Imaging of Bone Sarcomas and Soft-Tissue Sarcomas

Abstract

Background In the diagnosis of bone and soft-tissue sarcomas, the continuous advancement of various imaging modalities has improved the detection of small lesions, surgical planning, assessment of chemotherapeutic effects, and, importantly, guidance for surgery or biopsy. Method This review was composed based on a PubMed literature search for the terms “bone sarcoma,” “bone cancer” and “soft tissue sarcoma,” “imaging,” “magnetic resonance imaging”, “computed tomography”, “ultrasound”, “radiography”, and “radiomics” covering the publication period 2005–2020. Results and Conclusion As discussed in this review, radiography, ultrasound, CT, and MRI all play key roles in the imaging evaluation of bone and soft-tissue sarcomas. In daily practice, advanced MRI techniques complement standard MRI but remain underused, as they are considered time-consuming, technically challenging, and not reliable enough to replace biopsy and histology. PET/MRI and radiomics have shown promise regarding the imaging of sarcomas in the future. Key Points: Citation Format

Pathological fracture due to primary bone lymphoma in a patient with a history of prostate cancer: A case report and review of literature

“…Whereas prostatic metastases are typically osteosclerotic or osteoblastic in appearance on plain film radiography, PBL and the sarcomas predominantly exhibit an osteolytic pattern with soft tissue extension (34)(35)(36). Moreover, PBL and Ewing Sarcoma are known to cause periosteal reactions (35,36). However, prostatic bony metastases were found in one study to present as osteolytic themselves 16.4% of the time (37).…”

“…Although we were unable to use MRI, it is a more suitable imaging modality for this purpose, with characteristic findings for PF including homogenous T1-hypointense signal abnormality at the site of fracture due, in part, to the tumor itself and potentially, in part, to edema and bleeding at the site (33). Whereas prostatic metastases are typically osteosclerotic or osteoblastic in appearance on plain film radiography, PBL and the sarcomas predominantly exhibit an osteolytic pattern with soft tissue extension (34)(35)(36). Moreover, PBL and Ewing Sarcoma are known to cause periosteal reactions (35,36).…”

Primary spindle cell sarcoma of gallbladder

“…We considered it difficult to differentiate between primary sarcoma, carcinosarcoma, and carcinoma of the gallbladder; therefore, we searched the literature and listed the main differences between the most common tumors of the gallbladder in Table 3 [25–29] . Recently, studies have shown that positron emission computed tomography scanning is useful in differentiating malignant from benign diseases when using various radiopharmaceutical agents to improve the detection and characterization of the pathophysiology of the disease [30] . The fusion of positron emission computed tomography-acquired images with CT scans or MRI has significantly improved the overall diagnostic accuracy for sarcoma [31] .…”

Experience in utilizing a novel 3D digital model with CT and MRI fusion data in sarcoma evaluation and surgical planning

“…With the wide use of 3D models with CT data in clinics, their limitations have been unveiled. The major limitation lies in their poor ability to distinguish the soft tissue part of the tumor from adjacent normal structures 14,15 . Poorly defined margins lead to inaccurate models which in turn results in misjudgments of the surgeons, increasing the risk of positive surgical margins.…”

“…The major limitation lies in their poor ability to distinguish the soft tissue part of the tumor from adjacent normal structures. 14,15 Poorly defined margins lead to inaccurate models which in turn results in misjudgments of the surgeons, increasing the risk of positive surgical margins. MRI, on the other hand, is a very handy tool in clinics in assessing soft tissue sarcoma margins.…”