Society of skeletal radiology position paper - recommendations for contrast use in musculoskeletal MRI: when is non-contrast imaging enough?

The following White Paper will discuss the appropriateness of gadolinium administration in MRI for musculoskeletal indications. Musculoskeletal radiologists should consider the potential risks involved and practice the judicious use of intravenous contrast, restricting administration to cases where there is demonstrable added value. Specific nuances of when contrast is or is not recommended are discussed in detail and listed in table format.

Advanced Imaging in Musculoskeletal Oncology: Moving Away From RECIST and Embracing Advanced Bone and Soft Tissue Tumor Imaging (ABASTI)-Part II-Novel Functional Imaging Techniques.

Functional imaging can add valuable information to conventional imaging in the settings of tumor characterization and treatment response assessment. Traditional response criteria rely primarily on physical measurements, while functional imaging can potentially give a more comprehensive evaluation of oncological status. The second part of this review article discusses advanced imaging techniques such as susceptibility-weighted imaging, tumor-associated macrophage imaging, diffusion-weighted imaging, perfusion-weighted imaging, Dixon imaging, whole-body magnetic resonance imaging, whole-body low-dose dual energy computed tomography with virtual noncalcium technique, and ultrasound elastography.

Advanced Imaging in Musculoskeletal Oncology: Moving Away From RECIST and Embracing Advanced Bone and Soft Tissue Tumor Imaging (ABASTI) - Part I - Tumor Response Criteria and Established Functional Imaging Techniques.

According to the Revised Response Evaluation Criteria in Solid Tumors (RECIST) 1.1, the majority of bone metastases are considered to be nonmeasurable disease. Traditional response criteria rely on physical measurements.

Bone Metastases: Mechanisms of the Metastatic Process, Imaging and Therapy.

The mechanisms by which tumors metastasize to bone are complex. Upon the successful establishment of metastatic deposits in the skeleton, detection of the disease becomes essential for therapeutic planning. The roles of CT, skeletal scintigraphy, SPECT/CT, MRI, PET/CT and PET/MRI will be reviewed.

An Approach to Undiagnosed Bone Tumors.

The radiographic appearance of primary bone tumors is important for initial diagnosis and often augments histopathological analysis. The original grading system relied on the radiographic analysis of the margin of the lesions to determine tumor aggression, which often corresponds with malignant potential. The recently developed, modified Lodwick-Madewell grading system also incorporates the appearance of lesion margins on radiographs but also considers the change in margins on serial radiographs and includes a category for clinically suspected, radiographically occult, aggressive lesions.

Gadolinium-based Contrast Agents Improve Detection of Recurrent Soft-Tissue Sarcoma at MRI.

Purpose: To determine the diagnostic efficacy of gadolinium-based contrast agents for the detection of recurrent soft-tissue sarcoma compared with non-contrast-enhanced conventional MRI sequences.

Materials And Methods: A retrospective study of patients with soft-tissue sarcomas who were imaged from January 2009 to December 2014 was performed. MRI studies from 69 patients (mean age, 61 years ± 15 [standard deviation], 45 men) with recurrent soft-tissue sarcoma and 63 age-, sex-, and tumor-matched controls with positive findings (nonrecurrence) were presented to six musculoskeletal radiologists at a tertiary cancer center in three image groupings.

WITHDRAWN: Risks and Benefits of Gadolinium-Based Contrast Enhanced MRI.

The Publisher regrets that this article is an accidental duplication of an article that has already been published in [Seminars in Ultrasound, CT, and MRI, 41/2 (2020) 170–182], https://dx.doi.org/10.

Risks and Benefits of Gadolinium-Based Contrast-Enhanced MRI.

The responsible use of gadolinium-based contrast agents (GBCAs) requires a balance between safety and clinical utility. While nephrogenic systemic fibrosis (NSF) has been associated with most linear GBCAs few, if any, new cases have been verified since the successful implementation of screening programs to detect renal impairment and prevent susceptible patients from receiving these higher-risk agents. The likelihood of developing nephrogenic systemic fibrosis has been shown to be negligible with macrocyclic agents, prompting the American College of Radiology and other regulatory agencies to suggest that no screening is necessary when they are used.

VIDEO: Preoperative CT Angiography for Scapula Osteocutaneous Free Flap Reconstructions.

The objective of this video article is to discuss the use of the scapular osteocutaneous free flap in reconstructive procedures. We attempt to discuss normal and variant vascular anatomy, image acquisition via CT angiography, and image interpretation as well as computer-assisted design and manufacturing. The scapular osteocutaneous free flap is commonly used for maxillary and mandibular reconstructive surgery.

VIDEO: Preoperative CT Angiography for Fibular Free Flap Reconstructions.

Objective: The objective of this video article is to provide an introduction to the use of fibular free flaps. Normal and variant vascular anatomy of the fibular free flap is discussed, as are imaging acquisition and CT angiography interpretation, computer-assisted design and manufacturing, and the limitations of the fibular free flap.

Conclusion: The fibular free flap is commonly used for head and neck reconstructive surgery.

F-FDG PET/CT as an Indicator of Survival in Ewing Sarcoma of Bone.

