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Grund C, Kerner D, Driulini D, Schneider G. [Innovations in the classification of soft tissue tumors]. RADIOLOGIE (HEIDELBERG, GERMANY) 2024; 64:663-674. [PMID: 38935287 DOI: 10.1007/s00117-024-01332-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/31/2024] [Indexed: 06/28/2024]
Abstract
Soft tissue tumors are a very heterogeneous group of tumors. Their classification is regularly updated by the World Health Organization (WHO), most recently in 2020. The current classification of soft tissue tumors emphasizes molecular biological tumor characteristics, which enable tumor-specific treatment. In addition to Ewing's sarcoma, which occurs as bone as well as extra-skeletal soft tissue tumors as a small round cell sarcoma, three other subtypes of undifferentiated, small and round cell sarcomas have been introduced. Some names of the new sarcomas can be derived from the gene mutations. The groups of adipocytic and (myo)fibroblastic tumors have been extended by three further entities. There were further additions to vascular soft tissue tumors, smooth muscle cell tumors, peripheral nerve sheath tumors and tumors of uncertain differentiation. A distinction is made between benign, intermediate locally aggressive, intermediate rarely metastatic and malignant soft tissue tumors.
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Affiliation(s)
- Caroline Grund
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum des Saarlandes, Kirrbergerstraße 100, 66421, Homburg/Saar, Deutschland.
| | - Dorothea Kerner
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum des Saarlandes, Kirrbergerstraße 100, 66421, Homburg/Saar, Deutschland
| | - Deborah Driulini
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum des Saarlandes, Kirrbergerstraße 100, 66421, Homburg/Saar, Deutschland
| | - Günther Schneider
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum des Saarlandes, Kirrbergerstraße 100, 66421, Homburg/Saar, Deutschland
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2
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Noebauer-Huhmann IM, Vanhoenacker FM, Vilanova JC, Tagliafico AS, Weber MA, Lalam RK, Grieser T, Nikodinovska VV, de Rooy JWJ, Papakonstantinou O, Mccarthy C, Sconfienza LM, Verstraete K, Martel-Villagrán J, Szomolanyi P, Lecouvet FE, Afonso D, Albtoush OM, Aringhieri G, Arkun R, Aström G, Bazzocchi A, Botchu R, Breitenseher M, Chaudhary S, Dalili D, Davies M, de Jonge MC, Mete BD, Fritz J, Gielen JLMA, Hide G, Isaac A, Ivanoski S, Mansour RM, Muntaner-Gimbernat L, Navas A, O Donnell P, Örgüç Ş, Rennie W, Resano S, Robinson P, Sanal HT, Ter Horst SAJ, van Langevelde K, Wörtler K, Koelz M, Panotopoulos J, Windhager R, Bloem JL. Soft tissue tumor imaging in adults: European Society of Musculoskeletal Radiology-Guidelines 2023-overview, and primary local imaging: how and where? Eur Radiol 2024; 34:4427-4437. [PMID: 38062268 PMCID: PMC11213759 DOI: 10.1007/s00330-023-10425-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/08/2023] [Accepted: 09/26/2023] [Indexed: 06/29/2024]
Abstract
OBJECTIVES Early, accurate diagnosis is crucial for the prognosis of patients with soft tissue sarcomas. To this end, standardization of imaging algorithms, technical requirements, and reporting is therefore a prerequisite. Since the first European Society of Musculoskeletal Radiology (ESSR) consensus in 2015, technical achievements, further insights into specific entities, and the revised WHO-classification (2020) and AJCC staging system (2017) made an update necessary. The guidelines are intended to support radiologists in their decision-making and contribute to interdisciplinary tumor board discussions. MATERIALS AND METHODS A validated Delphi method based on peer-reviewed literature was used to derive consensus among a panel of 46 specialized musculoskeletal radiologists from 12 European countries. Statements were scored online by level of agreement (0 to 10) during two iterative rounds. Either "group consensus," "group agreement," or "lack of agreement" was achieved. RESULTS Eight sections were defined that finally contained 145 statements with comments. Overall, group consensus was reached in 95.9%, and group agreement in 4.1%. This communication contains the first part consisting of the imaging algorithm for suspected soft tissue tumors, methods for local imaging, and the role of tumor centers. CONCLUSION Ultrasound represents the initial triage imaging modality for accessible and small tumors. MRI is the modality of choice for the characterization and local staging of most soft tissue tumors. CT is indicated in special situations. In suspicious or likely malignant tumors, a specialist tumor center should be contacted for referral or teleradiologic second opinion. This should be done before performing a biopsy, without exception. CLINICAL RELEVANCE The updated ESSR soft tissue tumor imaging guidelines aim to provide best practice expert consensus for standardized imaging, to support radiologists in their decision-making, and to improve examination comparability both in individual patients and in future studies on individualized strategies. KEY POINTS • Ultrasound remains the best initial triage imaging modality for accessible and small suspected soft tissue tumors. • MRI is the modality of choice for the characterization and local staging of soft tissue tumors in most cases; CT is indicated in special situations. Suspicious or likely malignant tumors should undergo biopsy. • In patients with large, indeterminate or suspicious tumors, a tumor reference center should be contacted for referral or teleradiologic second opinion; this must be done before a biopsy.
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Affiliation(s)
- Iris-Melanie Noebauer-Huhmann
- Department of Biomedical Imaging and Image Guided Therapy, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria.
| | - Filip M Vanhoenacker
- Department of Radiology AZ Sint Maarten Mechelen, University Hospital Antwerp, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
| | - Joan C Vilanova
- Department of Radiology, Clínica Girona, Institute of Diagnostic Imaging (IDI) Girona, University of Girona, Girona, Spain
| | - Alberto S Tagliafico
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Department of Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - 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, UK
| | - Thomas Grieser
- Dept. for Diagnostic and Interventional, Radiology University Hospital Augsburg, Augsburg, Germany
| | - Violeta Vasilevska Nikodinovska
- Medical Faculty, Ss. Cyril and Methodius University, Skopje, Macedonia
- Department of Radiology, University Surgical Clinic "St. Naum Ohridski" Skopje, Skopje, Macedonia
| | - Jacky W J de Rooy
- Department of Imaging, Radiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Olympia Papakonstantinou
- 2Nd Department of Radiology, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Catherine Mccarthy
- Oxford Musculoskeletal Radiology and Oxford University Hospitals, Oxford, UK
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Dipartimento Di Scienze Biomediche Per La Salute, Università Degli Studi Di Milano, Milan, Italy
| | | | | | - Pavol Szomolanyi
- High Field MR Center, Department of Biomedical Imaging and Image-Guided Therapy, Medical University Vienna, Vienna, Austria
- Department of Imaging Methods, Institute of Measurement Science, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Frédéric E Lecouvet
- Department of Radiology and Medical Imaging, Cliniques Universitaires Saint Luc, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Diana Afonso
- Hospital Particular da Madeira, and Hospital da Luz Lisboa, Lisbon, Portugal
| | - Omar M Albtoush
- Department of Radiology, University of Jordan, Ammam, Jordan
| | - Giacomo Aringhieri
- Academic Radiology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Remide Arkun
- Ege University Medical School Izmir, Izmir, Turkey Star Imaging Center Izmir, Izmir, Turkey
| | - Gunnar Aström
- Department of Immunology, Genetics and Pathology (Oncology) and Department of Surgical Sciences (Radiology), Uppsala University, Uppsala, Sweden
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Rajesh Botchu
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK
| | | | | | - Danoob Dalili
- Academic Surgical Unit, South West London Elective Orthopaedic Centre (SWLEOC), London, UK
| | - Mark Davies
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK
| | - Milko C de Jonge
- Department of Radiology, St. Antonius Hospital, Utrecht, The Netherlands
| | - Berna D Mete
- Department of Radiology School of Medicine, Izmir Demokrasi University, Izmir, Turkey
| | - Jan Fritz
- Department of Radiology, NYU Grossman School of Medicine, New York, USA
- Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, University Hospital Tuebingen, Tübingen, Germany
| | - Jan L M A Gielen
- Department of Radiology and Medical Imaging, University Hospital Antwerp, Edegem, Belgium
| | - Geoff Hide
- Department of Radiology, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Amanda Isaac
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Slavcho Ivanoski
- St. Erasmo Hospital for Orthopaedic Surgery and Traumatology Ohrid, Ohrid, Macedonia
| | | | | | - Ana Navas
- Department of Radiology, Division of Musculoskeletal Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Winston Rennie
- Clinical MSK Radiology, Loughborough University, Leicester Royal Infirmary, Leicester, UK
| | | | - Philip Robinson
- Musculoskeletal Radiology Department Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - Hatice T Sanal
- Radiology Department, University of Health Sciences, Gülhane Training and Research Hospital, Istanbul, Turkey
| | - Simone A J Ter Horst
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | - Klaus Wörtler
- Musculoskeletal Radiology Section, Klinikum Rechts der Isar, Technical University of Munich - TUM School of Medicine, Munich, Germany
| | - Marita Koelz
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - Joannis Panotopoulos
- Departement of Orthopaedics and Traumatology, Division of Orthopaedics, Medical University of Vienna, Vienna, Austria
| | - Reinhard Windhager
- Departement of Orthopaedics and Traumatology, Medical University of Vienna, Vienna, Austria
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Riley GM, Steffner R, Kwong S, Chin A, Boutin RD. MRI of Soft-Tissue Tumors: What to Include in the Report. Radiographics 2024; 44:e230086. [PMID: 38696323 DOI: 10.1148/rg.230086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
MRI serves as a critical step in the workup, local staging, and treatment planning of extremity soft-tissue masses. For the radiologist to meaningfully contribute to the management of soft-tissue masses, they need to provide a detailed list of descriptors of the lesion outlined in an organized report. While it is occasionally possible to use MRI to provide a diagnosis for patients with a mass, it is more often used to help with determining the differential diagnosis and planning of biopsies, surgery, radiation treatment, and chemotherapy (when provided). Each descriptor on the list outlined in this article is specifically aimed to assist in one or more facets of the overall approach to soft-tissue masses. This applies to all masses, but in particular sarcomas. Those descriptors are useful to help narrow the differential diagnosis and ensure concordance with a pathologic diagnosis and its accompanying grade assignment of soft-tissue sarcomas. These include a lesion's borders and shape, signal characteristics, and contrast enhancement pattern; the presence of peritumoral edema and peritumoral enhancement; and the presence of lymph nodes. The items most helpful in assisting surgical planning include a lesion's anatomic location, site of origin, size, location relative to a landmark, relationship to adjacent structures, and vascularity including feeding and draining vessels. The authors provide some background information on soft-tissue sarcomas, including their diagnosis and treatment, for the general radiologist and as a refresher for radiologists who are more experienced in tumor imaging. ©RSNA, 2024 See the invited commentary by Murphey in this issue.
