Evaluation Of Soft Tissue Masses Research Articles

Ultrasound Evaluation of Soft Tissue Masses and Parotid Gland in Clinical Rheumatology.

Soft tissue masses are very common and may appear in the context of rheumatic diseases. They usually occur alone but may occasionally be part of the syndromes and can sometimes involve periarticular tissues. Soft tissue masses can be divided into several categories. In this article, we have categorized them into 3 different groups: (1) pseudotumors, (2) benign tumors, and (3) malignant tumors. Parotid enlargement will also be discussed in this study. The majority of Soft tissue masses are pseudotumors or benign tumors, which can be easily characterized with ultrasound, therefore, considered the first screening tool in the study of this type of lesion. If the tumor is deep or poorly accessible, or present with suspected signs of malignancy, the sonographer may suggest expanding the study with magnetic resonance imaging and/or an ultrasound-guided biopsy of the lesion. Ultrasound is also a good technique for the parotid and submandibular glands and is very useful for evaluating and monitoring Sjogren's syndrome.

The AIUM Practice Parameter for the Performance of the Musculoskeletal Ultrasound Examination.

The AIUM Practice Parameter for the Performance of the Musculoskeletal Ultrasound Examination.

Role of Ultrasound Elastography and Diffusion Weighted Magnetic Resonance Imaging in Evaluation of Soft Tissue Masses

Role of Ultrasound Elastography and Diffusion Weighted Magnetic Resonance Imaging in Evaluation of Soft Tissue Masses

Multiparametric Evaluation of Soft Tissue Sarcoma: Current Perspectives and Future Directions

Imaging plays an essential role in diagnosing and managing musculoskeletal soft tissue masses. It provides anatomic details and aids in the characterization and prognostication of tumors. Advanced imaging is also essential for assessing treatment response and post-treatment surveillance. Several novel imaging techniques are now available that provide additional functional and metabolic information about these tumors. This additional information may be used to predict the biological behavior of the tumors and effectively assess the treatment response for optimizing their management. This article focuses on multiparametric imaging evaluation of soft tissue masses with a discussion of advancements in the domains of ultrasound, MRI, and CT imaging and how these may be helpful in pre- and post-treatment assessment of soft tissue tumors. Current perspectives on the role of diffusion imaging, perfusion imaging, and MR spectroscopy have been highlighted, and future directions of metabolic imaging are briefly outlined. As these advances hold a promising role in the multidisciplinary management of soft tissue sarcomas, it is important for the radiologist to be familiar with the latest advances and developments in imaging soft tissue tumors.

Ultrasound of Soft Tissue Masses: Part II

In part I of this two-part series, we discussed the utility of ultrasound (US) for evaluation of soft tissue masses. Optimal scanning techniques were addressed. Multiple benign masses were highlighted in the first article, with particular attention to the features that were characteristic for a specific begin diagnosis. This article addresses more benign masses. Additionally, features of malignant soft tissue masses are reviewed and these findings reinforced with a discussion of several malignant diagnoses.

Ultrasound of Soft Tissue Masses: Part I

Ultrasound is an important initial imaging study for evaluation of soft tissue masses. Many benign masses have characteristic locations and imaging findings, which indicate their diagnosis. Likewise, malignant masses frequently have imaging features, which indicate a suspicious finding. It is important for radiologists to be able to differentiate benign from malignant soft tissue masses, and in turn, to recommend the appropriate next step for suspicious masses. This article focuses on multiple different benign masses and their imaging findings.

Imaging of Anterior Skull Base

Imaging evaluation of soft tissue masses is essential for diagnosis, preoperative staging, and post-treatment follow-up. Magnetic resonance imaging plays the major role because of its superior resolution that helps in better tissue characterization, and its multiplanar imaging capability in evaluation of soft tissue masses. Additional imaging techniques, such as radiographs, computed tomography, positron-emission tomography-CT, radionuclide scintigraphy and ultrasonography, also play vital roles by providing additional information required in management of soft tissue masses. Knowledge of the usefulness and limitations of these imaging techniques is essential for their judicious selection. This article reviews the current role of various imaging techniques in diagnosis, presurgical planning, and post-treatment follow-up of soft tissue masses.

Soft Tissue Sarcomas

Imaging evaluation of soft tissue masses is essential for diagnosis, preoperative staging, and post-treatment follow-up. Magnetic resonance imaging plays the major role because of its superior resolution that helps in better tissue characterization, and its multiplanar imaging capability in evaluation of soft tissue masses. Additional imaging techniques, such as radiographs, computed tomography, positron-emission tomography-CT, radionuclide scintigraphy and ultrasonography, also play vital roles by providing additional information required in management of soft tissue masses. Knowledge of the usefulness and limitations of these imaging techniques is essential for their judicious selection. This article reviews the current role of various imaging techniques in diagnosis, presurgical planning, and post-treatment follow-up of soft tissue masses.

