Diagnosis of Soft-Tissue Masses

Abstract

AJR 2011; 197:W365 0361–803X/11/1972–W365 © American Roentgen Ray Society Diagnosis of Soft-Tissue Masses We read with great interest the article by Subhawong et al. [1], “Soft-Tissue Masses and Masslike Conditions: What Does CT Add to Diagnosis and Management?” in the June 2010 issue of the AJR. As stated in the article, CT in combination with MRI is particularly useful for the evaluation of soft-tissue masses. In fact, CT may allow the detection of tiny calcifications as a key element in the early diagnosis of some soft-tissue masses, including myositis ossificans circumscripta (MOC) or paraosteoarthropathy (POA). However, it is noteworthy that sonography may allow the detection of the onset of mineralization before calcifications appear on radiographs or CT scans. Indeed, sonography is actually the most sensitive imaging modality for early diagnosis of the MOC zone phenomenon, in which a thin annular hyperechoic zone corresponds to the calcification area [2] (Fig. 1). Similarly, early sonographic assessment of patients with local signs of inflammation suggesting initial POA formation may permit a prompt and confident diagnosis as well [3] (Fig. 2). In both cases, hyperhemia can be observed contiguously on Doppler sonography. Using sonography for diagnosis may thus improve patient management: Nonsteroidal antiinflammatory agent therapy may stop the evolutionary process of POAs and MOC and prevent further heterotopic bone production [4]. Biopsy performance in acute and subacute MOC phases can yield falsepositive results in favor of malignancy owing to the malignant soft-tissue-like aspect at that time [5]. Because earlier diagnosis may permit earlier and more effective treatment and avoid useless biopsy, we think that sonography should be used as a first-choice diagnostic step in combination with MRI and CT to diagnose such soft-tissue masses. Alexis Lacout Centre d’Imagerie Medicale Centre Medico Chirugical (CMC)– groupe VITALIA Aurillac, France Pierre-Yves Marcy Antoine Lacassagne Cancer Research Institute Nice, France Robert Yves Carlier Hopital Raymond Poincare Service d’Imagerie Medicale Universite Paris Ile-de-France Ouest Garches, France DOI:10.2214/AJR.10.5203 WEB—This is a Web exclusive article.