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Affiliation(s)
- Geoffrey M Riley
- From the Departments of Radiology (G.M.R., R.D.B.) and Orthopedic Surgery (R.S.), Stanford University Medical Center, 300 Pasteur Dr, Stanford, CA 94305-5105; Department of Radiology, The Permanente Medical Group, Oakland, Calif (S.K.); and Department of Radiation Oncology, Stanford Cancer Institute, Stanford, Calif (A.C.)
| | - Robert Steffner
- From the Departments of Radiology (G.M.R., R.D.B.) and Orthopedic Surgery (R.S.), Stanford University Medical Center, 300 Pasteur Dr, Stanford, CA 94305-5105; Department of Radiology, The Permanente Medical Group, Oakland, Calif (S.K.); and Department of Radiation Oncology, Stanford Cancer Institute, Stanford, Calif (A.C.)
| | - Steven Kwong
- From the Departments of Radiology (G.M.R., R.D.B.) and Orthopedic Surgery (R.S.), Stanford University Medical Center, 300 Pasteur Dr, Stanford, CA 94305-5105; Department of Radiology, The Permanente Medical Group, Oakland, Calif (S.K.); and Department of Radiation Oncology, Stanford Cancer Institute, Stanford, Calif (A.C.)
| | - Alexander Chin
- From the Departments of Radiology (G.M.R., R.D.B.) and Orthopedic Surgery (R.S.), Stanford University Medical Center, 300 Pasteur Dr, Stanford, CA 94305-5105; Department of Radiology, The Permanente Medical Group, Oakland, Calif (S.K.); and Department of Radiation Oncology, Stanford Cancer Institute, Stanford, Calif (A.C.)
| | - Robert D Boutin
- From the Departments of Radiology (G.M.R., R.D.B.) and Orthopedic Surgery (R.S.), Stanford University Medical Center, 300 Pasteur Dr, Stanford, CA 94305-5105; Department of Radiology, The Permanente Medical Group, Oakland, Calif (S.K.); and Department of Radiation Oncology, Stanford Cancer Institute, Stanford, Calif (A.C.)
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4
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Li C, Chen W, Jin Y, Xu H, Luo H. Ultrasound performance in pediatric deep soft-tissue tumor characterization. Sci Rep 2023; 13:22107. [PMID: 38092843 PMCID: PMC10719244 DOI: 10.1038/s41598-023-48931-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 12/01/2023] [Indexed: 12/17/2023] Open
Abstract
This study investigated the performance of ultrasonography in diagnosing deep soft-tissue tumors and tumor-like lesions in children with histological results. Demographic information and ultrasound characteristics of benign and malignant masses were statistically analyzed. Three radiologists (Radiologists 1, 2, and 3) independently reviewed the ultrasonography studies while being blinded to the medical history and other imaging findings. The 82 lesions included in the study were histopathologically classified as malignant (n = 25) or benign (n = 57). No statistically significant differences were observed between the benign and malignant subgroups regarding age (p = 0.059), sex (p = 1.0), disease course (p = 0.812), presence or absence of symptoms (p = 0.534), maximum diameter (p = 0.359), margin (p = 1.0), calcification (p = 0.057), or blood Adler type (p = 0.563). However, statistically significant differences were observed between the benign and malignant subgroups in terms of isolated or Multiple occurrences (p < 0.001), history of malignancy (p < 0.001), shape (p < 0.001), and echogenicity (p < 0.001). Parameters such as tumor shape (p = 0.042, OR = 6.222), single or multiple occurrences (p = 0.008, OR = 17.000), and history of malignancy (p = 0.038, OR = 13.962) were identified as independent predictors of benign and malignant tumors. The diagnostic sensitivities evaluated by the three radiologists were 68.0%, 72.0%, 96.0%, respectively, while the specificities were 77.2%, 82.5%, 77.2%, respectively. Ultrasound demonstrates good performance in the diagnosis of benign deep lesions such as hemangiomas/venous malformation and adipocytic tumors. Multiple irregular morphologies and a history of malignancy were identified as independent risk factors for malignant masses. The experience of radiologists in recognizing specific tumors is important. Careful attention should be paid to masses with ambiguous ultrasound features, as well as small lesions.
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Affiliation(s)
- Cong Li
- Department of Ultrasonography, West China Second University Hospital, Sichuan University, Chengdu, 610000, Sichuan, China
- Department Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second Hospital, Sichuan University, Chengdu, China
| | - Wenyi Chen
- Department of Ultrasonography, West China Second University Hospital, Sichuan University, Chengdu, 610000, Sichuan, China
- Department Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second Hospital, Sichuan University, Chengdu, China
| | - Ya Jin
- Department of Ultrasonography, West China Second University Hospital, Sichuan University, Chengdu, 610000, Sichuan, China
- Department Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second Hospital, Sichuan University, Chengdu, China
| | - Hong Xu
- Department of Ultrasonography, West China Second University Hospital, Sichuan University, Chengdu, 610000, Sichuan, China
- Department Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second Hospital, Sichuan University, Chengdu, China
| | - Hong Luo
- Department of Ultrasonography, West China Second University Hospital, Sichuan University, Chengdu, 610000, Sichuan, China.
- Department Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second Hospital, Sichuan University, Chengdu, China.
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Generaal JD, Glas HH, Ubbels JF, Stevenson MG, Huijing MA, van Leeuwen BL, Been LB. Calculating Tumor Volume Using Three-Dimensional Models in Preoperative Soft-Tissue Sarcoma Surgical Planning: Does Size Matter? J Clin Med 2023; 12:7242. [PMID: 38068294 PMCID: PMC10871107 DOI: 10.3390/jcm12237242] [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: 10/18/2023] [Revised: 11/12/2023] [Accepted: 11/21/2023] [Indexed: 02/18/2024] Open
Abstract
This feasibility study aims to explore the use of three-dimensional virtual surgical planning to preoperatively determine the need for reconstructive surgery following resection of an extremity soft-tissue sarcoma. As flap reconstruction is performed more often in advanced disease, we hypothesized that tumor volume would be larger in the group of patients that had undergone flap reconstruction. All patients that were treated by surgical resection for an extremity soft-tissue sarcoma between 1 January 2016 and 1 October 2019 in the University Medical Center Groningen were included retrospectively. Three-dimensional models were created using the diagnostic magnetic resonance scan. Tumor volume was calculated for all patients. Three-dimensional tumor volume was 107.8 (349.1) mL in the group of patients that had undergone primary closure and 29.4 (47.4) mL in the group of patients in which a flap reconstruction was performed, p = 0.004. Three-dimensional tumor volume was 76.1 (295.3) mL in the group of patients with a complication following ESTS treatment, versus 57.0 (132.4) mL in patients with an uncomplicated course following ESTS treatment, p = 0.311. Patients who had undergone flap reconstruction had smaller tumor volumes compared to those in the group of patients treated by primary closure. Furthermore, a larger tumor volume did not result in complications for patients undergoing ESTS treatment. Therefore, tumor volume does not seem to influence the need for reconstruction. Despite the capability of three-dimensional virtual surgical planning to measure tumor volume, we do not recommend its utilization in the multidisciplinary extremity soft-tissue sarcoma treatment, considering the findings of the study.
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Affiliation(s)
- Jasmijn D. Generaal
- Department of Surgery, Division of Surgical Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (B.L.v.L.); (L.B.B.)
| | - Haye H. Glas
- Department of Maxillofacial Surgery, 3D Lab, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
| | - Jan F. Ubbels
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
| | - Marc G. Stevenson
- Department of Surgery, Isala Hospital, Dr. van Heesweg 2, 8025 AB Zwolle, The Netherlands;
| | - Marijn A. Huijing
- Department of Plastic Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
| | - Barbara L. van Leeuwen
- Department of Surgery, Division of Surgical Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (B.L.v.L.); (L.B.B.)
| | - Lukas B. Been
- Department of Surgery, Division of Surgical Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (B.L.v.L.); (L.B.B.)
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Porrello G, Cannella R, Randazzo A, Badalamenti G, Brancatelli G, Vernuccio F. CT and MR Imaging of Retroperitoneal Sarcomas: A Practical Guide for the Radiologist. Cancers (Basel) 2023; 15:cancers15112985. [PMID: 37296946 DOI: 10.3390/cancers15112985] [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: 04/30/2023] [Revised: 05/21/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023] Open
Abstract
Primary retroperitoneal sarcomas (RPS) represent around 10-16% of all sarcomas, with liposarcomas and leiomyosarcomas being the most common subtypes. RPS have some peculiar characteristics, imaging appearances, worse prognosis, and complications compared to other locations of sarcoma. Commonly, RPS primarily present as large masses, progressively encasing adjacent structures, causing mass effect, and complications. RPS diagnosis is often challenging, and these tumors may be overlooked; however, failure to recognize RPS characteristics leads to a worse prognosis for the patients. Surgery is the only recognized curative treatment, but the anatomical constraints of the retroperitoneum limit the ability to achieve wide resection margins; therefore, these tumors have a high rate of recurrence, and require long-term follow-up. The radiologist has an important role in the diagnosis of RPS, the definition of their extent, and their follow-up. Specific knowledge of the main imaging findings is required to reach an early diagnosis, and, ultimately, to guarantee the best patient management. This article provides an overview of the current knowledge regarding cross-sectional imaging features of patients with retroperitoneal sarcomas, presenting tips and tricks to improve imaging diagnosis of RPS.
