Imaging of soft tissue sarcomas

Abstract

Soft tissue sarcomas are rare and a heterogeneous group of neoplasms. Over the years imaging has played a crucial role in the initial staging, monitoring response to chemotherapy, and surveillance for recurrence. In the era of rapidly evolving individualized treatment due to evolving chemotherapies, increasing demand has been placed on the role of imaging in the management of this heterogeneous group. The rapidly evolving technologies in imaging are trying to keep up with the challenge, with development of newer strategies and hybrid imaging. However, many of these newer technologies are either not available or too costly, even in advanced countries, and hence their exact role remains uncertain. Due to this, and the vast diversity of sarcomas, the imaging appearance and management strategies vary and there is no universally accepted algorithm for the role of individual imaging technologies. The basic imaging techniques; however, remain the same, with these newer techniques and strategies vying for their roles in management. We review current imaging techniques and their role in the management of soft tissue sarcomas.

Imaging of Bone Sarcomas and Soft-Tissue Sarcomas

“…Patel et al showed that a discrete elevated Cho-peak could diagnose malignancy with a sensitivity and specificity of 88 % and 68 %, respectively. In comparison, a low concentration (< 0.3 mmol/kg) has a negative predictive value of 100 % for excluding malignancy [6]. In our opinion, the limitation and the most probable reason this method has not yet been implemented in standard practice is that it is technically challenging and has potential pitfalls.…”

“…MRI provides excellent characterization of tissues and enables adequate evaluation of local tumor extent, which is crucial for delineating safe surgical margins. Regarding the signal characteristics of lesions, Patel divides all softtissue masses into four categories (see ▶ Table 4) [6].…”

“…Imaging techniques are rapidly evolving to address new and individualized treatment regimens [3][4][5][6][7][8] (▶ Table 3). In addition to conventional MRI (cMRI) sequences, advanced MRI techniques, including diffusion-weighted imaging (DWI), chemical shift imaging (CSI), dynamic contrast-enhanced MRI (DCE-MRI), MR spectroscopy (MRS), diffusion tensor imaging (DTI) are being assessed for sarcoma imaging.…”

Atualização no estadiamento dos sarcomas ósseos e das partes moles

“…14,15 In soft tissue tumors, radiographs allow the detection and definition of the mineraliza-tion pattern of a lesion, aiding the diagnosis/differential diagnosis with other tumors or pseudotumoral lesions (ossifying myositis, tumor calcinosis, vascular malformations, gout, extraskeletal mesenchymal chondrosarcoma, extraskeletal osteosarcoma, liposarcoma and synovial sarcoma); in addition, they reveal valuable information on tumor density (adipocytic tumors) and possible underlying bone involvement. 14,16 In view of a bone or soft tissue lesion with clinical and radiographic characteristics denoting biological aggressiveness, additional imaging tests are required 12 to determine local extension, distant spread (metastases) and histological diagnosis (►Figure 1).…”

“…Later studies confirmed its value in Ewing sarcoma staging 28 and, to date, the MSC recommends that the size of nine centimeters is the best prognostic indicator for osteosarcoma. The addition of the T3 designation for skip metastasis 9,16 was another modification -Wuisman et al 29 compared 224 patients without skip metastasis at diagnosis with 23 patients who presented such lesions. Twenty two of these 23 individuals had local recurrence or distant metastasis and died; adjuvant chemotherapy did not improve their prognosis.…”