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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References
Hajdu SI. Soft tissue sarcomas: classification and natural history. CA Cancer J Clin. 1981;31:271–80.
Fletcher C, Bridge J, Hogendoorn P, Mertens F, editors. World Health Organization classification of tumours of soft tissue and bone: pathology and genetics of tumours of soft tissue and bone. 4th ed. Lyon, France: IARC Press; 2013.
ESMO/European Sarcoma Network Working Group. Soft tissue and visceral sarcomas: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2014;25(Suppl 3:iii):102–12.
Cormier JN, Pollock RE. Soft tissue sarcomas. CA Cancer J Clin. 2004;54:94–109.
van Vliet M, Kliffen M, Krestin GP, Van Dijke CF. Soft tissue sarcomas at a glance: clinical, histological, and MR imaging features of malignant extremity soft tissue tumors. Eur Radiol. 2009;19(6):1499–511.
Noebauer-Huhmann IM, Weber MA, Lalam RK, et al. Soft tissue tumors in adults: ESSR-approved guidelines for diagnostic imaging. Semin Musculoskelet Radiol. 2015;19:475–82.
Bauer HC, Trovik CS, Alvegård TA, Berlin O, Erlanson M, Gustafson P, et al. Monitoring referral and treatment in soft tissue sarcoma: study based on 1,851 patients from the scandinavian sarcoma group register. Acta Orthop Scand. 2001, Apr;72:150–9.
Grimer R, Athanasou N, Gerrand C, et al. UK guidelines for the management of bone sarcomas. Sarcoma. 2010;2010:317462.
LeVay J, O’sullivan B, Catton C, et al. Outcome and prognostic factors in soft tissue sarcoma in the adult. Int J Radiat Oncol Biol Phys. 1993;27:1091–9.
Robinson E, Bleakney RR, Ferguson PC, O’Sullivan B. Oncodiagnosis panel: 2007: multidisciplinary management of soft-tissue sarcoma. Radiographics. 2008;28:2069–86.
Dalinka MK, Zlatkin MB, Chao P, Kricun ME, Kressel HY. The use of magnetic resonance imaging in the evaluation of bone and soft-tissue tumors. Radiol Clin N Am. 1990;28:461–70.
Elias DA, White LM, Simpson DJ, et al. Osseous invasion by soft-tissue sarcoma: assessment with MR imaging. Radiology. 2003;229:145–52.
Panicek DM, Go SD, Healey JH, Leung DH, Brennan MF, Lewis JJ. Soft-tissue sarcoma involving bone or neurovascular structures: MR imaging prognostic factors. Radiology. 1997;205:871–5.
Kransdorf MJ, Murphey MD. Imaging of soft-tissue musculoskeletal masses: fundamental concepts. Radiographics. 2016;36:1931–48.
Khoo MM, Saifuddin A. The role of MRI in image-guided needle biopsy of focal bone and soft tissue neoplasms. Skelet Radiol. 2013;42:905–15.
Manaster BJ. Soft-tissue masses: optimal imaging protocol and reporting. AJR Am J Roentgenol. 2013;201:505–14.
Holzapfel K, Regler J, Baum T, et al. Local staging of soft-tissue sarcoma: emphasis on assessment of neurovascular encasementvalue of MR imaging in 174 confirmed cases. Radiology. 2015;275:501–9.
Kransdorf MJ, Murphey MD. Radiologic evaluation of soft-tissue masses: a current perspective. AJR Am J Roentgenol. 2000;175:575–87.
Verstraete KL, Lang P. Bone and soft tissue tumors: the role of contrast agents for MR imaging. Eur J Radiol. 2000;34:229–46.
Belli P, Costantini M, Mirk P, Maresca G, Priolo F, Marano P. Role of color doppler sonography in the assessment of musculoskeletal soft tissue masses. J Ultrasound Med. 2000;19:823–30.
Khoo MM, Tyler PA, Saifuddin A, Padhani AR. Diffusion-weighted imaging (DWI) in musculoskeletal MRI: a critical review. Skelet Radiol. 2011;40:665–81.
