank test was used to compare the semiquantitative values (SUVmax and TBR) of [18F]FDG and [68 Ga]Ga-DOTA-FAPI-04 in tumor lesions, and McNemar test was applied to test for differences of both tracers. Results Among the 45 patients, 282 local relapses and distant metastases were identified. Compared to [18F]FDG, [68 Ga]Ga-DOTA-FAPI-04 PET/CT detected more lesions (275 vs. 186) and outperformed in sensitivity, specificity, PPV, NPV, and accuracy for the diagnosis of recurrent lesions (P < 0.001). [68 Ga]Ga-DOTA-FAPI-04 demonstrated significantly higher values of SUVmax and TBR than [18F]FDG PET/CT in liposarcoma (P = 0.011 and P < 0.001, respectively), malignant solitary fibrous tumor (MSFT) (P < 0.001 and P < 0.001, respectively), and interdigitating dendritic cell sarcoma (IDCS) (P < 0.001and P < 0.001, respectively). While mean SUVmax and TBR presented favorable uptake of [18F]FDG over [68 Ga]Ga-DOTA-FAPI-04 in undifferentiated pleomorphic sarcoma (UPS) (P = 0.003 and P < 0.001, respectively) and rhabdomyosarcoma (RMS) (P < 0.001 and P < 0.001, respectively). Conclusion [68 Ga]Ga-DOTA-FAPI-04 PET/CT is a promising new imaging modality for recurrent surveillance of STS, and compares favorably with [18F]FDG for identifying recurrent lesions of liposarcoma, MSFT, and IDCS. Supplementary Information The online version contains supplementary material available at 10.1007/s00259-022-05700-4.
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Affiliation(s)
- Bingxin Gu
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Center for Biomedical Imaging, Fudan University, Shanghai, China.,Shanghai Engineering Research Center of Molecular Imaging Probes, Shanghai, China.,Key Laboratory of Nuclear Physics and Ion-Beam Application (MOE), Fudan University, Shanghai, China
| | - Xin Liu
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Shuoer Wang
- Department of Musculoskeletal Tumor, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Xiaoping Xu
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Center for Biomedical Imaging, Fudan University, Shanghai, China.,Shanghai Engineering Research Center of Molecular Imaging Probes, Shanghai, China.,Key Laboratory of Nuclear Physics and Ion-Beam Application (MOE), Fudan University, Shanghai, China
| | - Xiaosheng Liu
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Center for Biomedical Imaging, Fudan University, Shanghai, China.,Shanghai Engineering Research Center of Molecular Imaging Probes, Shanghai, China.,Key Laboratory of Nuclear Physics and Ion-Beam Application (MOE), Fudan University, Shanghai, China
| | - Silong Hu
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Center for Biomedical Imaging, Fudan University, Shanghai, China.,Shanghai Engineering Research Center of Molecular Imaging Probes, Shanghai, China.,Key Laboratory of Nuclear Physics and Ion-Beam Application (MOE), Fudan University, Shanghai, China
| | - Wangjun Yan
- Department of Musculoskeletal Tumor, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Zhiguo Luo
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
| | - Shaoli Song
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai, China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China. .,Center for Biomedical Imaging, Fudan University, Shanghai, China. .,Shanghai Engineering Research Center of Molecular Imaging Probes, Shanghai, China. .,Key Laboratory of Nuclear Physics and Ion-Beam Application (MOE), Fudan University, Shanghai, China.
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9
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Bajaj G, Callan AK, Weinschenk RC, Chhabra A. Multiparametric Evaluation of Soft Tissue Sarcoma: Current Perspectives and Future Directions. Semin Roentgenol 2022; 57:212-231. [DOI: 10.1053/j.ro.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/31/2022] [Accepted: 02/02/2022] [Indexed: 11/11/2022]
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10
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Kwee RM, Kwee TC. Diagnostic performance of MRI in detecting locally recurrent soft tissue sarcoma: systematic review and meta-analysis. Eur Radiol 2022; 32:3915-3930. [PMID: 35020015 DOI: 10.1007/s00330-021-08457-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 10/04/2021] [Accepted: 11/03/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To systematically review the diagnostic criteria and performance of MRI in detecting locally recurrent soft tissue sarcoma. METHODS Medline and Embase were searched for original studies on the diagnostic performance of MRI detecting locally recurrent soft tissue sarcoma. Study quality was assessed using QUADAS-2. Sensitivity and specificity were pooled using a bivariate random-effects model. RESULTS Ten studies were included. There was a high risk of bias with respect to patient selection in 2 studies and a high risk of bias with respect to flow and timing in 8 studies. The presence of a mass yielded a pooled sensitivity of 80.9% and a pooled specificity of 77.0%. Hyperintensity at T2-weighted imaging yielded a pooled sensitivity of 82.4% and a pooled specificity of 11.0%. Hypo- or isointensity at T1-weighted imaging yielded a pooled sensitivity of 82.0% and a pooled specificity of 14.3%. Contrast enhancement images yielded a pooled sensitivity of 95.9% and a pooled specificity of 12.3%. Low signal mass on the apparent diffusion coefficient (ADC) map yielded a pooled sensitivity of 67.5% and a pooled specificity of 95.3%. Early and rapid arterial phase enhancement at dynamic contrast-enhanced (DCE) MRI yielded a pooled sensitivity of 91.3% and a pooled specificity of 84.7%. CONCLUSION The presence of a mass appears a useful criterion to diagnose locally recurrent soft tissue sarcoma. Signal characteristics at standard T2- and T1-weighted imaging and contrast enhancement seem less useful because they lack specificity. Functional MRI techniques, including DWI with ADC mapping and DCE, may help to make a correct diagnosis. KEY POINTS • The presence of a mass at MRI appears useful to diagnose locally recurrent soft tissue sarcoma, because both sensitivity and specificity are fairly high. • Signal characteristics at standard T2- and T1-weighted sequences and contrast enhancement suffer from poor specificity. • DWI with ADC mapping and DCE may help to make a correct diagnosis, but further research is needed to better understand the value of these functional MRI techniques.
