Musculoskeletal Soft Tissue Tumors Research Articles

The effect of gadolinium-based intravenous contrast in the initial characterization of musculoskeletal soft tissue tumors

ObjectiveTo determine if gadolinium-based contrast agents increase the sensitivity, specificity or reader confidence of malignant potential in musculoskeletal soft tissue tumors. MethodsPre- and post-contrast MRI studies from 87 patients were read by three independent radiologists of different experience. Readers noted malignant potential and confidence in their diagnosis based on pre-contrast and post-contrast MRI studies. Statistical models assessed for agreement between MRI reader diagnosis and pathologic results as well as analyzing effects of contrast on reader confidence. Inter- and intra-observer variabilities of malignant potential were also calculated. Results87 patients (48 benign and 39 malignant; mean [± SD] age 51 ± 17.9 and 57.1 ± 17.1, respectively) were evaluated. For all readers, pre-contrast and post-contrast sensitivities were 68.1 % and 70.6 % while pre-contrast and post-contrast specificities were 84.6 % and 83.8 %, respectively without significant change (p=0.88). There was not a significant association with the use of contrast and prediction of malignant potential with or without the resident reader (p=0.65 and p=0.82). Use of contrast was significantly associated with higher levels of reader confidence (p=0.02) for all readers. Inter- and intra-observer variabilities were in good agreement (W = 0.77 and 0.70). ConclusionThe addition of a post-contrast sequence increased reader confidence in their diagnosis without a corresponding significant increase in accurate prediction of malignant potential.

Characteristics and Role of Apparent Diffusion Coefficient (ADC) Value in Musculoskeletal Soft Tissue Tumor

Introduction: Musculoskeletal soft tissue tumors (STTs) consist of a group of malignant and benign tumors that present challenges in diagnosis and therapy. Adding diffusion-weighted imaging and apparent diffusion coefficient (DWI/ADC) ​​provides tissue characteristics that are different from those obtained by conventional MR techniques. Quantitative examination of the diffusion of water molecules in tissue is expressed as ADC value, which is expected to be more helpful in differentiating malignant and benign soft tissue masses. This study was carried out to determine the characteristics and role of ADC values ​​in musculoskeletal STTs. Methods: This research was conducted retrospectively. Analysis was performed using MRI results of patients with musculoskeletal STTs who met the inclusion and exclusion criteria. Three regions of interest (ROI) were assessed in the tumor area with the strongest contrast enhancement for DWI mapping, ADC, and ROI ADC value placement. An Independent T-test test was performed to determine the mean difference of ADC in each tumor category. Receiver Operating Characteristics (ROC) were generated to find the optimal cut-off value. Then, a diagnostic test was carried out to determine the sensitivity, specificity, PPV, and NPV of the ADC value. Results: There were 41 research subjects with musculoskeletal STTs with male predominance, in which 75.61% of cases were malignant. DWI/ADC showed that 78.05% of patients with musculoskeletal soft tissue tumors had restricted diffusion areas. In this study, the ADC cutoff value to differentiate benign and malignant musculoskeletal STT is 0,84 x 10-3mm2/s with 77.4% sensitivity and 90% specificity, 96% positive predictive value and 56.3% negative predictive value. Conclusion: In differentiating malignant and benign musculoskeletal STTs, the ADC value provides fair sensitivity, very good specificity, good positive predictive value, and low negative predictive value.

Abstract 932: Snapshot! Exploring sample diversity of sarcoma cancers across common data repositories