Teixeira PA, Beaumont M, Gabriela H, et al. Advanced techniques in musculoskeletal oncology: perfusion, diffusion, and spectroscopy. Semin Musculoskelet Radiol. 2015;19:463–74.
Wu JS, Hochman MG. Soft-tissue tumors and tumorlike lesions: a systematic imaging approach. Radiology. 2009;253:297–316.
Crundwell N, O’Donnell P, Saifuddin A. Nonneoplastic conditions presenting as soft-tissue tumors: pictorial review. Clin Radiol. 2007;62:18–27.
Goodwin RW, O’Donnell P, Saifuddin A. MRI appearances of common benign soft-tissue tumours. Clin Radiol. 2007;62:843–53.
O’Regan KN, Jagannathan J, Krajewski K, et al. Imaging of liposarcoma: classification, patterns of tumor recurrence, and response to treatment. AJR Am J Roentgenol. 2011;197:W37–43.
Baheti AD, Tirumani SH, Rosenthal MH, et al. Myxoid soft-tissue neoplasms: comprehensive update of the taxonomy and MRI features. AJR Am J Roentgenol. 2015;204:374–85.
Suresh S, Saifuddin A, O’Donnell P. Lymphoma presenting as a musculoskeletal soft tissue mass: MRI findings in 24 cases. Eur Radiol. 2008;18:2628–34.
Crim JR, Seeger LL, Yao L, Chandnani V, Eckardt JJ. Diagnosis of soft-tissue masses with MR imaging: can benign masses be differentiated from malignant ones? Radiology. 1992;185:581–6.
Berquist TH, Ehman RL, King BF, Hodgman CG, Ilstrup DM. Value of MR imaging in differentiating benign from malignant soft-tissue masses: study of 95 lesions. AJR Am J Roentgenol. 1990;155:1251–5.
Gerrand CH, Wunder JS, Kandel RA, et al. Classification of positive margins after resection of soft-tissue sarcoma of the limb predicts the risk of local recurrence. J Bone Joint Surg Br. 2001;83:1149–55.
Jalgaonkar A, Dawson-Bowling SJ, Mohan AT, et al. Identification of the biopsy track in musculoskeletal tumour surgery: a novel technique using india ink. Bone Joint J. 2013;95-B:250–3.
Amin MB, Edge S, Greene F, et al (eds). 2017 AJCC cancer staging manual, 8th edition.
Anderson MW, Temple HT, Dussault RG, Kaplan PA. Compartmental anatomy: relevance to staging and biopsy of musculoskeletal tumors. AJR Am J Roentgenol. 1999;173:1663–71.
Galant J, Martí-Bonmatí L, Soler R, et al. Grading of subcutaneous soft tissue tumors by means of their relationship with the superficial fascia on MR imaging. Skelet Radiol. 1998;27:657–63.
Yoo HJ, Hong SH, Kang Y, et al. MR imaging of myxofibrosarcoma and undifferentiated sarcoma with emphasis on tail sign; diagnostic and prognostic value. Eur Radiol. 2014;24:1749–57.
Lefkowitz RA, Landa J, Hwang S, et al. Myxofibrosarcoma: prevalence and diagnostic value of the "tail sign" on magnetic resonance imaging. Skelet Radiol. 2013;42(6):809–18.
Panicek DM, Gatsonis C, Rosenthal DI, et al. CT and MR imaging in the local staging of primary malignant musculoskeletal neoplasms: report of the radiology diagnostic oncology group. Radiology. 1997;202:237–46.
Khosa F, Otero HJ, Prevedello LM, Rybicki FJ, Di Salvo DN. Imaging presentation of venous thrombosis in patients with cancer. AJR Am J Roentgenol. 2010;194:1099–108.
Ferguson PC, Griffin AM, O’Sullivan B, et al. Bone invasion in extremity soft-tissue sarcoma: impact on disease outcomes. Cancer. 2006;106:2692–700.