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Affiliation(s)
- Robert M Kwee
- Department of Radiology, Zuyderland Medical Center, Heerlen/Sittard/Geleen, The Netherlands
| | - Thomas C Kwee
- Medical Imaging Center, Department of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
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11
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Seifert R, Kersting D, Rischpler C, Opitz M, Kirchner J, Pabst KM, Mavroeidi IA, Laschinsky C, Grueneisen J, Schaarschmidt B, Catalano OA, Herrmann K, Umutlu L. Clinical Use of PET/MR in Oncology: An Update. Semin Nucl Med 2021; 52:356-364. [PMID: 34980479 DOI: 10.1053/j.semnuclmed.2021.11.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/21/2021] [Accepted: 11/23/2021] [Indexed: 12/30/2022]
Abstract
The combination of PET and MRI is one of the recent advances of hybrid imaging. Yet to date, the adoption rate of PET/MRI systems has been rather slow. This seems to be partially caused by the high costs of PET/MRI systems and the need to verify an incremental benefit over PET/CT or sequential PET/CT and MRI. In analogy to PET/CT, the MRI part of PET/MRI was primarily used for anatomical imaging. Though this can be advantageous, for example in diseases where the superior soft tissue contrast of MRI is highly appreciated, the sole use of MRI for anatomical orientation lessens the potential of PET/MRI. Consequently, more recent studies focused on its multiparametric potential and employed diffusion weighted sequences and other functional imaging sequences in PET/MRI. This integration puts the focus on a more wholesome approach to PET/MR imaging, in terms of releasing its full potential for local primary staging based on multiparametric imaging and an included one-stop shop approach for whole-body staging. This approach as well as the implementation of computational analysis, in terms of radiomics analysis, has been shown valuable in several oncological diseases, as will be discussed in this review article.
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Affiliation(s)
- Robert Seifert
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany; Department of Nuclear Medicine, University Hospital Münster, Münster, Germany; West German Cancer Center, University Hospital Essen, Essen, Germany.; German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany.
| | - David Kersting
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany; West German Cancer Center, University Hospital Essen, Essen, Germany.; German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
| | - Christoph Rischpler
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany; West German Cancer Center, University Hospital Essen, Essen, Germany.; German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
| | - Marcel Opitz
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Julian Kirchner
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Dusseldorf, Germany
| | - Kim M Pabst
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany; West German Cancer Center, University Hospital Essen, Essen, Germany.; German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
| | - Ilektra-Antonia Mavroeidi
- West German Cancer Center, University Hospital Essen, Essen, Germany.; Clinic for Internal Medicine (Tumor Research), University Hospital Essen, Essen, Germany
| | - Christina Laschinsky
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany; West German Cancer Center, University Hospital Essen, Essen, Germany.; German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
| | - Johannes Grueneisen
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Benedikt Schaarschmidt
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Onofrio Antonio Catalano
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA; Abdominal Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany; West German Cancer Center, University Hospital Essen, Essen, Germany.; German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
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12
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Mills MK, Leake RL, Crawford AM, Soltanolkotabi M, Hansford BG. Concepts in Musculoskeletal Bone and Soft Tissue Biopsy. Semin Musculoskelet Radiol 2021; 25:711-724. [PMID: 34937112 DOI: 10.1055/s-0041-1735471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Imaging-guided needle biopsy of musculoskeletal lesions is a high-yield and low-risk procedure that can be used for definitive characterization of indeterminate bone and soft tissue lesions. Familiarity with the preprocedural, technical, and postprocedural steps is vital for the appropriate management of these cases. Biopsy request triage requires an awareness of definitively benign conditions and other tumor mimics. A complete clinical, laboratory, and imaging work-up is essential for procedural planning and determining pathologic concordance. Consultation with an orthopaedic oncologist is a requisite step to ensure maximizing biopsy yield and to avoid interference with any future limb-sparing surgical intervention. Knowledge of the equipment, pertinent medications, and appropriate biopsy technique can minimize the risk of periprocedural complications. Finally, the radiologist may be required to discuss the concordance of histopathology with preprocedure imaging, perform repeat image-guided biopsy, and carefully interpret sarcoma surveillance imaging examinations.