Abstract Sarcoma is a cancer which originates in the body's connective tissues of mesenchymal origin. These are tissues like bones and muscles that support or protect other parts of the body. About ~16,000 sarcomas are diagnosed annually in the US, with ~6,700 deaths attributed to the disease. Sarcomas are typically divided into two major groups: bone sarcomas and soft-tissue sarcomas, each of which has multiple subtypes. However, because of their diversity in site-of-origin, sarcomas vary greatly in their presentation and histological features. Based on The World Health Organization’s (WHO) current classification system that categorizes musculoskeletal soft tissue tumours (STT) and bone tissue tumours, there are 50+ subtypes of sarcoma recognized today. Unsurprisingly, given the relative rarity of sarcoma type tumors, sample procurement has proved a challenge for the field. Consequently, there currently exist major gaps in our understanding of the genetic and molecular hallmarks of various sarcoma subtypes. Here we examine the sample and subtype classifications of sarcoma across some of the major DNA sequencing studies and data repositories to provide an overview of the available sample space. We highlight areas where the sample procurement is lagging and discuss subtypes that are missing all-together. Inclusion of some of the major genomic correlates showcases some of the similarities shared by these sequencing efforts, while emphasizing key genetic differences between subtypes. This work provides a clear roadmap for clinicians on how to best prioritize future sarcoma sample procurement and sequencing. Citation Format: Alfredo Enrique Gonzalez, Yash Patel, Chenghao Zhu, Takafumi N. Yamaguchi, Mao Tian, Sarah Hiyari, Ahmad A. Shihabi, Stefan Eng, Helena Winata, Jaron Arbert, Arpi Beshlikyan, Ardalan Davarifar, Alice Soragni, Paul C. Boutros. Snapshot! Exploring sample diversity of sarcoma cancers across common data repositories [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 932.

Can Radiomics and Machine Learning Predict Diagnosis in Musculoskeletal Myxoid Soft Tissue Tumors?

Introduction: Differentiating benign and malignant musculoskeletal myxoid soft tissue tumors is challenging due to their shared clinical, imaging, and histologic features. We assess if radiomics and machine learning can assist in differentiating benign and malignant musculoskeletal myxoid tumors. Methods: Forty patients with a pre-treatment MRI and a histologically confirmed myxoid soft tissue tumor (20 myxomas and 20 myxofibrosarcomas) on final resection pathology were reviewed. Baseline clinical features consisted of patient age, sex, tumor size, tumor depth, tumor location, pain, and tumor as an incidental finding. Manual image segmentation of the tumor was performed on T1 and T2 images by attending clinicians. A LASSO model was used for MRI feature reduction. The performance of five machine learning models were implemented using cross validation and compared with classify benign and malignant myxoid soft tissue tumors. Results: The five models using T1 and T2 radiomics features + clinical features achieved mean area under the ROC curves (AUC) of 0.729 to 0.780 and accuracy of 0.696 to 0.757. The highest AUC achieved was 0.780 using a support vector machine model. All combined radiomics + clinical feature models outperformed the classification models using clinical features alone. Conclusion: Classification models using T1 and T2 radiomics features + clinical features perform better in differentiating benign and malignant myxoid soft tissue tumors than models using clinical features alone. Future studies include validation of these preliminary findings in a larger and separate data set, and comparison of the diagnostic performance of radiomics to manual review of images by clinicians.

Ultrasound-guided Biopsy of Musculoskeletal Soft-tissue Tumors: Basic Principles, Usefulness and Limitations.

The aim of this article is to provide a short review of the literature concerning the basic principles, usefulness and limitations of ultrasound-guided biopsy of musculoskeletal soft-tissue tumors, with particular focus on core needle biopsies. Musculoskeletal soft-tissue tumors represent a rare and complex group of heterogeneous lesions. Prompt diagnosis of these uncommon lesions can improve the outcome and increase the patient survival rate. A biopsy examination of soft-tissue tumors with imaging modalities is necessary in all cases of aggressive or undetermined lesions. Although fine needle aspiration can be helpful for the biopsy of certain tumor types, core needle biopsy is a standard procedure in most tertiary sarcoma centers. It has a high diagnostic accuracy, low complication rate and lower price in comparison to open biopsy, and can replace it in the majority of cases of soft-tissue tumor assessment. However, the examining physician has to be familiar with the technique, and the strengths and potential difficulties in performing ultrasound-guided biopsy, as well as possible solutions to obstacles. Several recently developed ultrasound techniques can be helpful and improve the outcome of imaging-guided biopsies of musculoskeletal lesions.

Role of Diffusion Weighted MRI in Characterization of Musculoskeletal Soft Tissue Tumors