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Affiliation(s)
- Giorgia Porrello
- Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnosis (Bi.N.D), University of Palermo, 90127 Palermo, Italy
- Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Via Tricomi 5, 90127 Palermo, Italy
| | - Roberto Cannella
- Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnosis (Bi.N.D), University of Palermo, 90127 Palermo, Italy
| | - Angelo Randazzo
- Department of Radiology, Azienda Sanitaria Provinciale, 92100 Agrigento, Italy
| | - Giuseppe Badalamenti
- Section of Medical Oncology, Department of Surgical, Oncological and Oral Sciences (DICHIRONS), University of Palermo, 90127 Palermo, Italy
| | - Giuseppe Brancatelli
- Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnosis (Bi.N.D), University of Palermo, 90127 Palermo, Italy
| | - Federica Vernuccio
- Department of Radiology, University Hospital of Padova, 35128 Padova, Italy
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Edelmuth DGL, Helito PVP, Filippi RZ, Baptista AM, Bordalo M. Staging of primary and secondary solid musculoskeletal tumors. Skeletal Radiol 2023; 52:365-378. [PMID: 35974195 DOI: 10.1007/s00256-022-04118-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 07/06/2022] [Accepted: 07/08/2022] [Indexed: 02/02/2023]
Affiliation(s)
- Diogo Guilherme Leão Edelmuth
- Radiology Department, Instituto de Ortopedia E Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,Radiology Department, Instituto de Radiologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Paulo Victor Partezani Helito
- Radiology Department, Instituto de Ortopedia E Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,Radiology Department, Instituto de Radiologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Renée Zon Filippi
- Pathology Department, Instituto de Ortopedia E Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - André Mathias Baptista
- Orthopedic Oncology Department, Instituto de Ortopedia E Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Marcelo Bordalo
- Radiology Department, Instituto de Ortopedia E Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil. .,Radiology Department, Instituto de Radiologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
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8
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Crombé A, Spinnato P, Righi A, Leopardi MP, Carpenzano M, Izzo F, Parmeggiani A, Linck PA, Perret R, Cesari M, Longhi A, Miceli M, Kind M, Bianchi G. Imaging presentation of extraskeletal osteosarcomas on CT and MRI and correlation with patients outcome: A two-center retrospective study of 54 patients. Diagn Interv Imaging 2023; 104:297-306. [PMID: 36813659 DOI: 10.1016/j.diii.2023.01.009] [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: 11/22/2022] [Revised: 01/18/2023] [Accepted: 01/26/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE The purpose of this study was to analyze the imaging features of extraskeletal osteosarcomas (ESOS) on computed tomography (CT) and magnetic resonance imaging (MRI) and to investigate their associations with overall survival (OS) using uni- and multivariable survival analyses. MATERIALS AND METHODS This two-center retrospective study included all consecutive adult patients between 2008 and 2021 with histopathologically-proven ESOS who underwent pre-treatment CT and/or MRI. Clinical and histological characteristics, ESOS presentation on CT and MRI, treatment and outcomes were reported. Survival analyses were performed using Kaplan-Meier analysis and Cox regressions. Associations between imaging features and OS were searched using uni- and multivariable analyses. RESULTS Fifty-four patients were included (30/54 [56%] men, median age: 67.5 years). Twenty-four died of ESOS (median OS: 18 months). ESOS were mostly deep-seated (46/54, 85%) in the lower limb (27/54, 50%) with a median size of 95 mm (interquartile range: 64, 142; range: 21-289 mm). Mineralization was seen on 26/42 (62%) patients, mainly gross-amorphous (18/26; 69%). ESOS were generally highly heterogeneous on T2-weighted images (38/48; 79%) and contrast-enhanced (CE) T1-weighted images (29/40; 72%), with necrosis (39/40; 97%), well-defined or focally infiltrative margins (39/47; 83%), with moderate peritumoral edema (39/47; 83%) and rim-like peripheral enhancement (17/40; 42%). Size, location, mineralization on CT, signal intensity heterogeneity on T1-, T2- and CE-T1-weighted images and hemorragic signal on MRI were associated with poorer OS (range of log-rank P = 0.0069-0.0485). At multivariable analysis, hemorragic signal and signal intensity heterogeneity on T2-weighted images remained predictive for poorer OS (hazard ratio [HR] = 2.68, P = 0.0299; HR = 9.85, P = 0.0262, respectively) CONCLUSION: ESOS typically presents as mineralized heterogeneous and necrotic soft tissue tumor with a possible rim-like enhancement and limited peritumoral abnormalities. MRI may help estimate outcome of patients with ESOS.
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Affiliation(s)
- Amandine Crombé
- Department of Musculoskeletal Imaging, Pellegrin University Hospital, 33000, Bordeaux, France; Department of Oncologic Imaging, Institut Bergonié, 33076, Bordeaux, France; Models in Oncology (MONC) Team, INRIA Bordeaux Sud-Ouest, CNRS UMR 5251 & Bordeaux University, 33400, Talence, France
| | - Paolo Spinnato
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Alberto Righi
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | | | - Maria Carpenzano
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Federica Izzo
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Anna Parmeggiani
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | | | - Raul Perret
- Department of Biopathology, Comprehensive Cancer Center, 33000, Bordeaux, France
| | - Marilena Cesari
- Osteoncology, Bone and Soft Tissue Sarcomas, and Innovative Therapies, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Alessandra Longhi
- Osteoncology, Bone and Soft Tissue Sarcomas, and Innovative Therapies, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Marco Miceli
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Michèle Kind
- Department of Oncologic Imaging, Institut Bergonié, 33076, Bordeaux, France
| | - Giuseppe Bianchi
- Department of Orthopedic Oncology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
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9
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Prognostic factors of the synovial sarcoma of the extremities: imaging does matter. Eur Radiol 2023; 33:1162-1173. [PMID: 35980435 DOI: 10.1007/s00330-022-09049-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 05/20/2022] [Accepted: 07/22/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Synovial sarcomas (SS) of the extremities are rare soft tissue sarcomas that are more common in young adults. We deciphered the imaging phenotype of SS with the aim to determine if imaging could provide an incremental value to currently known prognostic factors (PF)-age and histological grade-to predict long-term overall survival (OS). METHODS This retrospective multicenter study included consecutive pediatric and adult patients with synovial sarcomas of the extremities from December 2002 to August 2020. Inclusion criteria were (i) a follow-up greater than 5 years and (ii) available pre-therapeutic MRI. A subset analysis included MRI and CT-scan. Clinical, pathological, and imaging variables were collected in all patients. The primary endpoint was to evaluate the association of these variables with OS using univariate and multivariate Cox regressions. RESULTS Out of 428 patients screened for eligibility, 98 patients (mean age: 37.1 ± 15.2 years) were included (MRI: n = 98/98, CT scan: n = 34/98; 35%). The median OS was 75.25 months (IQR = 55.50-109.12) and thirty-six patients (n = 36/98;37%) died during follow-up. The recurrence rate was 12.2% (n =12/98). SS lesions were mostly grade 2 (57/98; 58%). On MRI, SS had a mean long-axis diameter of 67.5 ± 38.3 mm. On CT scan, 44% (15/34) were calcified. Grade (hazard ratio [HR] = 2.71; 95%CI = 1.30-5.66; p = 0.008), size of the lesions evaluated on MRI (HR = 1.02; 95% CI = 1.01-1.03; p < 0.001), and calcifications on CT scan (HR = 0.10; 95% CI = 0.02-0.50; p = 0.005) were independent PF of OS. CONCLUSIONS This study demonstrated that imaging biomarkers can be used to predict long-term outcome in patients with SS. Strikingly, the presence of calcifications on CT scan is associated with favorable outcome and provides an incremental value over existing PF such as age, grade, and size. KEY POINTS • Beyond its diagnostic value, MRI is a pre-operative prognostic tool in synovial sarcomas of the extremities since the size of the lesion is an important prognostic factor. • Calcifications on CT scans are independently and significantly associated with prolonged overall survival.
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10
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Spinnato P, Chiesa AM, Ledoux P, Kind M, Bianchi G, Tuzzato G, Righi A, Crombé A. Primary Soft-Tissue Lymphomas: MRI Features Help Discriminate From Other Soft-Tissue Tumors. Acad Radiol 2023; 30:285-299. [PMID: 36088202 DOI: 10.1016/j.acra.2022.08.009] [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] [Received: 06/22/2022] [Revised: 08/02/2022] [Accepted: 08/05/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES MRI presentation of extra-nodal soft-tissue lymphomas (STLs) is scarcely reported and lacks of comparison with other soft-tissue tumors (STTs) including sarcomas (STS). Yet, suggesting this diagnosis on MRI would considerably reduce diagnostic intervals. Our aim was to investigate if conventional MRI could discriminate STLs from other STTs. METHODS MRIs of STL patients were compared with those of patients addressed to a sarcoma reference center for the diagnosis of a STT. MRI characteristics depicting the tumor (size, signal, habitats, shape, surrounding tissues) were reported. Uni- and multivariate associations with STL diagnosis were evaluated in the entire cohort, and in the subgroups of benign and malignant STTs patients. Diagnostic performances of MRI features combinations were tested. RESULTS We included 39 patients with STLs (median age: 69 years) and 368 patients with other STTs (122 benign STTs and 246 STS; median age: 58 years). Six MRI features were independent predictors of STL compared to all other STTs: intermediate SI on T1-WI, homogeneous enhancement (without necrotic areas), no blood signal, no fibrotic signal, no peritumoral enhancement and lack of abnormal intra- and peritumoral vasculature (p-value range: <0.0001-0.0163). Their simultaneous presence had a sensitivity of 0.88 (0.71-0.96) and a specificity of 0.88 (0.84-0.91). Other relevant MRI features were: no fat signal to discriminate against STS (p = 0.0409), the infiltrative growth pattern and the vessel and nerve encasement to discriminate against benign STTs (p = 0.0016 and 0.0011, respectively). CONCLUSION Our research demonstrates that conventional MRI can help discriminating STLs from other STTs. Indeed, radiologists can help suggesting the possible diagnosis of STL, which could speed-up the subsequent proper histopathological analysis in light of MRI findings.
