Der Radiologe / Weichteilsarkome : Wie lassen sich posttherapeutische Veränderungen von Rezidiven unterscheiden?

Die Erkennung von Weichteilsarkomrezidiven und ihre Differenzierung von posttherapeutischen Veränderungen sind komplex. Der Beitrag soll dem klinisch tätigen Radiologen helfen, lokale Nachkontrollen systematisch zu beurteilen. Voraussetzungen sind einerseits die genaue Kenntnis der klinischen und therapeutischen Anamnese und der aktuellen klinischen Situation sowie andererseits eine adäquate Untersuchungstechnik, für die Empfehlungen gegeben werden, und ein Vergleich mit der initialen Bildgebung. Der Beitrag gibt einen Überblick über Rezidivhäufigkeiten und Therapiemodalitäten wie der Operation, Bestrahlung und Chemotherapie. Er beschreibt das MR(Magnetresononanz)-tomographische Spektrum regulärer posttherapeutischer Veränderungen im zeitlichen Ablauf und geht auf therapieassoziierte Komplikationen ein. Diese umfassen akute Komplikationen, wie Serome, Hämatome oder Infektionen, und späte Komplikationen, wie Ödeme, Fibrosen und Gelenksteife, sowie nach variablen Intervallen auftretende Pseudotumoren. Diesen Veränderungen gegenübergestellt wird das Erscheinungsbild von Rezidiven und strahlenassoziierten Sarkomen. Es werden insbesondere MR-tomographische Kriterien vorgestellt, die helfen können, posttherapeutische Veränderungen von Rezidiven besser zu unterscheiden.The recognition of recurrent soft tissue sarcomas and the differentiation from post-treatment alterations is complex. This article aims to assist the clinical radiologist in the systematic evaluation of local follow-up imaging in soft tissue sarcoma patients. Soft tissue sarcomas encompass multiple entities with different recurrence rates and follow-up intervals. Approved and up to date recommendations are provided, including imaging techniques. The past medical history of the patient, the clinical situation and previous therapies should be known in detail, including surgery, radiation therapy and chemotherapy. Previous imaging results should be consulted, if available. This article describes the time-dependent imaging spectrum of local post-therapeutic as well as local treatment-related complications. These include early complications, such as seromas, hematomas and infections, as well as late complications, including edema, fibrosis and joint stiffness, and also inflammatory pseudotumors, which may occur after variable time intervals. The imaging appearance of local recurrent and radiation-associated sarcoma are elucidated. In particular, magnetic resonance imaging (MRI) criteria are provided, which may help in differentiating post-therapeutic alterations from recurrent soft tissue sarcomas.(VLID)356974

T2-weighted Hypointense Tumors and Tumor-like Lesions

Most musculoskeletal tumors are hyperintense on T2-weighted images. However, some T2-weighted hypointense tumors and tumor-like lesions are encountered in everyday clinical practice. We explore the spectrum of such T2 hypointense tumors and tumor mimickers that can arise from (1) the bones, presenting as diffuse processes or focal lesions; (2) the joints including diffuse or focal synovial disorders, loose bodies, or substance depositions; and (3) soft tissues, comprising T2 hypointense tumors and tumor mimickers (those that contain abundant fibrous tissue, mineralization, or hemosiderin deposits). Appropriate magnetic resonance imaging sequence selection is required to identify and characterize these lesions confidently when imaging musculoskeletal tumors. Copyright © 2019 by Thieme Medical Publishers, Inc

Soft Tissue Sarcoma Follow-up Imaging: Strategies to Distinguish Post-treatment Changes from Recurrence

Soft tissue sarcomas encompass multiple entities with differing recurrence rates and follow-up intervals. The detection of recurrences and their differentiation from post-therapeutic changes is therefore complex, with a central role for the clinical radiologist. This article describes approved recommendations. Prerequisite is a precise knowledge of the current clinical management and surgical techniques. We review recurrence rates and treatment modalities. An adequate imaging technique is paramount, and comparison with previous imaging is highly recommended. We describe time-dependent therapy-related complications on magnetic resonance imaging compared with the spectrum of regular post-therapeutic changes. Early complications such as seromas, hematomas, and infections, late complications such as edema and fibrosis, and inflammatory pseudotumors are elucidated. The appearance of recurrences and radiation-associated sarcomas is contrasted with these changes. This systematic approach in follow-up imaging of soft tissue sarcoma patients will facilitate the differentiation of post-therapeutic changes from recurrences. © 2020 BMJ Publishing Group. All rights reserved

Erratum: Soft Tissue Sarcoma Follow-up Imaging: Strategies to Distinguish Post-treatment Changes from Recurrence (Musculoskeletal Radiology (2020) 24:6 DOI: 10.1055/s-0040-1721464)

It has been brought to our attention that Figs. 1a and 1b and Figs. 2a and 2b were erroneously duplicated in the above article in Seminars in Musculoskeletal Radiology, Volume 24, Number 6, 2020 (DOI: https://doi.org/10.1055/s-0040-1721464). The figures have been corrected in the revised article. © 2020 Thieme Medical Publishers, Inc.. All rights reserved

Soft Tissue Tumors in Adults: ESSR-Approved Guidelines for Diagnostic Imaging

Imaging- and therapeutic targets in neoplastic and musculoskeletal inflammatory diseas

The Lisbon Agreement on Femoroacetabular Impingement Imaging-part 1: overview

OBJECTIVES: Imaging assessment for the clinical management of femoroacetabular impingement (FAI) syndrome remains controversial because of a paucity of evidence-based guidance and notable variability in clinical practice, ultimately requiring expert consensus. The purpose of this agreement is to establish expert-based statements on FAI imaging, using formal techniques of consensus building. METHODS: A validated Delphi method and peer-reviewed literature were used to formally derive consensus among 30 panel members (21 musculoskeletal radiologists and 9 orthopaedic surgeons) from 13 countries. Forty-four questions were agreed on, and recent relevant seminal literature was circulated and classified in five major topics ('General issues', 'Parameters and reporting', 'Radiographic assessment', 'MRI' and 'Ultrasound') in order to produce answering statements. The level of evidence was noted for all statements, and panel members were asked to score their level of agreement with each statement (0 to 10) during iterative rounds. Either 'consensus', 'agreement' or 'no agreement' was achieved. RESULTS: Forty-seven statements were generated, and group consensus was reached for 45 (95.7%). Seventeen of these statements were selected as most important for dissemination in advance. There was no agreement for the two statements pertaining to 'Ultrasound'. CONCLUSION: Radiographic evaluation is the cornerstone of hip evaluation. An anteroposterior pelvis radiograph and a Dunn 45\ub0 view are recommended for the initial assessment of FAI although MRI with a dedicated protocol is the gold standard imaging technique in this setting. The resulting consensus can serve as a tool to reduce variability in clinical practices and guide further research for the clinical management of FAI