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Affiliation(s)
- Megan K Mills
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah
| | - Richard L Leake
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah
| | - Amanda M Crawford
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah
| | - Maryam Soltanolkotabi
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah
| | - Barry G Hansford
- Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Oregon
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13
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Husseini JS, Balza R, Evangelista L, Cañamaque LG, Catalano OA. PET/MR for evaluation of musculoskeletal malignancies. Clin Transl Imaging 2021. [DOI: 10.1007/s40336-021-00470-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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14
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Galgano SJ, Calderone CE, Xie C, Smith EN, Porter KK, McConathy JE. Applications of PET/MRI in Abdominopelvic Oncology. Radiographics 2021; 41:1750-1765. [PMID: 34597228 DOI: 10.1148/rg.2021210035] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
With PET/MRI, the strengths of PET and MRI are combined to allow simultaneous image acquisition and near-perfect image coregistration. MRI is increasingly being used for staging and restaging of abdominopelvic oncologic lesions, including prostate, hepatobiliary, pancreatic, neuroendocrine, cervical, and rectal cancers. Fluorine 18-fluorodeoxyglucose PET/CT has long been considered a cornerstone of oncologic imaging, and the development of multiple targeted radiotracers has led to increased research on and use of these agents in clinical practice. Thus, simultaneously performed PET/MRI enables the acquisition of complementary imaging information, with distinct advantages over PET/CT and MR image acquisitions. The authors provide an overview of PET/MRI, including descriptions of the major differences between PET/MRI and PET/CT, as well as case examples and treatment protocols for patients with commonly encountered malignancies in the abdomen and pelvis. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Samuel J Galgano
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JT N325, Birmingham, AL 35249
| | - Carli E Calderone
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JT N325, Birmingham, AL 35249
| | - Charlies Xie
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JT N325, Birmingham, AL 35249
| | - Elainea N Smith
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JT N325, Birmingham, AL 35249
| | - Kristin K Porter
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JT N325, Birmingham, AL 35249
| | - Jonathan E McConathy
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JT N325, Birmingham, AL 35249
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15
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Vibhakar AM, Cassels JA, Botchu R, Rennie WJ, Shah A. Imaging update on soft tissue sarcoma. J Clin Orthop Trauma 2021; 22:101568. [PMID: 34567971 PMCID: PMC8449057 DOI: 10.1016/j.jcot.2021.101568] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/13/2021] [Accepted: 08/14/2021] [Indexed: 01/15/2023] Open
Abstract
Soft tissue sarcomas (STS) are rare tumours presenting as soft tissue lumps. Ultrasound is often the primary modality for the initial assessment, with MRI the mainstay for lesion characterisation. PET/CT along with other emerging MRI sequences are used in certain situations as an adjunct and problem solving tool in STS staging and assessment of disease recurrence. Recent advances include the promise of whole body MRI, hybrid PET/MRI, diffusion weighted imaging, dynamic contrast enhanced MRI and advances in artificial intelligence. This article discusses current concepts in extremity STS imaging and highlights recent advances.
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Affiliation(s)
- Aanand M. Vibhakar
- Department of Radiology, Leicester Royal Infirmary, University Hospitals of Leicester, Leicester, United Kingdom,Corresponding author. Department of Radiology, Leicester Royal Infirmary, Infirmary Square, Leicester, LE1 5WW, United Kingdom.
| | - James A. Cassels
- Department of Radiology, Kettering General Hospital, Kettering, United Kingdom
| | - Rajesh Botchu
- Department of Radiology, Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - Winston J. Rennie
- Department of Radiology, Leicester Royal Infirmary, University Hospitals of Leicester, Leicester, United Kingdom
| | - Amit Shah
- Department of Radiology, Leicester Royal Infirmary, University Hospitals of Leicester, Leicester, United Kingdom
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16
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Singh TP, Sharma A, Sharma A, Bakhshi S, Patel C, Pandey AK, Dhamija E, Batra A, Kumar R. Utility of 18F-FDG-PET/CT in management and prognostication of treatment naïve late-stage soft tissue sarcomas. Nucl Med Commun 2021; 42:818-825. [PMID: 33741856 DOI: 10.1097/mnm.0000000000001401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study evaluated the utility of 18F-fluorodexoyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in staging, grading, and prognostication of Stage III and IV soft tissue sarcomas (STSs). METHODS Forty patients (Median age = 32.5 years; 25 men) with histologically proven STSs, prospectively underwent 18F-FDG-PET/CTs at baseline. Three-dimensional region of interests were drawn encompassing the lesions to calculate standardized uptake values (SUVs) and metabolic tumor volumes (MTVs). After segmentation, Haralick statistical texture analysis was performed. Follow-up was available for 35 patients. Survival at 6 months was 71.4% and at 1 year was 57.1%. RESULTS American Joint Committee on Cancer Stage III was seen in 23 and Stage IV in 17 patients. None of the baseline quantitative and semi-quantitative parameters could predict response or progression. Only reduction in SUVmax in interim PET/CT correlated with baseline SUVmax (Spearman's Rho = 0.533; P = 0.019). Textural parameters namely 'contrast' in CT (P = 0.039) and 'difference entropy' in PET/CT (P = 0.051) could differentiate intermediate from high-grade lesions, with corresponding area under curves being 0.736 (0.533-0.889) and 0.700 (0.518-0.882). M1 disease [Hazard ratio (HR): 3.184 (1.179-8.595); P = 0.022], absence of surgical treatment [HR 0.305 (0.106-0.873), P = 0.027 with surgery], lower MTV/total tumor volume (TTV) [HR: 0.975 (0.953-0.997; P = 0.028] and progressive disease in interim PET/CT [3.483 (0.898-13.515); P = 0.056] were predictors of lower survival in univariate analysis. Only M1 disease was found to be reaching significance in multivariate analysis [HR = 2.683 (0.949-7.580); P = 0.063]. Baseline PET/CT changed management in 12.5% of patients [compared to local-imaging and high-resolution CT chest]; with detection of extra-pulmonary metastases. Though, interim and end of treatment PET/CTs detected more metastatic lesions, management was not impacted. CONCLUSION 18F-FDG-PET/CT allows for more accurate M-staging in late-stage STSs, which in turn influences the option of curative surgical resection and thus impacts patient prognosis. Lower baseline MTV/TTV and progression in interim PET/CT are also associated with lower survival. Textural analysis may have a role in noninvasive grading.