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Affiliation(s)
- Paolo Spinnato
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy.
| | - Anna Maria Chiesa
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Pauline Ledoux
- Department of Diagnostic and Interventional Oncological Imaging, Institut Bergonié, Regional Comprehensive Cancer of Nouvelle-Aquitaine, Bordeaux, France
| | - Michele Kind
- Department of Diagnostic and Interventional Oncological Imaging, Institut Bergonié, Regional Comprehensive Cancer of Nouvelle-Aquitaine, Bordeaux, France
| | - Giuseppe Bianchi
- Orthopaedic Musculoskeletal Oncology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Gianmarco Tuzzato
- Orthopaedic Musculoskeletal Oncology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Righi
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Amandine Crombé
- Department of Diagnostic and Interventional Oncological Imaging, Institut Bergonié, Regional Comprehensive Cancer of Nouvelle-Aquitaine, Bordeaux, France; Department of musculoskeletal imaging, Pellegrin University Hospital, Bordeaux, France; Models in Oncology (MONC) Team, INRIA Bordeaux Sud-Ouest, Talence, France
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11
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Crombé A, Kind M, Fadli D, Miceli M, Linck PA, Bianchi G, Sambri A, Spinnato P. Soft-tissue sarcoma in adults: Imaging appearances, pitfalls and diagnostic algorithms. Diagn Interv Imaging 2022; 104:207-220. [PMID: 36567193 DOI: 10.1016/j.diii.2022.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/08/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
This article provides an overview of the current knowledge regarding diagnostic imaging of patients with soft-tissue sarcomas, which is a heterogeneous group of rare mesenchymal malignancies. After an initial contextualization, diagnostic flow-chart based on initial radiological findings of soft-tissue masses (with specific focus on adipocytic soft-tissue tumors [STTs], hemorragic STTs and retroperitoneal STTs) are provided considering relevant results from novel researches, guidelines, and experts' viewpoints, with the aim to help radiologists and clinicians in their practice. Particularly, the central place of sarcoma reference centers in the diagnostic and therapeutic management is highlighted, as well as the pivotal role that radiologists should play to correctly identify patients with soft-tissue sarcoma at the initial stage of the disease. Indications and methods for performing imaging-guided biopsies are also discussed, as well as clues to improve soft-tissue sarcoma grading with conventional and quantitative imaging.
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Affiliation(s)
- Amandine Crombé
- Department of Musculoskeletal Imaging, Pellegrin University Hospital, Bordeaux 33076, France; Department of Diagnostic and Interventional Oncological Imaging, Institut Bergonié, Regional Comprehensive Cancer of Nouvelle-Aquitaine, Bordeaux 33076, France; Models in Oncology (MONC) Team, INRIA Bordeaux Sud-Ouest, CNRS UMR 5251 & Bordeaux University, 33400 Talence, France.
| | - Michèle Kind
- Department of Diagnostic and Interventional Oncological Imaging, Institut Bergonié, Regional Comprehensive Cancer of Nouvelle-Aquitaine, Bordeaux 33076, France
| | - David Fadli
- Department of Musculoskeletal Imaging, Pellegrin University Hospital, Bordeaux 33076, France
| | - Marco Miceli
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna 40136, Italy
| | - Pierre-Antoine Linck
- Department of Diagnostic and Interventional Oncological Imaging, Institut Bergonié, Regional Comprehensive Cancer of Nouvelle-Aquitaine, Bordeaux 33076, France
| | - Giuseppe Bianchi
- Orthopedic Musculoskeletal Oncology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna 40136, Italy
| | - Andrea Sambri
- Orthopedics and Traumatology Department, IRCCS Azienda Ospedaliero Universitaria di Bologna, Via Massarenti 9, Bologna 40138, Italy
| | - Paolo Spinnato
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna 40136, Italy
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12
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Meyers AB, Epelman M. Ultrasound versus magnetic resonance imaging of soft-tissue lesions: competitive or complementary? Pediatr Radiol 2022; 52:1639-1647. [PMID: 35122484 DOI: 10.1007/s00247-021-05274-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/10/2021] [Accepted: 12/17/2021] [Indexed: 10/19/2022]
Abstract
Soft-tissue lumps and bumps are a common referral for imaging in children and adolescents. The etiology of these lesions includes benign non-tumorous lesions, as well as benign and malignant tumors. Some of these lesions have a characteristic imaging appearance but others do not and require tissue sampling to make a diagnosis. MRI typically provides the best overall characterization of soft-tissue masses; however, in some cases US provides complementary information to that provided by MRI that can help make a diagnosis.
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Affiliation(s)
- Arthur B Meyers
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave., Cincinnati, OH, 45229, USA.
| | - Monica Epelman
- Department of Radiology, Nemours Children's Health System/Nemours Children's Hospital, Orlando, FL, USA
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13
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MRI evaluation of soft tissue tumors: comparison of a fast, isotropic, 3D T2-weighted fat-saturated sequence with a conventional 2D T2-weighted fat-saturated sequence for tumor characteristics, resolution, and acquisition time. Eur Radiol 2022; 32:8670-8680. [PMID: 35751699 DOI: 10.1007/s00330-022-08937-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/24/2022] [Accepted: 05/30/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To test whether a 4-fold accelerated 3D T2-weighted (T2) CAIPIRINHA SPACE TSE sequence with isotropic voxel size is equivalent to conventional 2DT2 TSE for the evaluation of intrinsic and perilesional soft tissue tumors (STT) characteristics. METHODS For 108 patients with histologically-proven STTs, MRI, including 3DT2 (CAIPIRINHA SPACE TSE) and 2DT2 (TSE) sequences, was performed. Two radiologists evaluated each sequence for quality (diagnostic, non-diagnostic), tumor characteristics (heterogeneity, signal intensity, margin), and the presence or absence of cortical involvement, marrow edema, and perilesional edema (PLE); tumor size and PLE extent were measured. Signal-to-noise (SNR) and contrast-to-noise (CNR) ratios and acquisition times for 2DT2 in two planes and 3DT2 sequences were reported. Descriptive statistics and inter-method agreement were reported. RESULTS Image quality was diagnostic for all sequences (100% [108/108]). No difference was observed between 3DT2 and 2DT2 tumor characteristics (p < 0.05). There was no difference in mean tumor size (3DT2: 2.9 ± 2.5 cm, 2DT2: 2.8 ± 2.6 cm, p = 0.4) or PLE extent (3DT2:0.5 ± 1.2 cm, 2DT2:0.5 ± 1.0 cm, p = 0.9) between the sequences. There was no difference in the SNR of tumors, marrow, and fat between the sequences, whereas the SNR of muscle was higher (p < 0.05) on 3DT2 than 2DT2. CNR measures on 3DT2 were similar to 2DT2 (p > 0.1). The average acquisition time was shorter for 3DT2 compared with 2DT2 (343 ± 127 s vs 475 ± 162 s, respectively). CONCLUSION Isotropic 3DT2 MRI offers higher spatial resolution, faster acquisition times, and equivalent assessments of STT characteristics compared to conventional 2DT2 MRI in two planes. 3DT2 is interchangeable with a 2DT2 sequence in tumor protocols. KEY POINTS • Isotropic 3DT2 CAIPIRINHA SPACE TSE offers higher spatial resolution than 2DT2 TSE and is equivalent to 2DT2 TSE for assessments of soft tissue tumor intrinsic and perilesional characteristics. • Multiplanar reformats of 3DT2 CAIPIRINHA SPACE TSE can substitute for 2DT2 TSE acquired in multiple planes, thereby reducing the acquisition time of MRI tumor protocols. • 3DT2 CAIPIRINHA SPACE TSE and 2DT2 TSE had similar CNR of tissues.
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14
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Jamshidi K, Mirzaei A, Bagherifard A, Jahansouz A, Mohaghegh MR. Does the adherence of distal femur parosteal osteosarcoma to the neurovascular bundle increase the rate of local recurrences? Orthop Traumatol Surg Res 2022; 108:103220. [PMID: 35093566 DOI: 10.1016/j.otsr.2022.103220] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/16/2021] [Accepted: 07/09/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Proximity of tumor to the neurovascular bundle (NVB) makes achieving a wide margin difficult. In low-grade parosteal osteosarcoma (POS), it is not clear whether adherence of tumor to NVB increases the rate of local recurrence (LR). In this study, we evaluated whether tumor adherence to the NVB increases the risk of LR in low-grade POS of the distal femur? HYPOTHESIS We hypothesized that if the thin neurovascular barrier (the adventitia of the vessels and the epineurium of the nerve) prevents tumor penetration, the rate of LR should be comparable between the lesions with and without a continuous layer of healthy fatty tissue between the tumor and NVB. MATERIALS AND METHODS In a retrospective survey, 30 patients with low-grade POS of the posterior aspect of the distal femur were evaluated for the proximity of mass to NVB. Based on the proximal to distal T1 axial MRI sections, the tumors were divided into two groups including the tumors with an uninterrupted (group A) and interrupted (group B) rim of fatty tissue between the mass and NVB. The rate of LR was compared between the two study groups. The concordance of MRI in detecting NVB adherence was checked with pathology specimen. RESULTS Using MRI, we identified 16 cases in group A and 14 cases in group B. The MRI status of fatty rim was concordant with pathology specimen in 96.4% of cases. The mean follow-up period of the two groups was not statistically different (117±27.6 vs. 105.8±29.4 months, respectively, p=0.29). The other baseline characteristics of the two groups were statistically comparable, as well. The rate of LR was 12.5% (2 out of 16 patients) in group A and 14.3% (2 out of 14 patients) in group B (95% CI: 0.142-9.586, p=0.87). The 10-year recurrence-free survival was 87.5% for group A and 85.7% for group B (p=0.9). DISCUSSION The absence of a continuous rim of fatty tissue between the tumor and NVB in MRI does not increase the risk of LR in low-grade POS of the distal femur. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Khodamorad Jamshidi
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Mirzaei
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Abolfazl Bagherifard
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Jahansouz
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Reza Mohaghegh
- Anesthesiology and Critical Care Department, Hasheminejad Kidney Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
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15
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Fadli D, Kind M, Michot A, Le Loarer F, Crombé A. Natural Changes in Radiological and Radiomics Features on
MRIs
of
Soft‐Tissue
Sarcomas Naïve of Treatment: Correlations With Histology and Patients' Outcomes. J Magn Reson Imaging 2021; 56:77-96. [DOI: 10.1002/jmri.28021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 11/26/2021] [Accepted: 11/29/2021] [Indexed: 01/03/2023] Open
Affiliation(s)
- David Fadli
- Department of Diagnostic and Interventional Oncological Imaging Institut Bergonié, Regional Comprehensive Cancer of Nouvelle‐Aquitaine Bordeaux France
| | - Michèle Kind
- Department of Diagnostic and Interventional Oncological Imaging Institut Bergonié, Regional Comprehensive Cancer of Nouvelle‐Aquitaine Bordeaux France
| | - Audrey Michot
- Department of Oncological Surgery Institut Bergonié, Regional Comprehensive Cancer of Nouvelle‐Aquitaine Bordeaux France
- Bordeaux University Bordeaux France
| | - François Le Loarer
- Bordeaux University Bordeaux France
- Department of Pathology Institut Bergonié, Regional Comprehensive Cancer of Nouvelle‐Aquitaine Bordeaux France
| | - Amandine Crombé
- Department of Diagnostic and Interventional Oncological Imaging Institut Bergonié, Regional Comprehensive Cancer of Nouvelle‐Aquitaine Bordeaux France
- Bordeaux University Bordeaux France
- Models in Oncology (MONC) Team INRIA Bordeaux Sud‐Ouest, CNRS UMR 5251 Talence France
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16
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Theruvath AJ, Rashidi A, Nyalakonda R, Avedian R, Steffner R, Spunt SL, Daldrup-Link HE. Ferumoxytol magnetic resonance imaging detects joint and pleural infiltration of bone sarcomas in pediatric and young adult patients. Pediatr Radiol 2021; 51:2521-2529. [PMID: 34410452 PMCID: PMC8602726 DOI: 10.1007/s00247-021-05156-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/10/2021] [Accepted: 07/12/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The diagnosis of joint infiltration by a malignant bone tumor affects surgical management. The specificity of standard magnetic resonance imaging (MRI) for diagnosing joint infiltration is limited. During our MRI evaluations with ferumoxytol nanoparticles of pediatric and young adult patients with bone sarcomas, we observed a surprising marked T1 enhancement of joint and pleural effusions in some patients but not in others. OBJECTIVE To evaluate if nanoparticle extravasation differed between joints and pleura with and without tumor infiltration. MATERIALS AND METHODS We retrospectively identified 15 pediatric and young adult patients (mean age: 16±4 years) with bone sarcomas who underwent 18 MRI scans at 1 h (n=7) or 24 h (n=11) after intravenous ferumoxytol infusion. Twelve patients also received a gadolinium-enhanced MRI. We determined tumor invasion into the joint or pleural space based on histology (n=11) and imaging findings (n=4). We compared the signal-to-noise ratios (SNR) and contrast-to-noise ratios (CNR) of the joint or pleural fluid for tumors with and without invasion using a Mann-Whitney U test. RESULTS MRI scans 24 h after intravenous ferumoxytol infusion demonstrated a positive T1 enhancement of the effusion in all joints and pleural spaces with tumor infiltration and no joint or pleural space without infiltration. Corresponding SNR (P=0.004) and CNR (P=0.004) values were significantly higher for joints and pleural spaces with tumor infiltration than without. By contrast, unenhanced MRI, gadolinium-enhanced MRI and 1-h post-contrast ferumoxytol MRI did not show any enhancement of the joint or pleural effusion, with or without tumor infiltration. CONCLUSION This pilot study suggests that 24-h post-contrast ferumoxytol MRI scans can noninvasively differentiate between joints with and without tumor infiltration.
