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The MR imaging appearances and natural history of seromas following excision of soft tissue tumours

  • Musculoskeletal
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Abstract

Fluid collections (seromas) may accumulate at the site of surgery following excision of musculoskeletal soft tissue tumours. The aim of this retrospective study was to review the magnetic resonance (MR) imaging features of postoperative seromas identifying changes over time on follow-up scans. A total of 170 MR scans from 80 patients were reviewed showing one or more seromas. All patients had undergone previous surgery for a musculoskeletal soft tissue tumour. The typical MR appearances of a seroma were shown to be a well-defined oval or rounded (54%) soft tissue mass, arising at the site of previous surgery, with a thin, dark pseudocapsule, surrounding soft tissue oedema (80%), homogeneous contents that are hypointense (relative to adjacent muscle) on T1-weighted images (74%) and hyperintense on T2-weighted and STIR images (79%). Approximately one-quarter of cases revealed atypical features including hyperintense contents on T1-weighted (26%) and/or heterogeneous contents on T2-weighted images (21%), reflecting the breakdown of blood products and organization of the fluid collection. A distinctive fine feathery pattern arising from the inner surface of the seroma or from septations was identified in 10% of cases. In those patients who underwent one or more follow-up scans, the volume of the seromas decreased in 66% cases, remained unchanged in 15% and increased in 19%. Seromas are not an uncommon finding (<10% of cases) following surgery for a soft tissue tumour. The majority of cases show the typical MR features of a fluid collection. The pitfalls in differentiating an atypical seroma from a recurrent soft tissue sarcoma are discussed.

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References

  1. Moreau G, Bush CH, Scarborough MT, Enneking WF (1995) Surgical considerations in diagnostic imaging evaluation of musculoskeletal masses. MRI Clin N Am 3:577–590

    CAS  Google Scholar 

  2. Varma DGK, Jackson EF, Pollock RE, Benjamin RS (1995) Soft tissue sarcoma of the extremities: MR appearance of post-treatment changes and local recurrences. MRI Clin N Am 3:695–711

    CAS  Google Scholar 

  3. Chang AE, Sondak V (1995) Clinical evaluation and treatment of soft tissue tumors. In: Enzinger FM, Weiss SW (eds) Soft tissue tumors, 3rd edn. Mosby, St Louis, pp 17–38

  4. Vanel D, Lacombe MJ, Couanet D, Kalifa C, Spielman M, Genin J (1987) Musculoskeletal tumors: follow-up with MR imaging after treatment with surgery and radiation therapy. Radiology 164:243–245

    CAS  PubMed  Google Scholar 

  5. Vanel D, Shapeero LG, De Baere T, Gilles R, Tardivon A, Genin J, Guinebretiere JM (1994) MR imaging in the follow-up of malignant and aggressive soft tissue tumors: results of 511 examinations. Radiology 190:263–268

    CAS  PubMed  Google Scholar 

  6. Choi H, Varma DGK, Fornage BD, Kim EE, Johnston DA (1991) Soft-tissue sarcoma: MR imaging versus sonography for detection of local recurrence after surgery. AJR 157:353–358

    CAS  Google Scholar 

  7. Varma DGK (1999) Optimal radiologic imaging of soft tissue sarcomas. Sem Surg Oncol 17:2–10

    Article  CAS  Google Scholar 

  8. Vanel D, Shapeero LG, Tardivon A, Western A, Guinebretiere JM (1998) Dynamic contrast-enhanced MRI with subtraction of aggressive soft tissue tumors after resection. Skeletal Radiol 27:505–510

    Article  CAS  PubMed  Google Scholar 

  9. Shapeero LG, Vanel D, Verstraete KL, Bloem JL (1999) Dynamic contrast-enhanced MR imaging for soft tissue sarcomas. Sem Musc Radiol 3:101–113

    Google Scholar 

  10. Shapeero LG, Vanel D (1999) MR imaging in the follow-up evaluation of aggressive soft tissue tumors. Sem Musc Radiol 3:197–205

    Google Scholar 

  11. Panicek DM, Schwartz LH, Heelan RT, Caravelli JF (1995) Non-neoplastic causes of high signal intensity at T2-weighted MR imaging after treatment for musculoskeletal neoplasm. Skeletal Radiol 24:185–190