Ferguson PC, Kulidjian AA, Jones KB, Deheshi BM, Wunder JS. Peripheral nerve considerations in the management of extremity soft tissue sarcomas. Recent Results Cancer Res. 2009;179:243–56.
Stotter A, McLean NR, Fallowfield ME, Breach NM, Westbury G. Reconstruction after excision of soft tissue sarcomas of the limbs and trunk. Br J Surg. 1988;75:774–8.
Schwab JH, Boland PJ, Antonescu C, Bilsky MH, Healey JH. Spinal metastases from myxoid liposarcoma warrant screening with magnetic resonance imaging. Cancer. 2007;110:1815–22.
Mendenhall WM, Indelicato DJ, Scarborough MT, Zlotecki RA, Gibbs CP, Mendenhall NP, et al. The management of adult soft tissue sarcomas. Am J Clin Oncol. 2009;32:436–42.
Crago AM, Lee AY. Multimodality management of soft tissue tumors in the extremity. Surg Clin North Am. 2016;96:977–92.
Cable MG, Randall RL. Extremity soft tissue sarcoma: tailoring resection to histologic subtype. Surg Oncol Clin N Am. 2016;25:677–95.
Clarkson PW, Griffin AM, Catton CN, et al. Epineural dissection is a safe technique that facilitates limb salvage surgery. Clin Orthop Relat Res. 2005;438:92–6.
Lee GW, Mackinnon SE, Brandt K, Bell RS. A technique for nerve reconstruction following resection of soft-tissue sarcoma. J Reconstr Microsurg. 1993;9:139–44.
Fuchs B, Davis AM, Wunder JS, Bell RS, Masri BA, Isler M, et al. Sciatic nerve resection in the thigh: a functional evaluation. Clin Orthop Relat Res. 2001;382:34–41.
Clark MA, Thomas JM. Major amputation for soft-tissue sarcoma. Br J Surg. 2003;90:102–7.
O’Sullivan B, Davis AM, Turcotte R, et al. Preoperative versus postoperative radiotherapy in soft-tissue sarcoma of the limbs: a randomised trial. Lancet. 2002;359:2235–41.
Dickie CI, Parent AL, Griffin AM, et al. Bone fractures following external beam radiotherapy and limb-preservation surgery for lower extremity soft tissue sarcoma: relationship to irradiated bone length, volume, tumor location and dose. Int J Radiat Oncol Biol Phys. 2009;75:1119–24.
Pitson G, Robinson P, Wilke D, et al. Radiation response: An additional unique signature of myxoid liposarcoma. Int J Radiat Oncol Biol Phys. 2004;60:522–6.
Delisca GO, Alamanda VK, Archer KR, Song Y, Schwartz HS, Holt GE. Tumor size increase following preoperative radiation of soft tissue sarcomas does not affect prognosis. J Surg Oncol. 2013;107:723–7.
Biau DJ, Weiss KR, Bhumbra RS, et al. Monitoring the adequacy of surgical margins after resection of bone and soft-tissue sarcoma. Ann Surg Oncol. 2013:1858–64.
Ratan R, Patel SR. Chemotherapy for soft tissue sarcoma. Cancer. 2016;122:2952–60.
Woll PJ, Reichardt P, Le Cesne A, et al. EORTC soft tissue and bone sarcoma group and the NCIC clinical trials group sarcoma disease site committee. Adjuvant chemotherapy with doxorubicin, ifosfamide, and lenograstim for resected soft-tissue sarcoma (EORTC 62931): a multicentre randomised controlled trial. Lancet Oncol. 2012;13:1045–54.
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De La Hoz Polo, M., Dick, E., Bhumbra, R. et al. Surgical considerations when reporting MRI studies of soft tissue sarcoma of the limbs. Skeletal Radiol 46, 1667–1678 (2017). https://doi.org/10.1007/s00256-017-2745-z
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DOI: https://doi.org/10.1007/s00256-017-2745-z