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Affiliation(s)
- Ashok J. Theruvath
- Department of Radiology, Pediatric Molecular Imaging Program, Stanford University
| | - Ali Rashidi
- Department of Radiology, Pediatric Molecular Imaging Program, Stanford University
| | - Ramya Nyalakonda
- Department of Radiology, Pediatric Molecular Imaging Program, Stanford University
| | - Raffi Avedian
- Department of Orthopedic Surgery, Lucile Packard Children’s Hospital, Stanford University
| | - Robert Steffner
- Department of Orthopedic Surgery, Lucile Packard Children’s Hospital, Stanford University
| | - Sheri L. Spunt
- Department of Pediatrics, Pediatric Hematology/Oncology, Lucile Packard Children’s Hospital
| | - Heike E. Daldrup-Link
- Department of Radiology, Pediatric Molecular Imaging Program, Stanford University,Department of Pediatrics, Pediatric Hematology/Oncology, Lucile Packard Children’s Hospital
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17
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Peeken JC, Neumann J, Asadpour R, Leonhardt Y, Moreira JR, Hippe DS, Klymenko O, Foreman SC, von Schacky CE, Spraker MB, Schaub SK, Dapper H, Knebel C, Mayr NA, Woodruff HC, Lambin P, Nyflot MJ, Gersing AS, Combs SE. Prognostic Assessment in High-Grade Soft-Tissue Sarcoma Patients: A Comparison of Semantic Image Analysis and Radiomics. Cancers (Basel) 2021; 13:1929. [PMID: 33923697 PMCID: PMC8073388 DOI: 10.3390/cancers13081929] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/13/2021] [Accepted: 04/13/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In patients with soft-tissue sarcomas of the extremities, the treatment decision is currently regularly based on tumor grading and size. The imaging-based analysis may pose an alternative way to stratify patients' risk. In this work, we compared the value of MRI-based radiomics with expert-derived semantic imaging features for the prediction of overall survival (OS). METHODS Fat-saturated T2-weighted sequences (T2FS) and contrast-enhanced T1-weighted fat-saturated (T1FSGd) sequences were collected from two independent retrospective cohorts (training: 108 patients; testing: 71 patients). After preprocessing, 105 radiomic features were extracted. Semantic imaging features were determined by three independent radiologists. Three machine learning techniques (elastic net regression (ENR), least absolute shrinkage and selection operator, and random survival forest) were compared to predict OS. RESULTS ENR models achieved the best predictive performance. Histologies and clinical staging differed significantly between both cohorts. The semantic prognostic model achieved a predictive performance with a C-index of 0.58 within the test set. This was worse compared to a clinical staging system (C-index: 0.61) and the radiomic models (C-indices: T1FSGd: 0.64, T2FS: 0.63). Both radiomic models achieved significant patient stratification. CONCLUSIONS T2FS and T1FSGd-based radiomic models outperformed semantic imaging features for prognostic assessment.
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Affiliation(s)
- Jan C. Peeken
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Ismaninger Straße 22, 81675 Munich, Germany; (R.A.); (O.K.); (H.D.); (S.E.C.)
- Institute of Radiation Medicine (IRM), Department of Radiation Sciences (DRS), Helmholtz Zentrum München, 85764 München, Germany
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Germany
- Department of Precision Medicine, GROW—School for Oncology and Developmental Biology, Maastricht University, 6200 MD Maastricht, The Netherlands; (H.C.W.); (P.L.)
| | - Jan Neumann
- Department of Radiology, Klinikum rechts der Isar, Technical University of Munich (TUM), 81675 Munich, Germany; (J.N.); (Y.L.); (J.R.M.); (S.C.F.); (C.E.v.S.); (A.S.G.)
| | - Rebecca Asadpour
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Ismaninger Straße 22, 81675 Munich, Germany; (R.A.); (O.K.); (H.D.); (S.E.C.)
| | - Yannik Leonhardt
- Department of Radiology, Klinikum rechts der Isar, Technical University of Munich (TUM), 81675 Munich, Germany; (J.N.); (Y.L.); (J.R.M.); (S.C.F.); (C.E.v.S.); (A.S.G.)
| | - Joao R. Moreira
- Department of Radiology, Klinikum rechts der Isar, Technical University of Munich (TUM), 81675 Munich, Germany; (J.N.); (Y.L.); (J.R.M.); (S.C.F.); (C.E.v.S.); (A.S.G.)
| | - Daniel S. Hippe
- Department of Radiation Oncology, University of Washington, Seattle, WA 98195, USA; (D.S.H.); (S.K.S.); (N.A.M.); (M.J.N.)
| | - Olena Klymenko
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Ismaninger Straße 22, 81675 Munich, Germany; (R.A.); (O.K.); (H.D.); (S.E.C.)
| | - Sarah C. Foreman
- Department of Radiology, Klinikum rechts der Isar, Technical University of Munich (TUM), 81675 Munich, Germany; (J.N.); (Y.L.); (J.R.M.); (S.C.F.); (C.E.v.S.); (A.S.G.)
| | - Claudio E. von Schacky
- Department of Radiology, Klinikum rechts der Isar, Technical University of Munich (TUM), 81675 Munich, Germany; (J.N.); (Y.L.); (J.R.M.); (S.C.F.); (C.E.v.S.); (A.S.G.)
| | - Matthew B. Spraker
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO 63110, USA;
| | - Stephanie K. Schaub
- Department of Radiation Oncology, University of Washington, Seattle, WA 98195, USA; (D.S.H.); (S.K.S.); (N.A.M.); (M.J.N.)
| | - Hendrik Dapper
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Ismaninger Straße 22, 81675 Munich, Germany; (R.A.); (O.K.); (H.D.); (S.E.C.)
| | - Carolin Knebel
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technical University of Munich (TUM), 81675 Munich, Germany;
| | - Nina A. Mayr
- Department of Radiation Oncology, University of Washington, Seattle, WA 98195, USA; (D.S.H.); (S.K.S.); (N.A.M.); (M.J.N.)
| | - Henry C. Woodruff
- Department of Precision Medicine, GROW—School for Oncology and Developmental Biology, Maastricht University, 6200 MD Maastricht, The Netherlands; (H.C.W.); (P.L.)
- Department of Radiology and Nuclear Imaging, GROW—School for Oncology and Developmental Biology, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands
| | - Philippe Lambin
- Department of Precision Medicine, GROW—School for Oncology and Developmental Biology, Maastricht University, 6200 MD Maastricht, The Netherlands; (H.C.W.); (P.L.)
- Department of Radiology and Nuclear Imaging, GROW—School for Oncology and Developmental Biology, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands
| | - Matthew J. Nyflot
- Department of Radiation Oncology, University of Washington, Seattle, WA 98195, USA; (D.S.H.); (S.K.S.); (N.A.M.); (M.J.N.)
- Department of Radiology, University of Washington, Seattle, WA 98195, USA
| | - Alexandra S. Gersing
- Department of Radiology, Klinikum rechts der Isar, Technical University of Munich (TUM), 81675 Munich, Germany; (J.N.); (Y.L.); (J.R.M.); (S.C.F.); (C.E.v.S.); (A.S.G.)
| | - Stephanie E. Combs
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Ismaninger Straße 22, 81675 Munich, Germany; (R.A.); (O.K.); (H.D.); (S.E.C.)