Magnetic resonance imaging biomarkers in musculoskeletal soft tissue tumors: Review of conventional features and focus on nonmorphologic imaging.

The majority of peripheral musculoskeletal soft tissue masses encountered in routine clinical practice are benign and associated with an excellent prognosis, whereas a small proportion of soft tissue masses are malignant and are associated with higher morbidity and mortality. Owing to the excellent tissue contrast resolution provided, magnetic resonance imaging (MRI) is a primary modality for the diagnostic evaluation of soft tissue masses, particularly for defining the anatomic extent. MRI is also useful for the characterization of soft tissue masses; however, after the exclusion of cysts and lipomas, it is challenging to accurately categorize neoplastic lesions as benign or malignant with conventional anatomic MRI. Quantitative MRI biomarkers obtained with nonconventional pulse sequences are becoming increasingly available, and can improve the accuracy of determining the character of soft tissue masses. In this article we discuss established qualitative and emerging quantitative MRI-based biomarkers available with dynamic contrast-enhanced MRI, diffusion-weighted imaging, and MR spectroscopy and their utility for the characterization of untreated soft tissue masses. Level of Evidence: 5 Technical Efficacy Stage: 5 J. Magn. Reson. Imaging 2019;50:11-27.

Role of MRI and Doppler Sonography in Evaluation of Soft Tissue Masses: A Comparative Study

Role of MRI and Doppler Sonography in Evaluation of Soft Tissue Masses: A Comparative Study

Accuracy of MRI-based Diagnoses for Distal Upper Extremity Soft Tissue Masses

To determine the accuracy of the pre-operative MRI-based diagnosis of soft tissue masses in the forearm, wrist, and hand, the records of 144 patients who underwent an MRI followed by excision of a soft tissue mass in the forearm, wrist, or hand were reviewed. The MRI-based diagnosis was compared to the histological diagnosis, which was considered the gold standard. The sensitivity, specificity, positive predictive value, and negative predictive value of the MRI-based diagnosis were calculated. A multivariate regression analysis was performed.While the accuracy of the MRI-based diagnosis varied widely, there was an overall sensitivity of 75%. The most accurate diagnosis was an MRI-based diagnosis of ganglion cyst, which had a sensitivity of 94.7% and a specificity of 94.4%. Of particular concern was that the MRI-based diagnosis of a malignancy was only 66.7% sensitive, with a positive predictive value of 44.4%. On multivariate regression analysis, there was a trend towards improved accuracy in the wrist when compared to the finger, although this did not reach statistical significance.While pre-operative MRI remains a valuable tool for the evaluation of soft tissue masses in the distal upper extremity, caution is warranted when basing the diagnosis on MRI evidence alone. Level IV/Diagnostic.

The pitfalls of ultrasonography in the evaluation of soft tissue masses

Ultrasonography is associated with a high error rate in the evaluation of soft tissue masses. The purposes of this study were to examine the nature of the diagnostic errors and to identify areas in which reporting could be improved. Patients who had soft tissue tumours and received ultrasonography during a 10-year period (1999-2009) were identified from a local tumour registry. The sonographic and pathological diagnoses were categorised as either 'benign' or 'non-benign'. The accuracy of ultrasonography was assessed by correlating the sonographic with the pathological diagnostic categories. Recommendations from radiologists, where offered, were assessed for their appropriateness in the context of the pathological diagnosis. One hundred seventy-five patients received ultrasonography, of which 60 had 'non-benign' lesions and 115 had 'benign' lesions. Ultrasonography correctly diagnosed 35 and incorrectly diagnosed seven of the 60 'non-benign' cases, and did not suggest a diagnosis in 18 cases. Most of the diagnostic errors related to misdiagnosing soft tissue tumours as haematomas (four out of seven). Recommendations for further management were offered by the radiologists in 144 cases, of which 52 had 'non-benign' pathology. There were eight 'non-benign' cases where no recommendation was offered, and the sonographic diagnosis was either incorrect or unavailable. Ultrasonography lacks accuracy in the evaluation of soft tissue masses. Ongoing education is required to improve awareness of the limitations with its use. These limitations should be highlighted to the referrers, especially those who do not have specific training in this area.

Diagnosis of Soft-Tissue Masses

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.