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Affiliation(s)
- Tejesh Pratap Singh
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anshul Sharma
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Akshima Sharma
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Chetan Patel
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anil Kumar Pandey
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ekta Dhamija
- Department of Radio-diagnosis, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Batra
- Department of Medical Oncology, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
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17
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Sedaghat S, Sedaghat M, Meschede J, Jansen O, Both M. Diagnostic value of MRI for detecting recurrent soft-tissue sarcoma in a long-term analysis at a multidisciplinary sarcoma center. BMC Cancer 2021; 21:398. [PMID: 33849475 PMCID: PMC8042876 DOI: 10.1186/s12885-021-08113-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 03/29/2021] [Indexed: 12/19/2022] Open
Abstract
Background Soft-tissue sarcomas (STS) are rare tumors of the soft tissue. Recent diagnostic studies on STS mainly dealt with only few cases of STS and did not investigate the post-therapeutic performance of MRI in a routine clinical setting. Therefore, we assessed the long-term diagnostic accuracy of MRI for detecting recurrent STS at a multidisciplinary sarcoma center. Methods In all, 1055 postoperative follow-up MRIs of 204 patients were included in the study. MRI follow-up scans were systematically reviewed for diagnostic values (true-positive/−negative and false-positive/−negative results) in detecting recurrences. Pathological reports and follow-up MRIs were set as baseline references. Results The median age of the patients was 55.3 ± 18.2 years. Of the patients, 34.8% presented with recurrences. Here, 65 follow-up scans were true positive, 23 false positive, 6 false negative, and 961 true negative. The overall sensitivity and specificity of MRI for detecting recurrences were 92 and 98%, respectively, with an accuracy of 97%. For intramuscular lesions and after surgery alone the sensitivity was higher (95 and 97%, respectively) than for subcutaneous lesions and surgery with additional radiation therapy (83 and 86%, respectively), at similarly high specificities (96–98%). The 6 false-negative results were found in streaky (n = 2) and small ovoid/nodular (n = 4) recurring lesions. The false-positive lesions imitated streaky (n = 14), ovoid/nodular (n = 8), and polycyclic/multilobulated recurring tumors (n = 1). All false-positive results were found in patients in whom the primary tumors were polycyclic/multilobulated in appearance. Conclusion MRI shows a high diagnostic accuracy for detecting recurrent STS, with a high sensitivity and specificity. The diagnostic accuracy decreases in subcutaneous lesions and after surgery with radiation therapy, compared to intramuscular lesions and surgery alone. Radiologists should pay particular attention to streaky and small ovoid/nodular recurring lesions and patients with polycyclic/multilobulated primary tumors.
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Affiliation(s)
- Sam Sedaghat
- Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany.
| | - Maya Sedaghat
- Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany.,Institute of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Bergmannsheil, Bürkle de la Camp-Platz 1, 44789, Bochum, Germany
| | - Jens Meschede
- Institute of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Bergmannsheil, Bürkle de la Camp-Platz 1, 44789, Bochum, Germany.,Department for Radiology and Neuroradiology, Klinikum Dortmund, Beurhausstraße 40, 44137, Dortmund, Germany
| | - Olav Jansen
- Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Marcus Both
- Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
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18
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Yoon I, Bae JS, Yoo J, Lee DH, Kim SH. Added value of [ 18F]FDG PET/MRI over MDCT alone in the staging of recurrent gastric cancer. Eur Radiol 2021; 31:7834-7844. [PMID: 33768290 DOI: 10.1007/s00330-021-07839-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/09/2021] [Accepted: 02/25/2021] [Indexed: 12/09/2022]
Abstract
OBJECTIVES To investigate whether 2-[18F]fluoro-2-deoxy-D-glucose ([18F]FDG) positron emission tomography/magnetic resonance imaging (PET/MRI) can improve the diagnostic performance of TNM staging and help in making an accurate decision regarding resectability in patients with recurrent gastric cancer compared to multi-detector computed tomography (MDCT). METHODS Fifty patients with histologically (n = 31) or clinically (n = 19) confirmed recurrent gastric cancer underwent both MDCT and [18F]FDG PET/MRI. Two radiologists independently assessed TNM staging using MDCT with and without [18F]FDG PET/MRI and scored resectability using a 5-point confidence scale. Diagnostic performance as assessed by radiologists was compared using McNemar's test and receiver operating characteristic curve analysis. RESULTS Of the 50 patients, pathologic T and N staging was available in seven and six patients, respectively. Diagnostic accuracies for T and N staging were not significantly different between MDCT with and without [18F]FDG PET/MRI for both reviewers (p > 0.05). However, for M staging, diagnostic accuracy was significantly improved when 18F-FDG PET/MRI was added to MDCT alone (68.0% [34/50] to 90.0% [45/50] for reviewer 1 [p = 0.001] and 66.0% [33/50] to 96.0% [46/50] for reviewer 2 [p < 0.001]). Regarding the resectability of recurrent gastric cancers, the addition of [18F]FDG PET/MRI increased the area under the curve values for both reviewers (from 0.860 to 0.989 for reviewer 1 and from 0.778 to 0.898 for reviewer 2), with a statistical significance for reviewer 2 (p = 0.002). CONCLUSION Compared to MDCT alone, MDCT plus [18F]FDG PET/MRI can improve the diagnostic accuracy for evaluating preoperative M staging as well as resectability for recurrent gastric cancers. KEY POINTS • [18F]FDG PET/MRI can improve diagnostic accuracy for preoperative M staging in patients with recurrent gastric cancers. • [18F]FDG PET/MRI can improve diagnostic accuracy for determining resectability in patients with recurrent gastric cancers. • [18F]FDG PET/MRI can provide critical clues for management options for recurrent gastric cancers.
