Update in Imaging Evaluation of Bone and Soft Tissue Sarcomas

Abstract

The evolution in imaging evaluation of musculoskeletal sarcomas contributed to a significant improvement in the prognosis and survival of patients with these neoplasms. The precise characterization of these lesions, using the most appropriate imaging modalities to each clinical condition presented, is of paramount importance in the design of the therapeutic approach to be instituted, with a direct impact on clinical outcomes. The present article seeks to update the reader regarding imaging methodologies in the context of local and systemic evaluation of bone sarcomas and soft tissues.

Keywords: diagnostic imaging; multimodal imaging; neoplasms, bone tissue; neoplasms, connective tissue; radiology; sarcoma.

Fig. 1

Male, 29 years old, high-grade sarcoma in the right knee. Sequences in prosthetic density with fat suppression in the sagittal plane before treatment (A) demonstrating heterogeneous lesion in the posterior compartment. Axial dynamic study (B) and color map (C) demonstrating early enhancement in the posterior and superficial part of the lesion with type III TIC (red line in D). Five months after treatment, conventional resonance does not show a significant change in the signal intensity of the lesion (E). However, the axial dynamic study (F) and color map (G) show a change in the enhancement pattern, with type V TIC (red line in H), indicating good response to treatment. Histological analysis showed more than 90% of tumor necrosis.

Fig. 2

Tissue characterization of soft tissue lesions. Myxoid liposarcoma in the thigh at T1 with contrast suppression after gadolinium administration (A) and ADC map (B) demonstrating ADC = 2.6 × 10 ³ mm ² /s. Nodular fasciitis of the forearm in T1 with contrast suppression after gadolinium administration (C) and ADC map (D) demonstrating ADC = 1.4 × 10 ³ mm ² /s. Non-Hodgkin lymphoma of the forearm at T1 with contrast suppression after gadolinium administration (E) and ADC (F) map demonstrating ADC = 0.6 × 10 ³ mm ² /s. Leiomyosarcoma of the arm on T1-day with contrast suppression after gadolinium administration (C) and ADC map (D) demonstrating ADC = 0.97 × 10 ³ mm ² /s.

Fig. 3

Different applicability of magnetic susceptibility sequences (SWI). Undifferentiated sarcoma of the left thigh in prosthetic density with suppression of fat in the axial plane (A) and axial SWI (B) demonstrating hemorrhagic foci inside the lesion. Melanoma metastasis in the right forearm in prosthetic density with coronal (C) and axial SWI (D) fat suppression, demonstrating areas of melanin inside the tumor. Ossifying myositis of the left knee in prosthetic density with fat suppression in the sagittal (E) and axial SWI (F) planes demonstrating peripheral calcification.

Fig. 1

Sexo masculino, 29 anos, sarcoma de alto grau no joelho direito. Sequências em densidade protônica com supressão de gordura no plano sagital antes do tratamento (A) demonstrando lesão heterogênea no compartimento posterior. Estudo dinâmico axial (B) e mapa colorido (C) demonstrando realce precoce na porção posterior e superficial da lesão com TIC tipo III (linha vermelha em D). Cinco meses após o tratamento, a ressonância convencional não evidencia mudança significativa na intensidade de sinal da lesão (E). Entretanto, o estudo dinâmico axial (F) e mapa colorido (G) evidenciam mudança no padrão do realce, com TIC tipo V (linha vermelha em H), indicando boa resposta ao tratamento. Análise histológica evidenciou > 90% de necrose tumoral.

Fig. 2

Caracterização tecidual de lesões de partes moles. Lipossarcoma mixoide na coxa em T1 com supressão de contraste após administração de gadolínio (A) e mapa de ADC (B) demonstrando ADC = 2.6 × 10 ³ mm ² /s. Fasciíte nodular do antebraço em T1 com supressão de contraste após administração de gadolínio (C) e mapa de ADC (D) demonstrando ADC = 1.4 × 10 ³ mm ² /s. Linfoma não-Hodgkin do antebraço em T1 com supressão de contraste após administração de gadolínio (E) e mapa de ADC (F) demonstrando ADC = 0.6 × 10 ³ mm ² /s. Leiomiossarcoma do braço em T1 com supressão de contraste após administração de gadolínio (C) e mapa de ADC (D) demonstrando ADC = 0.97 × 10 ³ mm ² /s.

Fig. 3

Diferentes aplicabilidades das sequências de susceptibilidade magnética (SWI). Sarcoma indiferenciado da coxa esquerda em densidade protônica com supressão de gordura no plano axial (A) e axial SWI (B) demonstrando focos hemorrágicos no interior da lesão. Metástase de melanoma no antebraço direito em densidade protônica com supressão de gordura no plano coronal (C) e axial SWI (D) demonstrando áreas de melanina no interior do tumor. Miosite ossificante do joelho esquerdo em densidade protônica com supressão de gordura no plano sagital (E) e axial SWI (F) demonstrando calcificação periférica.