Abstract Background: Magnetic Resonance Imaging is the method of choice for the diagnostic work-up of soft tissue tumors. It is the modality of choice to evaluate such masses, because of its excellent soft tissue contrast. Aim of Study: To assess the efficacy of Diffusion weighted MRI in characterization of musculoskeletal soft tissue tumors. Patients and Methods: The current study enrolled 20 patients (11 female and 9 male) with musculoskeletal STTs with mean age was 41.08±11.54 year. The most frequent affected site with the swelling was the thigh (48%) followed by the arm (20%). Four (16%) patients suffered from leg swelling while three (12%) patients had shoulder swelling. Our results revealed that malignant musculoskeletal soft tissue masses had significantly lower ADC value in comparison to those with benign masses (0.70±0.09 vs. 1.58±0.52x10-3m2/s; p < 0.001). Results: Patients with malignant lesions had significantly lower ADC value in comparison to those with benign lesions (0.70±0.09 vs. 1.58±0.52 (103mm2/s). Myxoma had the highest ADC value that was 2.44 (103mm2/s) while sarcoma had lowest value that was 0.54±0.03 (103mm2/s). It was noticed that MRI had 100% sensitivity and 81.8% specificity for diagnosis of malignant musculoskeletal soft tissue masses with overall accuracy was 92% and area under curve was 0.91 at cut off value was <1.14 (103mm2/s). Based on final diag-nosis; MRI was successful in diagnosis of all cases with malignant musculoskeletal soft tissue masses but as the same time, MRI falsely diagnosed two cases with benign nature to be malignant. Those two cases were finally diagnosed to be lipoma. Conclusion: Based on the current study, DWI-MRI con-sidered the method of choice for the characterization of muscul oskel etal STTs; however, DW-MRI with ADC mapping is a rapidly, valuable, non-invasive, non-contrast tool for reliably differentiating between benign and malignant STTs. It's recommended to perform such study in large sample of patients and in more centers to confirm the great values of DWI-MRI in evaluation of such lesions.

Diagnostic Performance of Diffusion MRI for differentiating Benign and Malignant Nonfatty Musculoskeletal Soft Tissue Tumors: A Systematic Review and Meta-analysis.

Objective: To evaluate the diagnostic performance of standard diffusion-weighted imaging (DWI), intravoxel incoherent motion (IVIM), and diffusion kurtosis imaging (DKI), for differentiating benign and malignant soft tissue tumors (STTs).Materials and methods: A thorough search was carried out to identify suitable studies published up to September 2020. The quality of the studies involved was evaluated using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). The pooled sensitivity (SEN), specificity (SPE), and summary receiver operating characteristic (SROC) curve were calculated using bivariate mixed effects models. A subgroup analysis was also performed to explore the heterogeneity.Results: Eighteen studies investigating 1319 patients with musculoskeletal STTs (malignant, n=623; benign, n=696) were enrolled. Thirteen standard DWI studies using the apparent diffusion coefficient (ADC) showed that the pooled SEN and SPE of ADC were 0.80 (95% CI: 0.77-0.82) and 0.63 (95% CI: 0.60-0.67), respectively. The area under the curve (AUC) calculated from the SROC curve was 0.806. The subgroup analysis indicated that the percentage of myxoid malignant tumors, magnet strength, study design, and ROI placement were significant factors affecting heterogeneity. Four IVIM studies showed that the AUCs calculated from the SROC curves of the parameters ADC and D were 0.859 and 0.874, respectively. The AUCs for the IVIM parameters pseudo diffusion coefficient (D*) and perfusion fraction (f) calculated from the SROC curve were 0.736 and 0.573, respectively. Two DKI studies showed that the AUCs of the DKI parameter mean kurtosis (MK) were 0.97 and 0.89, respectively.Conclusion: The DWI-derived ADC value and the IVIM DWI-derived D value might be accurate tools for discriminating musculoskeletal STTs, especially for non-myxoid SSTs, using more than two b values, with maximal b value ranging from 600 to 800 s/mm2, additionally, a high-field strength (3.0 T) optimizes the diagnostic performance.

Interventional Techniques for Bone and Musculoskeletal Soft Tissue Tumors: Current Practices and Future Directions - Part I. Ablation.

Musculoskeletal (MSK) image-guided oncologic intervention is an established field within radiology. Numerous studies have described its clinical benefits, safety, cost effectiveness, patient satisfaction, and improved quality of life, thereby establishing image-guided oncologic intervention as a preferred pathway in treating patients presenting with specific benign MSK tumors. But there is a paradigm shift on the horizon because these techniques may also support established pillars (surgery, systemic treatment, radiotherapy) in the treatment of malignant MSK tumors. Unlike benign tumors, where they are used as primary therapy lines with curative intent, such interventions can be selected for malignant tumors as adjuvant treatment in painful or unstable bone or soft tissue lesions or as more palliative therapy strategies. Using examples from our clinical practices, we elaborate on the benefits of applying a multidisciplinary approach (traditionally involving MSK radiologists, oncologists, orthopaedic surgeons, microbiologists, pathologists, physiotherapists, and pain management experts), ideally within a sarcoma treatment center to deliver a patient-specific therapy plan and illustrate methods to assess the benefits of this model of care.In this article, we review the current repertoire of ablation techniques, demonstrate why such procedures offer value-based alternatives to conventional treatments of specific tumors, and reflect on future directions. Additionally, we review the advantages and limitations of each technique and offer guidance to improve outcomes.