Learning from Haiti

In May, 2010, a 37-year-old woman, displaced from Port-au-Prince after the January earthquake, presented to Hopital St Therese in Hinche, Haiti, with a 2-year history of a slowly growing abdominal mass with associated dyspepsia, intermittent abdominal pain, anorexia, and weight loss. Her surgical history included four caesarean section deliveries and tubal ligation. Physical examination found her in no acute distress, with stable vital signs and a large, mobile abdominal mass extending to the subhepatic space. Haemoglobin was 106 g/L. A handwritten ultrasonography report from Port-au-Prince before the earthquake reported that she had a 10 cm mass with no further description, although on physical examination the mass was palpated at twice that size. No other laboratory or imaging capabilities were available. With no intensive care capabilities and limited transfusion supplies, local physicians had deferred surgery owing to diagnostic uncertainty. In July, 2010, a humanitarian surgical team brought a portable ultrasonography device to Hinche. Imaging of our patient showed a well-circumscribed, homogeneous, hypoechoic mass without invasion of adjacent structures (fi gure). The surgeons felt comfortable doing an exploratory laparotomy which revealed a well-demarcated, cystic ovarian mass, about 20 cm in diameter, resected via right oophorectomy (webappendix). Gross examination was consistent with a simple ovarian cyst. Diff erential diagnosis included ovarian and uterine tumours, pancreatic pseudocyst, and mesenteric cyst. She was discharged 2 days later with follow-up by local physicians. Our patient’s case demon strated the usefulness of portable devices in resource-limited settings. The well-circumscribed appearance of the mass and lack of invasion of adjacent structures provided enough supplementary information for surgeons to proceed safely at Hopital St Therese despite limited resources. Further delay in treatment would have resulted in persistent disability and possible torsion. In February, 2011, at last follow-up, she had had no complications. Diagnostic ultrasonography is a recognised, costeff ective aid for procedure-based care in under-resourced areas of the world. However, access to ultrasonography in these settings is limited. While we were in Haiti, ultrasonography also aided in the evaluation of soft-tissue masses, peritoneal disease, and uterine pathology. We recognise limitations of ultra sonography in these settings. Durability, weight, battery life, and ease of use all hindered our use of the device, but the greatest limitation of ultrasonography is cost. Although an aff ordable imaging modality, eff ective ultrasonography requires proper training, and the costs of both equipment and training can still exceed the budget for care of patients outside the industrialised world. Ideally, local physicians would be trained in diagnostic and therapeutic ultrasonographic techniques to allow for the continued benefi t of the local population. Although investment in both equipment and training would be needed, eff orts to implement programmes with portable ultrasonography in Tanzania and Rwanda have shown initial success, and we believe ultrasonography can play a vital role in resource-poor settings.

Ultrasound of the airway

Currently, the role of ultrasound (US) in anaesthesia-related airway assessment and procedural interventions is encouraging, though it is still ill defined. US can visualise anatomical structures in the supraglottic, glottic and subglottic regions. The floor of the mouth can be visualised by both transcutaneous view of the neck and also by transoral or sublinguial views. However, imaging the epiglottis can be challenging as it is suspended in air. US may detect signs suggestive of difficult intubation, but the data are limited. Other possible applications in airway management include confirmation of correct endotracheal tube placement, prediction of post-extubation stridor, evaluation of soft tissue masses in the neck prior to intubation, assessment of subglottic diameter for determination of paediatric endotracheal tube size and percutaneous dilatational tracheostomy. With development of better probes, high-resolution imaging, real-time picture and clinical experience, US has become the potential first-line noninvasive airway assessment tool in anaesthesia and intensive care practice.

Imaging of Benign Pediatric Soft Tissue Tumors

There is a broad spectrum of benign soft tissue tumors in children, including, among others, vascular, fibroblastic/myofibroblastic, and adipocytic lesions as well as pseudotumors. The diagnosis of superficial soft tissue tumors is in many instances made clinically, whereas those with more equivocal presentation and those found in the deeper soft tissues often require imaging. Ultrasonography is the modality of choice for smaller and superficial lesions and is particularly useful for vascular tumors. Magnetic resonance imaging is the modality of choice for the larger and deeper lesions and for those in which ultrasonography is not adequate. Plain radiographs and computed tomography have a very limited role in the evaluation of soft tissue masses. Correlation with clinical history and findings on physical examination are imperative for an appropriate interpretation of the imaging findings. Although certain entities can be confidently diagnosed based on the combination of clinical and imaging findings, histology is frequently required for a definitive diagnosis. The differentiation of benign from malignant tumors is also challenging and often not possible based on the imaging findings. This article reviews the clinical features and imaging findings of the most common benign pediatric soft tissue tumors.

