Learning objectives
Identify the magnetic resonance imaging (MRI) features that are mostimportant for preoperative characterization and local staging ofsoft-tissue sarcomas.
Present a reporting checklist of the MRI features of soft-tissue sarcomas for assisting the surgical oncologist in the planning of patient management.
Background
Sarcomas are the most common type of soft-tissue tumor.
Most of them occur in the extremities (43%),
but many of these tumors also display a predilection for the viscera,
retroperitoneum,
trunk and the head and neck region.
Table 1 summarizes the age distribution of soft-tissue sarcomas.
MRis the imaging modality of choice for local staging,
monitoring response to therapy,
and surveillance for recurrence.
However,
MRI features can be nonspecific and overlap with more common pathologic conditions,
making diagnosis difficult or,
in some cases,
delaying diagnosis....
Findings and procedure details
IMAGING TECHNIQUES
Plain radiographs
Initial assessment of soft-tissue sarcomas should begin with radiographic evaluation.
Often unrewarding,
but may reveal important diagnostic information
Secondary bone involvement
To distinguish myositis ossyficans and tumoral calcinosis from mineralization of soft-tissuesarcomas
Mineralization or fat that assists diagnosis [extraskeletal chondrosarcoma and osteosarcoma,
liposarcoma,
synovial sarcoma (Fig. 1)]
Ultrasound
Ultrasound (US) is the modality of choice for evaluation of superficial soft-tissue mass.
MRIshould be performedwhen US features are not diagnostic of a benign tumor
Computed tomography
Current utility in soft-tissue sarcomas is...
Conclusion
Knowledge of MRI features characteristic of soft-tissue sarcomas is esential to avoid the delay in diagnosis and to assist the surgical oncologist in the planning of patient management.
In some cases,
MRI allows to establish the preoperative diagnosis of the histological subtype sarcoma.
The management of soft-tissue sarcomas is challenging,
and patients should be referred to tertiary centers experienced in the diagnosis and treatment of these tumors.
References
Baheti AD,
Tirumani SH,
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Baheti AD,
O'Malley RB,
Kim S,et al (2016) Soft-Tissue Sarcomas: An Updatefor Radiologists Based on the Revised 2013 World Health OrganizationClassification.
AJR Am J Roentgenol 206(5):924-932.
Berquist TH,
Ehman RL,
King BF,
Hodgman CG,
Ilstrup DM (1990) Value of MRimaging in differentiating benign from malignant soft-tissue masses: study of 95 lesions.
AJR Am J Roentgenol 155(6):1251-1255.
Costa FM,
Martins PH,
Canella C,...