    CAS  PubMed  Google Scholar 

  12. Biondetti PR, Ehman RL (1992) Soft-tissue sarcomas: use of textural patterns in skeletal muscle as a diagnostic feature in postoperative MR imaging. Radiology 183:845–848

    CAS  PubMed  Google Scholar 

  13. Richardson ML, Zink-Brody GC, Patten RM, Koh WJ, Conrad EU (1996) MR characterization of post-irradiation soft tissue oedema. Skeletal Radiol 25:537–543

    Article  CAS  PubMed  Google Scholar 

  14. Davies AM, Vanel D (1998) Pictorial review: follow-up of musculoskeletal tumors. I. Local recurrence. Eur Radiol 8:791–799

    Article  CAS  PubMed  Google Scholar 

  15. Ma LD, McCarthy EF, Bluemke DA, Frassica FJ (1998) Differentiation of benign from malignant musculoskeletal lesions using MR imaging: pitfalls in MR evaluation of lesions with cystic appearance. AJR 170:1251–1258

    CAS  Google Scholar 

  16. Poon-Chue A, Menendez L, Gerstner MM, Colletti P, Terk M (1999) MRI evaluation of postoperative seromas in extremity soft tissue sarcomas. Skeletal Radiol 28:279–282

    Article  CAS  PubMed  Google Scholar 

  17. Skibber JM, Lotze MT, Seipp CA et al (1987) Limb-sparing surgery for soft tissue sarcomas: wound related morbidity in patients undergoing wide local excision. Surgery 102:447–452

    CAS  PubMed  Google Scholar 

  18. Sauter ER, Hoffman JP, Eisenberg BL (1993) Diagnosis and surgical management of locally recurrent soft-tissue sarcomas of the extremity. Semin Oncol 20:451–455

    CAS  PubMed  Google Scholar 

  19. Sitzmann JV, Dufresne C, Zuidena GD (1983) The use of sclerotherapy for treatment of post mastectomy wound seromas. Surgery 93:345–347

    CAS  PubMed  Google Scholar 

  20. Sterling A, Butterfield WC, Bonner R (1977) Post-traumatic cysts of soft tissue. J Trauma 17:392–396

    CAS  PubMed  Google Scholar 

  21. Alexander AA, Nazarian LN, Feld RI (1997) Superficial soft tissue masses suggestive of recurrent malignancy: sonographic localization and biopsy. AJR 169:1449–1451

    CAS  Google Scholar 

  22. Hahn PF, Saini S, Stark DD (1987) Intraabdominal hematoma: the concentric ring sign in MR imaging. Am Journal Roentgen 148:115–119

    CAS  Google Scholar 

  23. Sundaram M, McGuire MH, Herbold DR, Beshany SE, Fletcher JW (1987) High signal intensity soft tissue masses on T1 weighted pulsing sequences. Skeletal Radiol 16:30–36

    CAS  PubMed  Google Scholar 

  24. Davies AM, Mehr A, Parsonage S, Evans N, Grimer RJ, Pynsent PB (2004) MR imaging in the assessment of residual tumour following inadequate excision of soft tissue sarcomas. Eur Radiol 14:506–513

    Article  Google Scholar 

  25. Shapeero L, Vanel D, Verstarte KL, Bloem JL (2002) Fast MR imaging with contrast for soft tissue sarcoma viability. Clin Orthop 397:212–227

    PubMed  Google Scholar 

  26. Baur A, Huber A, Arbogast S, Durr HR, Zysk S, Wendtner C, Deimling M, Reiser M (2001) Diffusion-weighted imaging of tumor recurrencies and posttherapeutical changes in humans. Eur Radiol 11:828–833

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. MRI Centre, Royal Orthopaedic Hospital, Birmingham, B31 2AP, UK

    A. M. Davies, A. D. Hall, P. D. Strouhal & N. Evans

  2. Department of Orthopaedic Oncology, Royal Orthopaedic Hospital, Birmingham, UK

    R. J. Grimer

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  1. A. M. Davies
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  2. A. D. Hall
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  3. P. D. Strouhal
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  4. N. Evans
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  5. R. J. Grimer
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Correspondence to A. M. Davies.

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Davies, A.M., Hall, A.D., Strouhal, P.D. et al. The MR imaging appearances and natural history of seromas following excision of soft tissue tumours. Eur Radiol 14, 1196–1202 (2004). https://doi.org/10.1007/s00330-004-2255-y

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  • DOI: https://doi.org/10.1007/s00330-004-2255-y

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