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Affiliation(s)
- Ieun Yoon
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Jae Seok Bae
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Jeongin Yoo
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Se Hyung Kim
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea. .,Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea. .,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, South Korea.
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19
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Chaudhari AJ, Raynor WY, Gholamrezanezhad A, Werner TJ, Rajapakse CS, Alavi A. Total-Body PET Imaging of Musculoskeletal Disorders. PET Clin 2021; 16:99-117. [PMID: 33218607 PMCID: PMC7684980 DOI: 10.1016/j.cpet.2020.09.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Imaging of musculoskeletal disorders, including arthritis, infection, osteoporosis, sarcopenia, and malignancies, is often limited when using conventional modalities such as radiography, computed tomography (CT), and MR imaging. As a result of recent advances in Positron Emission Tomography (PET) instrumentation, total-body PET/CT offers a longer axial field-of-view, higher geometric sensitivity, and higher spatial resolution compared with standard PET systems. This article discusses the potential applications of total-body PET/CT imaging in the assessment of musculoskeletal disorders.
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Affiliation(s)
- Abhijit J Chaudhari
- Department of Radiology, University of California Davis, 4860 Y Street, Sacramento, CA 95825, USA.
| | - William Y Raynor
- Department of Radiology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA; Drexel University College of Medicine, 2900 West Queen Lane, Philadelphia, PA 19129, USA
| | - Ali Gholamrezanezhad
- Keck School of Medicine, University of Southern California, 1520 San Pablo Street, Los Angeles, CA 90033, USA
| | - Thomas J Werner
- Department of Radiology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Chamith S Rajapakse
- Department of Radiology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Abass Alavi
- Department of Radiology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
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20
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Noebauer-Huhmann IM, Chaudhary SR, Papakonstantinou O, Panotopoulos J, Weber MA, Lalam RK, Albtoush OM, Fueger BJ, Szomolanyi P, Grieser T, Bloem JL. Soft Tissue Sarcoma Follow-up Imaging: Strategies to Distinguish Post-treatment Changes from Recurrence. Semin Musculoskelet Radiol 2020; 24:627-644. [PMID: 33307581 DOI: 10.1055/s-0040-1721464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Soft tissue sarcomas encompass multiple entities with differing recurrence rates and follow-up intervals. The detection of recurrences and their differentiation from post-therapeutic changes is therefore complex, with a central role for the clinical radiologist. This article describes approved recommendations. Prerequisite is a precise knowledge of the current clinical management and surgical techniques. We review recurrence rates and treatment modalities. An adequate imaging technique is paramount, and comparison with previous imaging is highly recommended. We describe time-dependent therapy-related complications on magnetic resonance imaging compared with the spectrum of regular post-therapeutic changes. Early complications such as seromas, hematomas, and infections, late complications such as edema and fibrosis, and inflammatory pseudotumors are elucidated. The appearance of recurrences and radiation-associated sarcomas is contrasted with these changes. This systematic approach in follow-up imaging of soft tissue sarcoma patients will facilitate the differentiation of post-therapeutic changes from recurrences.
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Affiliation(s)
- Iris-M Noebauer-Huhmann
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Snehansh R Chaudhary
- Department of Clinical Radiology, Aintree University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | | | - Joannis Panotopoulos
- Department of Orthopedics and Trauma-Surgery, Medical University of Vienna, Vienna, Austria
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany
| | - Radhesh K Lalam
- Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, United Kingdom
| | - Omar M Albtoush
- Department of Radiology, University of Jordan, and Department of Radiology, King Hussein Cancer Center, Amman, Jordan
| | - Barbara J Fueger
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Pavol Szomolanyi
- High Field MR Center, Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Thomas Grieser
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Augsburg, Germany
| | - Johan L Bloem
- Department of radiology, Leiden University Medical Center, Leiden, The Netherlands
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21
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Sedaghat S, Sedaghat M, Krohn S, Jansen O, Freund K, Streitbürger A, Reichardt B. Long-term diagnostic value of MRI in detecting recurrent aggressive fibromatosis at two multidisciplinary sarcoma centers. Eur J Radiol 2020; 134:109406. [PMID: 33254066 DOI: 10.1016/j.ejrad.2020.109406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/02/2020] [Accepted: 11/06/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE To assess the diagnostic accuracy of MRI in detecting recurrent aggressive fibromatosis (AF) during long-term follow-up at two multidisciplinary sarcoma centers. METHODS Seventy-nine patients from two sarcoma centers were included in this IRB-approved study and were examined postoperatively using 1.5-T MRI. MRI follow-up scans were reviewed for true-positive/-negative and false-positive/-negative results. Available pathological reports and MRI follow-ups were set as reference. RESULTS The median age of the patients was 38.1 ± 15.3 years. Of the patients 27.9 % showed recurrent AF lesions. The most common localizations of AF were the axilla/shoulder (n = 15) and the thigh (n = 11). From 498 postoperative MRI follow-ups, 24 true-positive, 16 false-positive, 6 false-negative, and 452 true-negative MRI follow-ups were identified. The overall sensitivity and specificity for detecting recurrent AF was 80 % and 97 %, respectively. There was no significant difference in the diagnostic accuracy at the two sarcoma centers. All false-negative results were found in small lesions. False-positive results mostly mimicked streaky (n = 10) and small ovoid/nodular (n = 5) lesions. The configuration of recurrent AF was significantly most often fascicular (50 %; p = 0.001-0.005). CONCLUSION MRI shows a high long-term diagnostic value in detecting AF recurrences. Nevertheless, radiologists should pay close attention when lesions are small, as they may remain undetected. Although the configuration of recurrent AF is most often fascicular, recurrences may also appear in different shapes.