: The existing literature of 18 F-FDG PET/CT in Ewing sarcoma investigates mixed populations of patients with both soft tissue and bone primary tumors. The aim of our study was to evaluate whether the maximum standardized uptake value (SUVmax) obtained with 18F-FDG PET/CT before and after induction chemotherapy can be used as an indicator of survival in patients with Ewing sarcoma originating exclusively in the skeleton. A retrospective database search from 2004-2011 identified 28 patients who underwent 18 F-FDG PET/CT before (SUV1, n= 28) and after (SUV2, n=23) induction chemotherapy.

VIDEO: Preoperative CT Angiography for Anterolateral Thigh Flap Reconstructions.

Objective: This video article will review the relevant vascular anatomy of the anterolateral thigh flap, describe the CT angiography (CTA) image acquisition, and describe how to report the locations of the perforating arteries along with characteristics that may be important to the surgeon.

Conclusion: Our method of performing and reporting CTA for patients scheduled to undergo anterolateral thigh flap reconstruction provides a reproducible method of identifying perforating vessels and communicating their location to surgeons.

TBCRC-010: Phase I/II Study of Dasatinib in Combination with Zoledronic Acid for the Treatment of Breast Cancer Bone Metastasis.

Purpose: Osteoclast-mediated bone resorption through src kinase releases growth factors, sustaining bone metastases. This trial determined the recommended phase II dose (RP2D) and clinical efficacy of the src kinase inhibitor dasatinib combined with zoledronic acid in bone predominant, HER2-negative breast cancer metastases.

Experimental Design: A 3+3 lead in phase I design confirmed the RP2D allowing activation of the single-arm, phase II trial.

Doxorubicin-Based Chemotherapy and Radiation Therapy Produces Favorable Outcomes in Limited-Stage Plasmablastic Lymphoma: A Single-Institution Review.

Background: Plasmablastic lymphoma (PBL) is an aggressive variant of diffuse large B-cell lymphoma. We sought to assess the treatment outcomes after combined-modality therapy for early-stage PBL.

Materials And Methods: We retrospectively reviewed the outcomes of 10 consecutive patients diagnosed with stage I-II PBL from February 2001 to December 2013 at a single institution.

Single-institution experience in the treatment of primary mediastinal B cell lymphoma treated with immunochemotherapy in the setting of response assessment by 18fluorodeoxyglucose positron emission tomography.

Purpose: Excellent outcomes obtained after infusional dose-adjusted etoposide, doxorubicin, cyclophosphamide, vincristine, prednisone, and rituximab (R-EPOCH) alone have led some to question the role of consolidative radiation therapy (RT) in the treatment of primary mediastinal B cell lymphoma (PMBL). We reviewed the outcomes in patients treated with 1 of 3 rituximab-containing regimens (cyclophosphamide, doxorubicin, vincristine, prednisone [R-CHOP]; hyperfractionated cyclophosphamide, vincristine, doxorubicin and dexamethasone [R-HCVAD], or R-EPOCH) with or without RT. We also evaluated the ability of positron emission tomography-computed tomography (PET-CT) to identify patients at risk of relapse.

FDG PET/CT of primary bone tumors.

Objective: Numerous primary bone tumors are encountered on (18)F-FDG PET/CT, and many are FDG avid. The degree of FDG uptake in bone tumors does not necessarily reflect malignant potential. In conjunction with radiographs, evaluation of morphologic characteristics on the CT portion of PET/CT scans is important for characterization of the lesions.

Differentiation of Benign Fluid Collections from Soft-Tissue Sarcomas on FDG-PET/CT.

Objective: To assess the diagnostic performance of (18)F-FDG PET-CT in differentiating soft tissue sarcomas (STSs) from benign fluid collections (BFs).

Materials And Methods: Four readers independently reviewed 100 lesions on (18)F-FDG PET-CT and subjectively classified each lesion as an STS or BF and scored the spatial pattern of (18)F-FDG avidity (SP) of each on a 4-point ordered scale (thin, moderate, thick, solid).

Results: Subjective assessment by readers allowed sensitive (91%-98%) differentiation of STSs from BFs, with lower specificity (59%-91%).

Bone Windows for Distinguishing Malignant from Benign Primary Bone Tumors on FDG PET/CT.

Objective. The default window setting on PET/CT workstations is soft tissue. This study investigates whether bone windowing and hybrid FDG PET/CT can help differentiate between malignant and benign primary bone tumors.

Conspicuity of bone metastases on fast Dixon-based multisequence whole-body MRI: clinical utility per sequence.

Purpose: The purpose of the study was to evaluate the conspicuity of bone metastases on each of the numerous sequences produced by fast Dixon-based multisequence whole-body (WB) magnetic resonance imaging (MRI) scanning in order to determine the most clinically useful sequences overall and per anatomic region.

Materials And Methods: Twenty-seven breast cancer patients with bone metastases were prospectively studied with fast Dixon-based WB MRI including head/neck, chest, abdominal, pelvic, thigh, calf/feet and either cervical, thoracic and lumbar or cervical/thoracic and thoracic/lumbar regions. Sequences included coronal T2, axial T1 without and with intravenous gadolinium (+C), sagittal T1 spine+C, each associated fat-only (FO) and fat-saturated (FS) sequence, axial diffusion-weighted imaging (DWI) and short tau inversion recovery (STIR).