Interventional Techniques for Bone and Musculoskeletal Soft Tissue Tumors: Current Practices and Future Directions - Part II. Stabilization.

Percutaneous image-guided oncologic interventions have rapidly evolved over the last two decades as an independent strategy or used within a first-, second-, or even third-line strategy in the treatment of musculoskeletal (MSK) tumors. Abundant mostly nonrandomized publications have described the safety, efficacy, and reproducibility of implementing percutaneous therapies both with curative and palliative intent. In this article, we continue to share our experience in bone and MSK soft tissue interventions focusing on stabilization and combined ablation and stabilization. We propose a pathway and explore future directions of image-guided interventional oncology related to skeletal disease. We reflect on the advantages and limitations of each technique and offer guidance and pearls to improve outcomes. Representing patterns from our practices, we demonstrate the role of collaborative working within a multidisciplinary team, ideally within a dedicated tumor treatment center, to deliver patient-specific therapy plans that are value based and favored by patients when given the choice.

MRI of Rhabdomyosarcoma and Other Soft-Tissue Sarcomas in Children.

Soft-tissue sarcomas in children comprise a heterogeneous group of entities with variable manifestation depending on the age of the patient and the location of the tumor. MRI is the modality of choice for evaluating musculoskeletal soft-tissue tumors and plays a paramount role in both initial diagnosis and assessment of tumor response during and after treatment. Conventional MRI sequences, such as T1- and T2-weighted imaging, offer morphologic information, which is important for localizing the lesion and describing anatomic relationships but not accurate for determining its malignant or benign nature and may be limited in differentiating tumor response from therapy-related changes. Advanced multiparametric MRI offers further functional information that can help with these tasks by using different imaging sequences and biomarkers. The authors present the role of MRI in rhabdomyosarcoma and other soft-tissue sarcomas in children, emphasizing a multiparametric approach with focus on the utility and potential added value of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced MRI in characterization and staging, determination of pretreatment extent, and evaluation of tumor response and recurrence after treatment. ©RSNA, 2020.

Diagnostic performance of conventional ultrasound and quantitative and qualitative real-time shear wave elastography in musculoskeletal soft tissue tumors

BackgroundTo explore the feasibility to identify malignant musculoskeletal soft tissue tumors using real-time shear wave elastography (rtSWE).MethodsOne hundred fifteen musculoskeletal soft tissue tumors in 92 consecutive patients were examined using both conventional ultrasonography (US) and rtSWE. For each patient, the rtSWE parameters including maximum elasticity (Emax), mean elasticity (Emean), minimum elasticity (Emin), standard deviation of the elasticity (Esd), and rtSWE image pattern were obtained. Eighty-one histopathologically confirmed tumors from 73 patients were subjected to analysis.ResultsThe 81 lesions included in the study were histopathologically classified as malignant (n = 21) or benign (n = 60). The statistically significant differences between benign and malignant lesions were found in conventional US characters including size, depth, margin, echogenicity, mass texture, and power Doppler signal. Meanwhile, the significant differences were also found in quantitative rtSWE findings including Emax, Emean, Emin, and Esd values and in qualitative rtSWE parameter named rtSWE image pattern. Multivariate analysis showed that infiltrative margin (OR, 4.470), and size (OR, 1.046) were independent predictors for malignancy in US findings, while Esd value (OR, 9.047) was independent predictors for malignancy in quantitative rtSWE parameters. Areas under the ROC curve (Azs) for US features, Esd value, and rtSWE image pattern were 0.851, 0.795, and 0.792, respectively.ConclusionsConventional US and quantitative and qualitative rtSWE parameters are useful for malignancy prediction of musculoskeletal soft tissue tumors. rtSWE can be used to supplement conventional US to diagnose musculoskeletal soft tissue tumors.