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Affiliation(s)
- Sam Sedaghat
- Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany; Institute of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Bergmannsheil, Bochum, Germany.
| | - Maya Sedaghat
- Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany; Institute of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Bergmannsheil, Bochum, Germany
| | - Sebastian Krohn
- Department of Prosthodontics, University Hospital Göttingen, Germany
| | - Olav Jansen
- Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Kai Freund
- Spinal Cord Injury Center, Clinic for Paraplegiologia and Neuro-Urology, Bad Berka, Germany
| | - Arne Streitbürger
- Department of Orthopedic Oncology, University Hospital Essen, Germany
| | - Benjamin Reichardt
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany; Department for Interventional Radiology and Neuroradiology, Klinikum Hochsauerland, Arnsberg, Germany
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22
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Cassarino G, Evangelista L, Giraudo C, Capizzi A, Carretta G, Zucchetta P, Cecchin D. 18F-FDG PET/MRI in adult sarcomas. Clin Transl Imaging 2020. [DOI: 10.1007/s40336-020-00395-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Abstract
Aim
This mini-review aims to summarize the main findings on PET/MRI in patients with sarcomas.
Materials and methods
A literature search was carried out on MEDLINE databases, such as PubMed, Scopus, Web of Science and Google Scholar, using the search terms “PET”, “positron emission tomography”, “PET/MRI”, “positron emission tomography/magnetic resonance imaging”, and “sarcoma”. No restrictions (i.e. language, age, type of manuscript, or the like) were applied to the search strategy. Abstracts, reviews, letters to editors, and editorials were excluded.
Results
Eight studies were ultimately included. From 2013 to 2019, a total of 154 adult patients with sarcomas underwent 18F-fluorodeoxyglucose (18F-FDG) PET/MRI. Of these patients, 129 had soft tissue sarcomas (STS), 5 had bone sarcomas, and 20 had cardiac masses. Thirty-two patients had PET/MRI for early-stage disease, 45 for recurrences, and 57 for the assessment of response to treatment. For staging purposes, the studies suggest that PET/MRI can significantly improve the delineation of surgical margins. At restaging, PET/MRI can also detect sarcoma recurrences more accurately than conventional imaging.
Conclusions
18F-FDG PET/MRI has promising indications in patients with sarcomas, from disease staging to the assessment of response to treatment. Further studies are warranted to confirm these results, especially in subgroups with specific histopathological features.
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23
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Hancin EC, Borja AJ, Nikpanah M, Raynor WY, Haldar D, Werner TJ, Morris MA, Saboury B, Alavi A, Gholamrezanezhad A. PET/MR Imaging in Musculoskeletal Precision Imaging - Third wave after X-Ray and MR. PET Clin 2020; 15:521-534. [DOI: 10.1016/j.cpet.2020.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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24
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Howe BM, Broski SM, Littrell LA, Pepin KM, Wenger DE. Quantitative Musculoskeletal Tumor Imaging. Semin Musculoskelet Radiol 2020; 24:428-440. [PMID: 32992370 DOI: 10.1055/s-0040-1708825] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The role of quantitative magnetic resonance imaging (MRI) and positron emission tomography/computed tomography (PET/CT) techniques continues to grow and evolve in the evaluation of musculoskeletal tumors. In this review we discuss the MRI quantitative techniques of volumetric measurement, chemical shift imaging, diffusion-weighted imaging, elastography, spectroscopy, and dynamic contrast enhancement. We also review quantitative PET techniques in the evaluation of musculoskeletal tumors, as well as virtual surgical planning and three-dimensional printing.
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Affiliation(s)
- B Matthew Howe
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Kay M Pepin
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Doris E Wenger
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
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25
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Gennaro N, Marrari A, Renne SL, Cananzi FCM, Quagliuolo VL, Di Brina L, Scorsetti M, Pepe G, Chiti A, Santoro A, Balzarini L, Politi LS, Bertuzzi AF. Multimodality imaging of adult rhabdomyosarcoma: the added value of hybrid imaging. Br J Radiol 2020; 93:20200250. [PMID: 32559113 DOI: 10.1259/bjr.20200250] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Rhabdomyosarcoma (RMS) represents more than 50% of paediatric soft tissue tumours. Conversely, it is extremely rare among adults, where it shows peculiar biological and clinical features that are still poorly investigated. RMS patients should be referred to a Sarcoma Centre, where the contribution of experienced radiologists plays a relevant role in the diagnostic assessment of the disease, including precise localisation, staging, image-guided biopsy, response evaluation after treatment and follow-up. Besides CT and MRI, hybrid imaging including positron emission tomography (PET)/CT and PET/MRI are giving an increasing contribution to provide functional insights about tumour biology and to improve the diagnostic accuracy of the imaging work-up. This review paper provides a revision of the pathology, clinical and radiological features of adult RMS, with a particular focus on the growing role of hybrid PET-based imaging.