- Institute of Radiation Medicine (IRM), Department of Radiation Sciences (DRS), Helmholtz Zentrum München, 85764 München, Germany
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Germany
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18
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Staging and Classification of Primary Musculoskeletal Bone and Soft Tissue Tumors Based on the 2020 WHO Update, From the AJR Special Series on Cancer Staging. AJR Am J Roentgenol 2021; 217:1038-1052. [PMID: 33852362 DOI: 10.2214/ajr.21.25658] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Staging of primary musculoskeletal bone and soft tissue tumors is most commonly performed using the AJCC and the Enneking or Musculoskeletal Tumor Society (MSTS) staging systems. Radiologic imaging is integral in achieving adequate musculoskeletal neoplastic staging by defining lesion extent and identifying regional lymph node involvement and distant metastatic disease. Additional important features in surgical planning, though not distinct components of the staging systems, include cortical involvement, joint invasion, and neurovascular encasement; these features are optimally evaluated by MRI. In 2020, the WHO updated the classification of primary musculoskeletal tumors of soft tissue and bone. The update reflects the continued explosion in identification of novel gene alterations in many bone and soft tissue neoplasms. This has resulted in newly designated lesions, reclassification of lesion categories, and improved specificity of diagnosis. While radiologists do not need to have a comprehensive knowledge of the pathologic details, a broad working understanding of the most recent update is important to aid accurate and timely diagnosis given that histologic grading is a component of all staging systems. By approaching primary musculoskeletal neoplasms through a multidisciplinary approach with colleagues in pathology, orthopedic oncology, radiation oncology, and medical oncology, radiologists may promote improved diagnosis, treatment, and outcomes.
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19
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Tsukamoto S, Mavrogenis AF, Tanaka Y, Errani C. Imaging of Soft Tissue Tumors. Curr Med Imaging 2021; 17:197-216. [PMID: 32660406 DOI: 10.2174/1573405616666200713183400] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/08/2020] [Accepted: 06/20/2020] [Indexed: 02/07/2023]
Abstract
Differentiation of malignant from benign soft tissue tumors is challenging with imaging alone, including that by magnetic resonance imaging and computed tomography. However, the accuracy of this differentiation has increased owing to the development of novel imaging technology. Detailed patient history and physical examination remain essential for differentiation between benign and malignant soft tissue tumors. Moreover, measurement only of tumor size based on Response Evaluation Criteria In Solid Tumors criteria is insufficient for the evaluation of response to chemotherapy or radiotherapy. Change in metabolic activity measured by 18F-fluorodeoxyglucose positron emission tomography or dynamic contrast enhanced-derived quantitative endpoints can more accurately evaluate treatment response compared to change in tumor size. Magnetic resonance imaging can accurately evaluate essential factors in surgical planning such as vascular or bone invasion and "tail sign". Thus, imaging plays a critical role in the diagnosis and treatment of soft tissue tumors.
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Affiliation(s)
- Shinji Tsukamoto
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | - Costantino Errani
- Department Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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20
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Annovazzi A, Rea S, Zoccali C, Sciuto R, Baldi J, Anelli V, Petrongari MG, Pescarmona E, Biagini R, Ferraresi V. Diagnostic and Clinical Impact of 18F-FDG PET/CT in Staging and Restaging Soft-Tissue Sarcomas of the Extremities and Trunk: Mono-Institutional Retrospective Study of a Sarcoma Referral Center. J Clin Med 2020; 9:jcm9082549. [PMID: 32781683 PMCID: PMC7463806 DOI: 10.3390/jcm9082549] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/31/2020] [Accepted: 08/04/2020] [Indexed: 12/14/2022] Open
Abstract
Background: Soft-tissue sarcomas (STS) represent a wide heterogeneous class of rare tumors. The exact role 18F-fluorodeoxyglucose positron emission/computed tomography (18F-FDG PET/CT) in the evaluation of STS is not well established. The aim of the present study was to evaluate how the use of 18F-FDG PET/CT in STS could influence patient therapy planning, looking for a possible added value over computed tomography and magnetic resonance imaging—the most used modalities in the study of STS. Differences in SUVmax according to histologic subtype and tumor grade were also considered. Methods: a total of 345 consecutive 18F-FDG PET/CT scans performed for initial staging (n = 171) or for suspected disease relapse (n = 174) in 282 patients with STS extracted from the local Information System database were retrospectively reviewed. Results: 18F-FDG PET/CT altered therapy planning in 80 cases (16.4% for staging and 29.9% in restaging), both for disease upstaging (58.8%) and downstaging (41.2%) Conclusions: 18F-FDG PET/CT could significantly influence management of patients with STS, particularly for restaging.
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Affiliation(s)
- Alessio Annovazzi
- Nuclear Medicine Unit, IRCCS—Regina Elena National Cancer Institute, 00144 Rome, Italy; (S.R.); (R.S.)
- Correspondence:
| | - Sandra Rea
- Nuclear Medicine Unit, IRCCS—Regina Elena National Cancer Institute, 00144 Rome, Italy; (S.R.); (R.S.)
| | - Carmine Zoccali
- Oncological Orthopaedics Unit, IRCCS—Regina Elena National Cancer Institute, 00144 Rome, Italy; (C.Z.); (J.B.); (R.B.)
| | - Rosa Sciuto
- Nuclear Medicine Unit, IRCCS—Regina Elena National Cancer Institute, 00144 Rome, Italy; (S.R.); (R.S.)
| | - Jacopo Baldi
- Oncological Orthopaedics Unit, IRCCS—Regina Elena National Cancer Institute, 00144 Rome, Italy; (C.Z.); (J.B.); (R.B.)
| | - Vincenzo Anelli
- Radiology and Diagnostic Imaging Unit, IRCCS—Regina Elena National Cancer Institute, 00144 Rome, Italy;
| | - Maria G. Petrongari
- Department of Radiation Oncology, IRCCS—Regina Elena National Cancer Institute, 00144 Rome, Italy;
| | - Edoardo Pescarmona
- Clinical Pathology, IRCCS—Regina Elena National Cancer Institute, 00144 Rome, Italy;
| | - Roberto Biagini
- Oncological Orthopaedics Unit, IRCCS—Regina Elena National Cancer Institute, 00144 Rome, Italy; (C.Z.); (J.B.); (R.B.)
| | - Virginia Ferraresi
- Medical Oncology 1, IRCCS—Regina Elena National Cancer Institute, 00144 Rome, Italy;
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21
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Perez JR, Jose J, Mohile NV, Boden AL, Greif DN, Barrera CM, Conway S, Subhawong T, Ugarte A, Pretell-Mazzini J. Limb salvage reconstruction: Radiologic features of common reconstructive techniques and their complications. J Orthop 2020; 21:183-191. [PMID: 32256002 DOI: 10.1016/j.jor.2020.03.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 03/25/2020] [Indexed: 01/26/2023] Open
Abstract
Limb salvage surgery refers to orthopaedic procedures designed to resect tumors and reconstruct limbs. Improvements in managing malignant bone lesions have led to a dramatic shift in limb salvage procedures. Orthopaedic surgeons now employ four main reconstructive procedures: endoprosthesis, autograft, bulk allograft, and allograft prosthetic composite. While each approach has its advantages, each technique is associated with complications. Furthermore, knowledge of procedure specific imaging findings can lead to earlier complication diagnosis and improved clinical outcomes. The aim of this article is to review leading reconstructive options available for limb salvage surgery and present a case series illustrating the associated complications.
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Affiliation(s)
- Jose R Perez
- Department of Orthopedic Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, 1600 NW 10th Ave, Miami, 33136, FL, USA
| | - Jean Jose
- Department of Radiology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, 1600 NW 10th Ave, Miami, 33136, FL, USA
| | - Neil V Mohile
- Department of Orthopedic Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, 1600 NW 10th Ave, Miami, 33136, FL, USA
| | - Allison L Boden
- Department of Orthopedic Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, 1600 NW 10th Ave, Miami, 33136, FL, USA
| | - Dylan N Greif
- Department of Orthopedic Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, 1600 NW 10th Ave, Miami, 33136, FL, USA
| | - Carlos M Barrera
- Department of Orthopedic Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, 1600 NW 10th Ave, Miami, 33136, FL, USA
| | - Sheila Conway
- Department of Orthopedic Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, 1600 NW 10th Ave, Miami, 33136, FL, USA
| | - Ty Subhawong
- Department of Radiology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, 1600 NW 10th Ave, Miami, 33136, FL, USA
| | - Ane Ugarte
- Hospital Universitario Donostia, Department of Radiology, Begiristain Doktorea Pasealekua #109, Gipuzkoa, 20014, Spain
| | - Juan Pretell-Mazzini
- Department of Orthopedic Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, 1600 NW 10th Ave, Miami, 33136, FL, USA
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22
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Jin Q, Xie X, Yao H, Wen L, Li H, Lv D, Zeng Z, Wang Y, Zou C, Yin J, Huang G, Wang B, Shen J. Clinical Significance of the Radiological Relationship between the Tumor and the main blood vessels in Enneking IIB Osteosarcoma of the extremities. J Cancer 2020; 11:3235-3245. [PMID: 32231729 PMCID: PMC7097963 DOI: 10.7150/jca.42341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 02/11/2020] [Indexed: 11/05/2022] Open
Abstract
Aim: Osteosarcoma is one of the most prevalent primary bone malignancies in children and adolescents. Magnetic resonance imaging (MRI) has been considered a very critical tool to provide anatomical information of tumor and surrounding main blood vessels. To evaluate the prognostic significance of the radiological vascular involvement according to the pre-treatment MRI in patients with Enneking IIB osteosarcoma. Methods: In this retrospective study, we included 482 patients younger than 50 years old with Enneking IIB primary osteosarcoma of the extremities with complete clinical records from 2005 to 2015.Univariate and multivariable analyses were conducted to identify the risk factors for OS (Overall survival) and EFS (Event-free survival). The correlations between the risk factors was performed using Spearman analysis. The Kaplan-Meier method was used to calculate survival curves. Based on the radiological relationship between the tumor lesion and the surrounding reactive area with the main blood vessels as shown on pretreatment MRI findings. Results: Radiological vascular involvement assessed via pretreatment MRI is an important risk factor for Enneking IIB primary patients with osteosarcoma (HROS=2.32/HREFS=1.81 P<0.01) according to the univariate and multivariable analyses. Enneking IIB patients with osteosarcoma were assigned to three subtypes based on the radiological relationship between the main blood vessels and the lesion or reactive area. The 5-year cumulative OS of patients classified by the three types were 81.6% (type I), 67.1% (type II) and 44.8% (type III)(P<0.01). The 5-year cumulative EFS of the three types were 60.2% (type I), 46.7% (type II) and 30.2% (type III)(P<0.05). The total 5-year cumulative OS and EFS for all patients were 68.3% and 48.3%, respectively. Conclusion: Vascular involvement according to radiological findings from pretreatment MRI is an independent risk factor for cumulative OS and EFS in patients with Enneking IIB primary osteosarcoma of the extremities. The new subtyping based on the relationship between the tumors and surrounding reactive area with the main blood vessels based on pretreatment MRI can predict the prognosis of patients with osteosarcoma and provide certain directive information for selecting the appropriate surgical procedure for individual patients.