Revisiting the WHO classification system of soft tissue tumours: emphasis on advanced magnetic resonance imaging sequences. Part 1.

The World Health Organisation (WHO) classification categorises musculoskeletal soft tissue tumours (STT) based on their similarity to normal adult tissue. The most recent WHO classification provides an updated scheme that integrates biological behaviour as a distinguishing feature in each subcategory; STTs are further subdivided as benign, intermediate (locally aggressive or rarely metastasising), and malignant. Although malignant STTs are infrequent in routine orthopaedic radiology practice, musculoskeletal radiologists must be familiar with the imaging appearance of malignant STTs and distinguish them from their benign counterparts for appropriate management. Magnetic resonance imaging (MRI) is the ideal modality for the detection, characterisation, and local staging of STT. This review will discuss the most recent updates to the WHO classification of STT that are relevant to radiologists in a routine clinical practice with MRI correlation. The utility of advanced MRI sequences such as diffusion weighted imaging, dynamic contrast enhanced sequences, and magnetic resonance spectroscopy to provide insight into the biological behaviour of various STTs is highlighted.

Development of a risk assessment model to differentiate malignant and benign musculoskeletal soft-tissue masses on magnetic resonance imaging.

This study aimed to develop a risk stratification model to differentiate benign and malignant MRI-imaged musculoskeletal soft-tissue tumours, informing decisions surrounding biopsy and follow-up imaging. Imaging of patients who underwent MRI and subsequent biopsy to evaluate a soft-tissue mass was retrospectively reviewed. Features analysed included patient age; tumour size; shape; margins; enhancement pattern; signal intensity pattern; deep fascia, neurovascular bundle, bone and joint involvement; and the presence of necrosis, haemorrhage, oedema and intralesional fat. Univariate comparisons, by final histopathological status, employed t-tests and chi-square tests, followed by simple and multiple logistic regressions. Variables included in the final multiple regression model were used to define a three-level risk stratification strategy. One-hundred and ten patients were included in the analysis. Univariate relationships were identified between malignancy and age, tumour size, deep fascia involvement, neurovascular involvement, necrosis, haemorrhage, oedema and heterogeneous enhancement (all P<0.01). Final multiple regression modelling included size, enhancement and oedema. Thirty of 40 (75%) tumours >5cm with surrounding oedema ('high risk') were malignant, 13 of 47 (28%) tumours with one or more of tumour size >5cm, surrounding oedema or heterogeneous enhancement ('moderate risk') were malignant, and none of the 16 tumours ≤5cm with the absence of surrounding oedema and heterogeneous enhancement ('low risk') were malignant. A model including tumour size, enhancement and oedema has potential to stratify soft-tissue tumours into high-, intermediate- and low-risk categories; this may inform decisions surrounding biopsy and follow-up imaging.

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.

The diagnostic value of diffusion-weighted magnetic resonance imaging in characterization of musculoskeletal soft tissue tumors

PurposeTo assess the utility of diffusion-weighted (DW) images and magnetic resonance imaging (MRI) in the detection and characterization of musculoskeletal soft tissue tumours (STTs) and in the determination of whether these tumours are benign or malignant. Patients and methodsA prospective study was performed between March 2016 and March 2017 that included all patients referred to the radio-diagnosis department for evaluation of musculoskeletal STTs. Contrast-enhanced MRI and DW images were performed for all included patients, and diagnoses were confirmed by biopsy and histopathological examination. ResultsThe apparent diffusion coefficient (ADC) of benign STTs was significantly higher than that of malignant (mean ± SD, −1.43 ± 0.56 × 10−3 mm2/s versus 0.74 ± 0.18 × 10−3 mm2/s, respectively (P < 0.001), ADC cut off value ≤1.10 × 10−3 mm2/s with a sensitivity of 83.3%, specificity of 72.7%, and PPV and NPP of 80%; the area under the receiver operating characteristic curve was = 0.892 (SE = 0.084, 95% CI (P < 0.001) and the Youden's index was calculated 58.4. ConclusionTo date, MRI has been considered the method of choice for the characterization of musculoskeletal STTs; however, DW-MRI with ADC mapping is a rapidly, valuable, non-invasive, non-contrast tool for reliably differentiating between benign and malignant STTs.