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Affiliation(s)
- Nicolò Gennaro
- Dept. of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Dept. of Radiology, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | - Andrea Marrari
- Dept. of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Medical Oncology and Hematology Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Salvatore Lorenzo Renne
- Dept. of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Dept. of Pathology, Humanitas Clinical and Research Hospital - IRCCS, Rozzano, Italy
| | - Ferdinando Carlo Maria Cananzi
- Dept. of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Sarcoma, Melanoma and Rare Tumors Surgery Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | - Vittorio Lorenzo Quagliuolo
- Sarcoma, Melanoma and Rare Tumors Surgery Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | - Lucia Di Brina
- Dept. of Radiation Oncology, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | - Marta Scorsetti
- Dept. of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Dept. of Radiation Oncology, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy.,Dept. of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Giovanna Pepe
- Dept. of Nuclear Medicine, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | - Arturo Chiti
- Dept. of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Dept. of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Dept. of Nuclear Medicine, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | - Armando Santoro
- Dept. of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Medical Oncology and Hematology Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy.,Dept. of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Luca Balzarini
- Dept. of Radiology, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | - Letterio Salvatore Politi
- Dept. of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Neuroradiology Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy.,Dept. of Radiology and Hematology & Oncology Division, Boston Children's Hospital, Boston, USA.,Dept. of Radiology and Advanced MRI Center, University of Massachusetts Medical School and Medical Center, Worcester, USA
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26
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Martin O, Schaarschmidt BM, Kirchner J, Suntharalingam S, Grueneisen J, Demircioglu A, Heusch P, Quick HH, Forsting M, Antoch G, Herrmann K, Umutlu L. PET/MRI Versus PET/CT for Whole-Body Staging: Results from a Single-Center Observational Study on 1,003 Sequential Examinations. J Nucl Med 2019; 61:1131-1136. [DOI: 10.2967/jnumed.119.233940] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 12/02/2019] [Indexed: 12/31/2022] Open
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27
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Kogan F, Broski SM, Yoon D, Gold GE. Applications of PET-MRI in musculoskeletal disease. J Magn Reson Imaging 2019; 48:27-47. [PMID: 29969193 DOI: 10.1002/jmri.26183] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 04/19/2018] [Indexed: 12/26/2022] Open
Abstract
New integrated PET-MRI systems potentially provide a complete imaging modality for diagnosis and evaluation of musculoskeletal disease. MRI is able to provide excellent high-resolution morphologic information with multiple contrast mechanisms that has made it the imaging modality of choice in evaluation of many musculoskeletal disorders. PET offers incomparable abilities to provide quantitative information about molecular and physiologic changes that often precede structural and biochemical changes. In combination, hybrid PET-MRI can enhance imaging of musculoskeletal disorders through early detection of disease as well as improved diagnostic sensitivity and specificity. The purpose of this article is to review emerging applications of PET-MRI in musculoskeletal disease. Both clinical applications of malignant musculoskeletal disease as well as new opportunities to incorporate the molecular capabilities of nuclear imaging into studies of nononcologic musculoskeletal disease are discussed. Lastly, we discuss some of the technical considerations and challenges of PET-MRI as they specifically relate to musculoskeletal disease. LEVEL OF EVIDENCE 5 TECHNICAL EFFICACY: Stage 3 J. Magn. Reson. Imaging 2018;48:27-47.
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Affiliation(s)
- Feliks Kogan
- Department of Radiology, Stanford University, Stanford, California, USA
| | | | - Daehyun Yoon
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Garry E Gold
- Department of Radiology, Stanford University, Stanford, California, USA.,Department of Bioengineering, Stanford University, Stanford, California, USA.,Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
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28
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Pennington Z, Ahmed AK, Cottrill E, Westbroek EM, Goodwin ML, Sciubba DM. Systematic review on the utility of magnetic resonance imaging for operative management and follow-up for primary sarcoma-lessons from extremity sarcomas. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:225. [PMID: 31297390 DOI: 10.21037/atm.2019.01.59] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Primary sarcomas of the vertebral column affect roughly 5 in every million persons annually, of which half to one-third are malignant. Treatment of these lesions requires multimodal management, often employing attempts at en bloc resection of the lesion with negative margins. This may be facilitated using magnetic resonance imaging for preoperative margin planning, but current literature is lacking regarding the use of such imaging to accurately predict planned surgical margins. Here we review prior studies describing the use of magnetic resonance imaging for en bloc resection of sarcomas of the extremities to identify learning points for application to the treatment of spinal neoplasms. We conducted a systematic review of the PubMed and EMBASE literature. Included studies described the accuracy of MRI for preoperative evaluation of tumor margins, intraoperative guidance for en bloc resection, or post-operative evaluation of residual or recurrent disease. All included studies described patients treated for osseous or soft tissue sarcoma of the limbs. We found 1,705 unique references of which 27 met criteria for inclusion. Seven studies reported MR had an overall diagnostic accuracy of 93.6-96% for preoperative margin evaluation with non-contrast T1 most accurately reflecting true margins. In the nine articles reporting results of MR-guided resection, negative margins were achieved in 88.8-100% of cases with a closest margin of 2-4 mm. Eleven articles combined reported the accuracy of MR for residual disease or local recurrence, with a mean sensitivity and specificity of 71.7% and 79.3%, respectively for residual disease and 87.9% and 85.9%, respectively for local recurrence. The current literature for appendicular musculoskeletal sarcoma suggests that MR is highly accurate for defining tumor margins preoperatively, guiding osteotomy cuts intraoperatively, and documenting recurrence or residual disease. Further evidence is necessary to evaluate the degree to which it can accurately guide osteotomy planning for en bloc resection of vertebral primaries.