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Affiliation(s)
- Qinglin Jin
- Department of Musculoskeletal Oncology Center, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2 nd Rd, Guangzhou 510080, China.,Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Guangzhou 510080, China
| | - Xianbiao Xie
- Department of Musculoskeletal Oncology Center, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2 nd Rd, Guangzhou 510080, China.,Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Guangzhou 510080, China
| | - Hao Yao
- Department of Musculoskeletal Oncology Center, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2 nd Rd, Guangzhou 510080, China.,Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Guangzhou 510080, China
| | - Lili Wen
- Department of Anesthesiology, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, 651 Dongfengdong Rd, Guangzhou 510060, China
| | - Hongbo Li
- Department of Musculoskeletal Oncology Center, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2 nd Rd, Guangzhou 510080, China.,Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Guangzhou 510080, China
| | - Dongming Lv
- Department of Musculoskeletal Oncology Center, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2 nd Rd, Guangzhou 510080, China.,Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Guangzhou 510080, China
| | - Ziliang Zeng
- Department of Musculoskeletal Oncology Center, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2 nd Rd, Guangzhou 510080, China.,Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Guangzhou 510080, China
| | - Yongqian Wang
- Department of Musculoskeletal Oncology Center, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2 nd Rd, Guangzhou 510080, China.,Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Guangzhou 510080, China
| | - Changye Zou
- Department of Musculoskeletal Oncology Center, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2 nd Rd, Guangzhou 510080, China.,Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Guangzhou 510080, China
| | - Junqiang Yin
- Department of Musculoskeletal Oncology Center, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2 nd Rd, Guangzhou 510080, China.,Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Guangzhou 510080, China
| | - Gang Huang
- Department of Musculoskeletal Oncology Center, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2 nd Rd, Guangzhou 510080, China.,Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Guangzhou 510080, China
| | - Bo Wang
- Department of Musculoskeletal Oncology Center, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2 nd Rd, Guangzhou 510080, China.,Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Guangzhou 510080, China
| | - Jingnan Shen
- Department of Musculoskeletal Oncology Center, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2 nd Rd, Guangzhou 510080, China.,Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Guangzhou 510080, China
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23
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Gemescu IN, Thierfelder KM, Rehnitz C, Weber MA. Imaging Features of Bone Tumors: Conventional Radiographs and MR Imaging Correlation. Magn Reson Imaging Clin N Am 2020; 27:753-767. [PMID: 31575404 DOI: 10.1016/j.mric.2019.07.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Imaging bone tumors often causes uncertainty, especially outside dedicated sarcoma treatment centers. Conventional radiography remains the backbone of bone tumor diagnostics, but MR imaging has a role. Radiographs are crucial for assessing the tumor matrix and aggressiveness. MR imaging is the best modality for local staging. This article reviews semiological aspects of bone tumors: patient age, tumor localization, pattern of bone destruction/margins, aggressiveness, growth speed, matrix formation, periosteal reaction, cortical involvement, size, and number of lesions. All aspects are discussed in terms of their appearance on radiographs and MR imaging, with a focus on the correlation between the 2 modalities.
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Affiliation(s)
- Ioan N Gemescu
- Department of Radiology and Medical Imaging, University Emergency Hospital Bucharest, Splaiul Independentei, 169, 050098, Bucharest, Romania.
| | - Kolja M Thierfelder
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Centre, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
| | - Christoph Rehnitz
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Centre, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
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24
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Crombé A, Fadli D, Buy X, Italiano A, Saut O, Kind M. High-Grade Soft-Tissue Sarcomas: Can Optimizing Dynamic Contrast-Enhanced MRI Postprocessing Improve Prognostic Radiomics Models? J Magn Reson Imaging 2020; 52:282-297. [PMID: 31922323 DOI: 10.1002/jmri.27040] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/07/2019] [Accepted: 12/11/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Heterogeneity on pretreatment dynamic contrast-enhanced (DCE)-MRI of sarcomas may be prognostic, but the best technique to capture this characteristic remains unknown. PURPOSE To investigate the best method to extract prognostic data from baseline DCE-MRI. STUDY TYPE Retrospective, single-center. POPULATION Fifty consecutive uniformly-treated adults with nonmetastatic high-grade sarcomas. FIELD STRENGTH/SEQUENCE 1.5T; T2 -weighted-imaging, fat-suppressed fast spoiled gradient echo DCE-MRI. ASSESSMENT Ninety-two radiomics features (RFs) were extracted at each DCE-MRI phase (11, from t = 0-88 sec). Relative changes in RFs (rRFs) since the acquisition baseline were calculated (11 × 92 rRFs). Curves of rRF as function of time postinjection were integrated (92 integrated-rRFs [irRFs]). Ktrans and area under the time-intensity curve at 88-sec parametric maps were computed and 2 × 92 parametric-RFs (pRFs) were extracted. Five DCE-MRI-based radiomics models were built on: an RFs subset (32 sec, 64 sec, 88 sec); all rRFs; all irRFs; and all pRFs. Two models were elaborated as reference, on: conventional radiological features; and T2 -WI RFs. STATISTICAL TESTS A common machine-learning approach was applied to radiomics models. Features with P < 0.05 at univariate analysis were entered in a LASSO-penalized Cox regression including bootstrapped 10-fold cross-validation. The resulting radiomics scores (RScores) were dichotomized per their median and entered in multivariate Cox models for predicting metastatic relapse-free survival. Models were compared with integrative area under the curve (AUC) and concordance index. RESULTS Only dichotomized RScores from models based on rRFs subset, all rRFS and irRFS correlated with prognostic (P = 0.0107-0.0377). The models including all rRFs and irRFs had the highest c-index (0.83), followed by the radiological model. The radiological model had the highest integrative AUC (0.87), followed by models including all rRFs and irRFs. The radiological and full rRFs models were significantly better than the T2 -based radiomics model (P = 0.02). DATA CONCLUSION The initial DCE-MRI of STS contains prognostic information. It seems more relevant to make predictions on rRFs instead of pRFs. Evidence Level: 3 Technical Efficacy: 3 J. Magn. Reson. Imaging 2020;52:282-297.
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Affiliation(s)
- Amandine Crombé
- Department of Radiology, Institut Bergonie, Bordeaux, France.,Modelisation in Oncology (MOnc) Team, INRIA Bordeaux-Sud-Ouest, CNRS UMR 5251 & Université de Bordeaux, Talence, France.,University of Bordeaux, Bordeaux, France
| | - David Fadli
- Department of Radiology, Institut Bergonie, Bordeaux, France
| | - Xavier Buy
- Department of Radiology, Institut Bergonie, Bordeaux, France
| | - Antoine Italiano
- University of Bordeaux, Bordeaux, France.,Department of Medical Oncology, Institut Bergonie, Bordeaux, France
| | - Olivier Saut
- Modelisation in Oncology (MOnc) Team, INRIA Bordeaux-Sud-Ouest, CNRS UMR 5251 & Université de Bordeaux, Talence, France.,University of Bordeaux, Bordeaux, France
| | - Michèle Kind
- Department of Radiology, Institut Bergonie, Bordeaux, France
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25
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Abstract
RATIONALE Chondrosarcoma is a malignant mesenchymal tumor originating from cartilage. The pelvis, ribs, femur, and humerus are the most frequently affected sites, and scapula involvement is relatively rare. The aim of the present study was to report a case of chondrosarcoma in the scapula. PATIENT CONCERNS A 42-year-old woman presented with a 3-month history of a painful mass in the right scapula. DIAGNOSES AND INTERVENTION The patient underwent tumor resection. The post-operative pathological diagnosis was scapula chondrosarcoma. OUTCOMES Following resection, the patient continued to receive routine follow-up care. There was no recurrence or tumor metastasis at a follow-up of 5 years. CONCLUSIONS Surgery remains the primary therapy for chondrosarcoma. One of the greatest challenges in the management of chondrosarcoma is to accurately assess tumor grade before surgical intervention. Chemotherapy and radiotherapy have been applied without success. Chemo- and radioresistance have been examined beyond classic phenotypic properties to identify more efficient therapeutic strategies. Therefore, development of future novel therapies is contingent upon elucidating the molecular mechanisms of chondrosarcoma.
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Affiliation(s)
- Shuai Qiang
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Xin-Nan Ma
- Department of Orthopedics, Second Affiliated Hospital of Harbin Medical University, Harbin City, Heilongjiang Province, China
| | - Hong-Wei Wang
- Department of Orthopedics, Second Affiliated Hospital of Harbin Medical University, Harbin City, Heilongjiang Province, China
| | - Song-Cen Lv
- Department of Orthopedics, Second Affiliated Hospital of Harbin Medical University, Harbin City, Heilongjiang Province, China
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26
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MR Imaging of Pediatric Musculoskeletal Tumors:: Recent Advances and Clinical Applications. Magn Reson Imaging Clin N Am 2019; 27:341-371. [PMID: 30910102 DOI: 10.1016/j.mric.2019.01.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Pediatric musculoskeletal tumors comprise approximately 10% of childhood neoplasms, and MR imaging has been used as the imaging evaluation standard for these tumors. The role of MR imaging in these cases includes identification of tumor origin, tissue characterization, and definition of tumor extent and relationship to adjacent structures as well as therapeutic response in posttreatment surveillance. Technical advances have enabled quantitative evaluation of biochemical changes in tumors. This article reviews recent updates to MR imaging of pediatric musculoskeletal tumors, focusing on advanced MR imaging techniques and providing information on the relevant physics of these techniques, clinical applications, and pitfalls.