Sonography of Pediatric Neck Masses

Duplex/color Doppler ultrasound is the imaging modality of choice for the evaluation of soft tissue masses of the pediatric neck. Information regarding the size, shape, borders, location, internal consistency and vascularity of the mass, and its relationship to the major neck vessels may be rapidly obtained. If the lesion is too large to be completely imaged within the ultrasound field of view available or malignancy is suspected, computed radiography or magnetic resonance imaging is required before surgical removal. Scintigraphy is reserved for evaluation of midline masses, which are thought to be due to ectopic thyroid, to determine preoperatively if the mass is the patient's only functioning thyroid tissue. Correlation of the sonographic findings with the clinical information narrows the differential diagnosis; thus, more appropriate therapeutic decisions can be made. When indicated, ultrasound-guided interventional procedures can be performed for diagnosis and/or treatment.

Ultrasound Evaluation of Soft Tissue Masses and Fluid Collections

Musculoskeletal ultrasound has utility as a first-line screening modality in the evaluation of soft tissue masses. The sonographic appearances of cysts or lipomas may be sufficient to obviate the need for further imaging. For other complex cystic or solid masses, ultrasound is an inexpensive, widely available imaging modality that can evaluate lesion vascularity, guide diagnostic and therapeutic aspiration or biopsy procedures, and be used for follow-up examinations to determine response to therapeutic interventions.

Prospective evaluation of soft tissue masses and sarcomas using fluorodeoxyglucose positron emission tomography.

The differentiation of soft tissue sarcoma (STS) from benign masses is difficult owing to their clinical and radiological similarities. Accurate staging is hindered by the large number of sites at which metastases may be found. This study examined the value of whole-body [18F]2-fluoro-2-deoxy-D-glucose positron emission tomography (FDG PET) in patients presenting with soft tissue masses. Thirty patients with a soft tissue mass suspected to be malignant were evaluated with FDG PET. The images were evaluated qualitatively and quantitatively for uptake of FDG to determine whether benign lesions could be differentiated from malignant tumours, and for the presence of metastases. Thirty-one masses were removed from 30 patients; 12 were benign and 19 were malignant STSs. Using qualitative assessment of the FDG PET images, all the high-grade STSs (n = 12) were correctly identified, but low-grade STS (n = 7) could not be differentiated from a benign lesion. Using a quantification assessment, there was a 95 per cent sensitivity and a 75 per cent specificity in diagnosing STS. Three patients had metastases at presentation; two were correctly identified by FDG PET. FDG PET has a role in distinguishing high-grade STS from low-grade or benign STS and may have a role in staging malignant tumours.

Evaluation of soft-tissue masses using segmented color Doppler velocity images: preliminary observations.

We report our initial experience with segmented color Doppler velocity-based estimates of tumor vascularity for various histogically proven soft-tissue masses. Color Doppler sonography of 23 histologically proven masses in 22 patients was performed. Digital color Doppler images were acquired directly off the scanner output or from video recordings and stored on a personal computer as 24-bit gray-scale and color composite images. A color Doppler velocity segmentation and analysis algorithm was applied to the digital images, from which we calculated the normalized percentage of color Doppler area. Normalization was determined by expressing color Doppler area as a percentage of the area enclosed by a preselected region of interest. We also calculated mean percentage, SD, and cumulative distribution of color Doppler area, relative to a fixed threshold, for the acquired image data sets. Estimates of mean percentage of color Doppler area showed a dynamic range of at least two or three orders of magnitude between lowest and highest values obtained. A scatterplot of mean percentage of color Doppler area versus SD of percentage of color Doppler area showed a linear monotonic relationship (r2 = .92), illustrating increasing vascular heterogeneity with mean vascularity. Preliminary data also suggest the presence of at least two distinct groups of masses (p < .0001) based on these vascularity estimates. One group corresponds to high-grade lesions in which tumor angiogenesis is expected to be important in predicting biologic behavior. The second group appeared to have little or no relationship to tumor vascularity or was of an intermediate (or lower) histologic grade. Quantitative color Doppler estimates of tumor vascularity can be obtained over a wide dynamic range. Such estimates provide a mechanism to assess vascular heterogeneity of soft-tissue tumors. Preliminary data suggest that two biologically distinct groups of masses may be separable on the basis of quantitative velocity-based estimates of tumor vascularity as obtained from color Doppler sonography.