Initial experience with dual-energy computed tomography-guided bone biopsies of bone lesions that are occult on monoenergetic CT

Semin Musculoskelet Radiol

Bazzocchi

et al. 2020

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.

Section: Image-guided Biopsymentioning

confidence: 99%

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

Semin Musculoskelet Radiol

Bazzocchi

et al. 2020

“…Computed tomography is particularly useful for further characterization of tumors with mineralized matrix and of sclerotic tumors. Most recently the application of dual energy CT virtual non-calcium algorithms has proven to be a valuable tool in the assessment of MBD lesions and disease load [33][34][35] as well as in identifying focal biopsy targets [36]. Moreover, CT is also useful for further characterization of tumors in the cortex, paracortical, and periosteal locations.…”

Section: Cross-sectional Imaging: Mri and Ctmentioning

confidence: 99%

State-of-the-art imaging for diagnosis of metastatic bone disease

et al. 2020

Radiologe

Table 1 Epidemiological indicators: total number of cancer cases in Germany in 2013 (modified according to [21]) New cases Women Men Death Women Men Absolute number 229,920 252,550 Absolute number 101,779 121,314 Mean age at diagnosis 67.2 68.3 Mean age at diagnosis 74.3 73.3 Raw rate 558.4 639.9 Raw rate 247.2 307.7 Age-standardized rate a 351.2 434.1 Age-standardized rate a 126.7 196.5 Current trend +0.8%-0.5% Current trend-0.7%-1.2% Age-standardized rate a 327.9 447.6 Age-standardized rate a 126.8 211.8 Prognosis for 2020 (absolute number) 244,100 274,900 Prognosis for 2020 (absolute number)-0.8%-1.5%

“…Most recently the application of DECT virtual non-calcium algorithms (where the calciumcontaining bony structures can be mathematically subtracted to reveal underlying medullary lesions) is being used to assess bone lesions and disease load as well as to identify focal biopsy targets. 1,59,60 DECT offers similar (or slightly higher but still acceptable) radiation doses when compared with standard CT scans. This technology shows promising results in patients where WB-MRI is contraindicated.…”

Section: Next-generation Imaging Modalitiesmentioning

confidence: 99%

Detection and Characterization of Musculoskeletal Cancer Using Whole-Body Magnetic Resonance Imaging

Lecouvet

Semin Musculoskelet Radiol

et al. 2020

Whole-body magnetic resonance imaging (WB-MRI) is gradually being integrated into clinical pathways for the detection, characterization, and staging of malignant tumors including those arising in the musculoskeletal (MSK) system. Although further developments and research are needed, it is now recognized that WB-MRI enables reliable, sensitive, and specific detection and quantification of disease burden, with clinical applications for a variety of disease types and a particular application for skeletal involvement. Advances in imaging techniques now allow the reliable incorporation of WB-MRI into clinical pathways, and guidelines recommending its use are emerging. This review assesses the benefits, clinical applications, limitations, and future capabilities of WB-MRI in the context of other next-generation imaging modalities, as a qualitative and quantitative tool for the detection and characterization of skeletal and soft tissue MSK malignancies.