MRI surveillance after resection for primary musculoskeletal sarcoma

Abstract

This study reports the experience of one treatment centre with routine surveillance MRI following excision of musculoskeletal sarcoma. The case notes, MRI and histology reports for 57 patients were reviewed. The primary outcome was local tumour recurrence detected on either surveillance MRI in asymptomatic patients, or interval MRI in patients with clinical concern. A total of 47 patients had a diagnosis of soft-tissue sarcoma and ten of a primary bone tumour. A total of 13 patients (22%) had local recurrence. Nine were identified on a surveillance scan, and four by interval scans. The cost of surveillance is estimated to be pound4414 per recurrence detected if low-grade tumours with clear resection margins are excluded. Surveillance scanning has a role in the early detection of local recurrence of bone and soft-tissue sarcoma.

Expert’s comment concerning Grand Rounds case entitled “Synovial sarcoma of the spine: a case involving paraspinal muscle with extensive calcification and the surgical consideration in treatment” (by Junhyung Kim, Sun-Ho Lee, Yoon-La Choi, Go Eun Bae, Eun-Sang Kim, Whan Eoh)

“…We have had two patients in whom their synovial sarcoma recurred in excess of 20 years after primary diagnosis. MRI surveillance is controversial with some authors [20] recommending its use, and others [9,21] less convinced. Regular CT scanning exposes the patient to high doses of ionising radiation, and in the UK, standard follow-up for detection of lung metastases would be chest radiology, providing the initial CT was clear [6].…”

Postoperative Tumor Imaging

“…18 If available, surveillance MRI is advised in patients after resection of musculoskeletal sarcoma because 20% of all sarcomas and 30% of all resected sarcomas with positive margins recur. 1,20 Susceptibility artifact from metallic fixation may obscure small recurrences on MRI and CT (Fig. 14), although MRI techniques are available to decrease artifact such as increasing receiver bandwidth, increasing matrix size, using fast spin-echo imaging and avoiding gradient-echo sequences.…”

Desmoid tumor mimics local recurrence of extremity sarcoma on MRI

“…Local recurrence after resection of extremity bone and soft‐tissue sarcoma has been reported in 5% to 35% of patients, typically occurring within 2 years of primary treatment 1‐5 . Magnetic resonance imaging (MRI) surveillance is commonly used postoperatively to monitor for local recurrence 3,6‐9 . MRI features of recurrent neoplasm include foci of increased signal on T2‐weighted, fat‐suppressed (T2‐FS) or short tau inversion recovery (STIR) sequences, with nodular or mass‐like enhancement on T1‐weighted postcontrast sequences 3,10 .…”