The Role of Diffusion-Weighted MRI in the Characterization of Musculoskeletal Soft Tissue Tumors

Background: magnetic resonance imaging (MRI) has an important role in characterization of soft tissue tumors, yet, it lacks specificity for differentiation between the benign and malignant lesions. Aim of the Work: this study aimed to evaluate the ability of DW MRI in detection and characterization of the musculoskeletal soft tissue tumors. Patients and methods: this prospective study included 30 patients (20 females and 10 males) referred to MRI unit Ain shams University Hospital for MRI evaluation of musculoskeletal soft tissue tumors. Results: from 30 cases, 12 cases were benign (40%), 18 cases malignant (60%). From 12 cases of the benign, 8 cases were ≤ 40 years and 4 cases were > 40. From 18 cases of the malignant, 7 cases were ≤ 40 and 11 cases > 40. Ranging of ADC value of benign tumors (1.72-2.58); mean ADC (2.21 ´ 10-3 mm2/sec). Ranging of ADC value of malignant tumors was 0.52-1.82. Mean ADC value was 0.90 ´ 10-3 mm2/sec. Cut-off ADC value ≤ 1.14 less than 1.14 was benign and more than 1.14 was malignant; sensitivity 94.4% and specificity 91.7%. Conclusion: DWI with ADC mapping and measurement of ADC value proved to be a valuable non –invasive tool in differentiating between benign and malignant musculoskeletal soft tissue tumors. Recommendations: a larger population for future studies is needed. Thus, histopathologic work up is required for reliable characterization of soft tissue tumors (4).

De Novo Assessment of Pediatric Musculoskeletal Soft Tissue Tumors: Beyond Anatomic Imaging.

MRI plays a central role in the assessment of pediatric musculoskeletal soft tissue tumors. Although these neoplasms may initially be evaluated on other modalities, such as sonography, MRI is essential for accurately determining the extent of disease. Traditionally, MRI has been performed with sequences that provide excellent anatomic detail, with T1-weighted, fluid-sensitive, and static postcontrast T1-weighted sequences. However, with the introduction of noncontrast sequences such as diffusion-weighted imaging and magnetic resonance spectroscopy to the arsenal of available MRI techniques, functional and metabolic features of a neoplasm can now be examined noninvasively. These more recent MRI methods offer information for lesion characterization, the assessment of treatment response, and the distinction of postoperative scar from recurrence. Dynamic contrast-enhanced perfusion imaging is another useful functional technique that can be acquired before conventional static postcontrast imaging, without requiring additional contrast material. This review presents recent advances in MRI methodology that enable a comprehensive clinical assessment of musculoskeletal tumors in the pediatric population. The roles and challenges of combining anatomic, functional, and metabolic MRI sequences will be discussed as they relate to newly discovered soft tissue tumors in children.

Accuracy of Ultrasound of Musculoskeletal Soft-Tissue Tumors

Accuracy of Ultrasound of Musculoskeletal Soft-Tissue Tumors

Intraoperative Ultrasound Assistance for Excision of Impalpable Musculoskeletal Soft Tissue Tumors

Intraoperative ultrasonography is a useful tool for the detection and extirpation of liver metastases, breast masses, and melanoma. However, the efficacy of this technology in intraoperative localization and resection of small soft tissue tumors has not been addressed. The purpose of this study is to report on the efficacy of intraoperative ultrasound assistance in excising impalpable musculoskeletal soft tissue tumors. Twenty-two soft tissue tumors <3 cm (range, 0.7-3 cm) were resected with intraoperative ultrasound assistance. All tumors were localized in the deep panniculus, fascia, or muscle. Surgical time and length of incisions was recorded in all the cases. Intra- and postoperative reregistration was made to confirm the tumor resection. Ultrasound assistance was successful in obtaining an accurate localization in all treated cases. Mean surgical time was 30 minutes (range, 13-87 minutes). Average incision length was 5.7 cm (range, 2.5-10.6 cm). Reregistration allowed intraoperative confirmation of the adequacy of the excision. The procedure allowed recognized and excised additional nodules not previously diagnosed in 3 cases. Postoperative echography done in all patients confirmed complete extirpation of the tumors, and histopathology confirmed adequate margins obtained. Intraoperative ultrasound can be used as an efficient tool to localize and treat impalpable small soft tissue tumors.

Tumor microenvironment in cancer treatment and metastasis

Tumor microenvironment in cancer treatment and metastasis