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27
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Crombé A, Brisse HJ, Ledoux P, Haddag-Miliani L, Bouhamama A, Taieb S, Le Loarer F, Kind M. Alveolar soft-part sarcoma: can MRI help discriminating from other soft-tissue tumors? A study of the French sarcoma group. Eur Radiol 2018; 29:3170-3182. [DOI: 10.1007/s00330-018-5903-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 10/25/2018] [Accepted: 11/22/2018] [Indexed: 02/07/2023]
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Raghavan M. Conventional Modalities and Novel, Emerging Imaging Techniques for Musculoskeletal Tumors. Cancer Control 2018; 24:161-171. [DOI: 10.1177/107327481702400208] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Meera Raghavan
- Department of Radiology, Northwell Health, New Hyde Park,
New York
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Macpherson RE, Pratap S, Tyrrell H, Khonsari M, Wilson S, Gibbons M, Whitwell D, Giele H, Critchley P, Cogswell L, Trent S, Athanasou N, Bradley KM, Hassan AB. Retrospective audit of 957 consecutive 18F-FDG PET-CT scans compared to CT and MRI in 493 patients with different histological subtypes of bone and soft tissue sarcoma. Clin Sarcoma Res 2018; 8:9. [PMID: 30116519 PMCID: PMC6086048 DOI: 10.1186/s13569-018-0095-9] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 02/26/2018] [Indexed: 12/22/2022] Open
Abstract
Background The use of 18F-FDG PET–CT (PET–CT) is widespread in many cancer types compared to sarcoma. We report a large retrospective audit of PET–CT in bone and soft tissue sarcoma with varied grade in a single multi-disciplinary centre. We also sought to answer three questions. Firstly, the correlation between sarcoma sub-type and grade with 18FDG SUVmax, secondly, the practical uses of PET–CT in the clinical setting of staging (during initial diagnosis), restaging (new baseline prior to definitive intervention) and treatment response. Finally, we also attempted to evaluate the potential additional benefit of PET–CT over concurrent conventional CT and MRI. Methods A total of 957 consecutive PET–CT scans were performed in a single supra-regional centre in 493 sarcoma patients (excluding GIST) between 2007 and 2014. We compared, PET–CT SUVmax values in relation to histology and FNCCC grading. We compared PET–CT findings relative to concurrent conventional imaging (MRI and CT) in staging, restaging and treatment responses. Results High-grade (II/III) bone and soft tissue sarcoma correlated with high SUVmax, especially undifferentiated pleomorphic sarcoma, leiomyosarcoma, translocation induced sarcomas (Ewing, synovial, alveolar rhabdomyosarcoma), de-differentiated liposarcoma and osteosarcoma. Lower SUVmax values were observed in sarcomas of low histological grade (grade I), and in rare subtypes of intermediate grade soft tissue sarcoma (e.g. alveolar soft part sarcoma and solitary fibrous tumour). SUVmax variation was noted in malignant peripheral nerve sheath tumours, compared to the histologically benign plexiform neurofibroma, whereas PET–CT could clearly differentiate low from high-grade chondrosarcoma. We identified added utility of PET–CT in addition to MRI and CT in high-grade sarcoma of bone and soft tissues. An estimated 21% overall potential benefit was observed for PET–CT over CT/MRI, and in particular, in ‘upstaging’ of high-grade disease (from M0 to M1) where an additional 12% of cases were deemed M1 following PET–CT. Conclusions PET–CT in high-grade bone and soft tissue sarcoma can add significant benefit to routine CT/MRI staging. Further prospective and multi-centre evaluation of PET–CT is warranted to determine the actual predictive value and cost-effectiveness of PET–CT in directing clinical management of clinically complex and heterogeneous high-grade sarcomas.
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Affiliation(s)
- Ruth E Macpherson
- 1Oxford Sarcoma Service (OxSarc), Oxford University Hospitals Foundation Trust, Oxford, OX3 7LE UK.,2Department of Radiology, Oxford University Hospitals Foundation Trust, Oxford, OX3 7LE UK
| | - Sarah Pratap
- 1Oxford Sarcoma Service (OxSarc), Oxford University Hospitals Foundation Trust, Oxford, OX3 7LE UK.,3Department of Oncology, Churchill Hospital, Oxford University Hospitals Foundation Trust, Oxford, OX3 7LE UK
| | - Helen Tyrrell
- 3Department of Oncology, Churchill Hospital, Oxford University Hospitals Foundation Trust, Oxford, OX3 7LE UK
| | - Mehrdad Khonsari
- 2Department of Radiology, Oxford University Hospitals Foundation Trust, Oxford, OX3 7LE UK
| | - Shaun Wilson
- 1Oxford Sarcoma Service (OxSarc), Oxford University Hospitals Foundation Trust, Oxford, OX3 7LE UK.,5Department of Paediatric Oncology, Oxford University Hospitals Foundation Trust, Oxford, OX3 7LE UK
| | - Max Gibbons
- 1Oxford Sarcoma Service (OxSarc), Oxford University Hospitals Foundation Trust, Oxford, OX3 7LE UK.,4Nuffield Orthopaedic Centre, Oxford University Hospitals Foundation Trust, Oxford, OX3 7LE UK
| | - Duncan Whitwell
- 1Oxford Sarcoma Service (OxSarc), Oxford University Hospitals Foundation Trust, Oxford, OX3 7LE UK.,4Nuffield Orthopaedic Centre, Oxford University Hospitals Foundation Trust, Oxford, OX3 7LE UK
| | - Henk Giele
- 1Oxford Sarcoma Service (OxSarc), Oxford University Hospitals Foundation Trust, Oxford, OX3 7LE UK.,4Nuffield Orthopaedic Centre, Oxford University Hospitals Foundation Trust, Oxford, OX3 7LE UK
| | - Paul Critchley
- 1Oxford Sarcoma Service (OxSarc), Oxford University Hospitals Foundation Trust, Oxford, OX3 7LE UK.,4Nuffield Orthopaedic Centre, Oxford University Hospitals Foundation Trust, Oxford, OX3 7LE UK
| | - Lucy Cogswell
- 1Oxford Sarcoma Service (OxSarc), Oxford University Hospitals Foundation Trust, Oxford, OX3 7LE UK.,4Nuffield Orthopaedic Centre, Oxford University Hospitals Foundation Trust, Oxford, OX3 7LE UK
| | - Sally Trent
- 1Oxford Sarcoma Service (OxSarc), Oxford University Hospitals Foundation Trust, Oxford, OX3 7LE UK.,3Department of Oncology, Churchill Hospital, Oxford University Hospitals Foundation Trust, Oxford, OX3 7LE UK
| | - Nick Athanasou
- 1Oxford Sarcoma Service (OxSarc), Oxford University Hospitals Foundation Trust, Oxford, OX3 7LE UK.,4Nuffield Orthopaedic Centre, Oxford University Hospitals Foundation Trust, Oxford, OX3 7LE UK.,6NIHR Musculoskeletal Biomedical Research Unit (Sarcoma Theme), Sarcoma and TYA Unit of the NHS Oncology Department, and Sir William Dunn School of Pathology, University of Oxford, South Parks Road, Oxford, OX1 3RE UK
| | - Kevin M Bradley
- 1Oxford Sarcoma Service (OxSarc), Oxford University Hospitals Foundation Trust, Oxford, OX3 7LE UK.,2Department of Radiology, Oxford University Hospitals Foundation Trust, Oxford, OX3 7LE UK
| | - A Bassim Hassan
- 1Oxford Sarcoma Service (OxSarc), Oxford University Hospitals Foundation Trust, Oxford, OX3 7LE UK.,3Department of Oncology, Churchill Hospital, Oxford University Hospitals Foundation Trust, Oxford, OX3 7LE UK.,6NIHR Musculoskeletal Biomedical Research Unit (Sarcoma Theme), Sarcoma and TYA Unit of the NHS Oncology Department, and Sir William Dunn School of Pathology, University of Oxford, South Parks Road, Oxford, OX1 3RE UK
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De La Hoz Polo M, Dick E, Bhumbra R, Pollock R, Sandhu R, Saifuddin A. Surgical considerations when reporting MRI studies of soft tissue sarcoma of the limbs. Skeletal Radiol 2017; 46:1667-1678. [PMID: 28884363 DOI: 10.1007/s00256-017-2745-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 07/28/2017] [Accepted: 08/01/2017] [Indexed: 02/02/2023]
Abstract
Soft tissue sarcomas (STS) are rare tumours that require prompt diagnosis and treatment at a specialist centre. Magnetic resonance imaging (MRI) has become the modality of choice for identification, characterisation, biopsy planning and staging of soft tissue masses. MRI enables both the operating surgeon and patient to be optimally prepared prior to surgery for the likelihood of margin-negative resection and to anticipate possible sacrifice of adjacent structures and consequent loss of function. The aim of this review is to aid the radiologist in performing and reporting MRI studies of soft tissue sarcomas, with particular reference to the requirements of the surgical oncologist.
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Affiliation(s)
- Marcela De La Hoz Polo
- Radiology Department, Kings College Hospital, Denmark Hill, London, Brixton, SE5 9RS, UK.
| | - Elizabeth Dick
- Radiology Department, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London, W2 1NY, UK
| | - Rej Bhumbra
- Trauma & Orthopaedic Department, Barts Health Orthopaedic Centre, Newham & The Royal London Hospitals, Whitechapel Rd, London, Whitechapel, E1 1BB, UK
| | - Rob Pollock
- Trauma & Orthopaedic Department, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
| | - Ranbir Sandhu
- Radiology Department, Queen Elizabeth Hospital, University Hospitals Birmingham, Mindelsohn Way, Birmingham, B15 2TH, UK
| | - Asif Saifuddin
- Radiology Department, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK.
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Abstract
Functional MR imaging is the technique of choice to evaluate and manage malignant musculoskeletal masses. Advanced MR imaging sequences include chemical shift MR imaging, diffusion-weighted imaging with apparent diffusion coefficient mapping, MR spectroscopy imaging, and dynamic contrast-enhanced perfusion imaging. Functional MR imaging adds value to morphologic sequences in the detection, characterization, staging, and posttherapy assessment of malignant musculoskeletal malignancies. This article reviews the technical role of each functional sequence and their clinical applications to allow more confident decisions to be made. Multiparametric analysis of functional and anatomic MR sequences allows musculoskeletal tumors analysis to be improved.
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