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Affiliation(s)
- Zach Pennington
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A Karim Ahmed
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ethan Cottrill
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Erick M Westbroek
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthew L Goodwin
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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29
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Kooraki S, Assadi M, Gholamrezanezhad A. Hot Topics of Research in Musculoskeletal Imaging. PET Clin 2019; 14:175-182. [DOI: 10.1016/j.cpet.2018.08.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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30
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Head and Neck Sarcomas: A Review of Clinical and Imaging Findings Based on the 2013 World Health Organization Classification. AJR Am J Roentgenol 2018; 212:644-654. [PMID: 30589383 DOI: 10.2214/ajr.18.19894] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Head and neck sarcomas are a complex, heterogeneous group of tumors that present a diagnostic challenge to radiologists because they have many overlapping imaging features. The purpose of this article is to review the imaging and clinical features and highlight distinguishing features of head and neck sarcomas. CONCLUSION An understanding of characteristic imaging and clinical features of head and neck sarcomas is important for the radiologist to narrow the differential diagnosis and help guide management.
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31
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Angelini A, Castellucci P, Ceci F. Future Perspective of the Application of Positron Emission Tomography-Computed Tomography-MR Imaging in Musculoskeletal Disorders. PET Clin 2018; 14:183-191. [PMID: 30420219 DOI: 10.1016/j.cpet.2018.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) is the imaging method of choice in sarcoma patients. PET may help in diagnosis, grading, staging, biopsy guidance, monitoring response to therapy, restaging for recurrence, and prognosis. 18F-FDG-PET/MRI combines the higher tissue contrast of MRI in the study of soft-tissue lesions and the peculiarities of PET imaging that allow the characterization of tissues. The use of 18F-FDG-PET/MRI in these patients has reduces the radiation dose, which is of great importance, particularly in children. Data support the routine use of 18F-FDG-PET either using CT or MRI in patients with sarcoma.
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Affiliation(s)
- Andrea Angelini
- Department of Orthopedics and Orthopedic Oncology, University of Padova, Via 8 Febbraio 1848, 2, 35122 Padova, Italy
| | - Paolo Castellucci
- Nuclear Medicine, Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Via massarenti 9, 40138, Bologna, Italy
| | - Francesco Ceci
- Department of Molecular and Medical Pharmacology, Ahmanson Translational Imaging Division, University of California at Los Angeles (UCLA), 200 Medical Plaza, Suite B114, Los Angeles CA 90095, USA; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
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32
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33
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Abstract
OBJECTIVE The purpose of this article is to provide an update on clinical PET/MRI, including current and developing clinical indications and technical developments. CONCLUSION PET/MRI is evolving rapidly, transitioning from a predominant research focus to exciting clinical practice. Key technical obstacles have been overcome, and further technical advances promise to herald significant advancements in image quality. Further optimization of protocols to address challenges posed by this hybrid modality will ensure the long-term success of PET/MRI.
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34
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Abstract
Superficial solid masses are common conditions in clinical practice, however, some of which can be easily diagnosed and others would be difficult. Although imaging of superficial masses is not always characteristic, it would be helpful to give a definitive diagnosis or narrow a differential diagnosis. Crossing-section imaging can depicture the masses directly, find some pathognomonic signs and demonstrate their relationship with adjacent structures, which can provide decision support for clinician's reference. Computed tomography (CT) can be used to detect calcifications and bone erosion which could not be seen on radiographs. Magnetic resonance imaging (MRI) is the preferred way for evaluating soft tissue lesions and provides information on hemorrhage, necrosis, edema, cystic and myxoid degeneration, and fibrosis. Other advantages of MRI are its superior soft tissue resolution and any profile imaging, which can aid the assessment of extension and adjacent infiltration. Positron emission tomography (PET)/CT and PET/MRI have been increasingly used in bone and soft tissue sarcomas and provides advantages in the initial tumor staging, tumor grading, therapy assessment, and recurrence detection. Therefore, imaging examination can play an important role in treatment decision making for superficial solid tumors. Here we review the important conditions presenting as superficial mass and show the imaging of typical cases diagnosed in our hospital.
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Affiliation(s)
- Jingfeng Zhang
- Department of Radiology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Yanyuan Li
- Department of Pathology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Yilei Zhao
- Department of Radiology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Jianjun Qiao
- Department of Dermatology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
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35
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Ogilvie CM, Schwartz AM, Reimer NB. What's New in Musculoskeletal Tumor Surgery. J Bone Joint Surg Am 2017; 99:2127-2132. [PMID: 29257020 DOI: 10.2106/jbjs.17.01072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Christian M Ogilvie
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Andrew M Schwartz
- Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia
| | - Nickolas B Reimer
- Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia
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