Complications of bone tumors after multimodal therapy.

Purpose: To define and compare the complications of bone tumors after resection, extracorporeal irradiation and re-implantation, with or without radiotherapy.

Materials And Methods: Eighty patients (40 males and 40 females, ages 4-77 years) with 61 malignant and 19 benign bone tumors were evaluated for local and distant complications after treatment. Two groups of patients were studied: (1) 53 patients had resection without (43 patients) or with external beam radiotherapy (RadRx) (10 patients) and (2) 27 patients underwent extracorporeal irradiation and re-implantation without (22 patients) or with RadRx (5 patients).

Post-treatment complications of soft tissue tumours.

Purpose: To identify local and distant complications of patients with soft tissue tumours and evaluate their relationships to types of therapy.

Methods And Materials: Fifty-one patients (29 males and 22 females, ages 14-80 years) with 34 malignant and 17 benign soft tissue tumours were evaluated for local and distant complications after resection or amputation only (26 patients) or after the addition of radiotherapy (25 patients: 17 patients had external beam therapy, 7 patients had external beam therapy and brachytherapy, and one patient had extracorporeal irradiation and reimplantation). Duration of follow-up averaged 3.

Follow-up of hepatic and peritoneal metastases of gastrointestinal tumors (GIST) under Imatinib therapy requires different criteria of radiological evaluation (size is not everything!!!).

Purpose: To define computed tomography (CT) criteria for evaluating the response of patients with gastrointestinal stromal tumors (GIST) who are receiving Imatinib (tyrosine-kinase inhibitor therapy).

Materials And Methods: This prospective CT study evaluated 107 consecutive patients with advanced metastatic GIST treated with Imatinib.

Results: Seventy patients had total or partial cystic-like transformation of hepatic and/or peritoneal metastases.

Role of computed tomography in the follow-up of hepatic and peritoneal metastases of GIST under imatinib mesylate treatment: a prospective study of 54 patients.

Purpose: To prospectively analyze the evolution of hepatic and peritoneal unresectable metastases from gastrointestinal stromal tumors (GIST) under imatinib mesylate, a new targeted treatment, which induces changes in lesion structure.

Materials And Methods: 54 patients with metastases from GIST underwent an abdominal and pelvic computed tomography examination without and with contrast enhancement, before and during treatment with imatinib mesylate. The number and size of lesions and contrast enhancement were noted before treatment and every 2 weeks for the first 2 months, then every 2 months for the first year of treatment and every 3 months thereafter.

Fast magnetic resonance imaging with contrast for soft tissue sarcoma viability.

Because dynamic (fast) contrast-enhanced magnetic resonance imaging with its temporal resolution allows evaluation of contrast kinetics of soft tissue sarcomas, its efficacy for defining viable tumor in these neoplasms was studied for three applications: biopsy localization, chemotherapeutic response, and differentiation between recurrence and inflammation after treatment. After conventional T1-weighted and T2-weighted magnetic resonance sequences to localize the lesion, patients had dynamic contrast-enhanced magnetic resonance imaging with fast and ultrafast sequences and postprocessing techniques (subtraction, time-intensity curves, and parametric color-encoding). In 10 of 40 patients, dynamic imaging more precisely defined the most malignant foci of tumor for biopsy than conventional magnetic resonance imaging.

An Algorithm for Soft Tissue Tumors: Current Perspectives.

The diagnosis and treatment of soft tissue sarcomas has dramatically changed in the last 10 to 15 years with more precise preoperative diagnosis, resection, adjunct therapy, and long-term follow-up. With correct preoperative diagnosis and staging of a soft tissue sarcoma, the surgeon, in conjunction with the radiation therapist and the medical oncologist, can select the optimal therapeutic approach to minimize the development of recurrences and metastases. Recognition of a mass as benign or non-neoplastic prevents unnecessary surgery.

MR Imaging in the Follow-Up Evaluation of Aggressive Soft Tissue Tumors.

Although newer imaging techniques aid in the diagnosis of soft tissue sarcomas and current surgical procedures and adjunct therapy decrease the incidence of their recurrences when patients are referred to oncologic centers, the majority of these tumors are suboptimally evaluated in general practice with frequent recurrences. Close surveillance of these patients is necessary for early recognition and treatment of recurrent disease. This article describes an organized, stepwise magnetic resonance imaging evaluation of these patients after surgery and radiation therapy.

Dynamic Contrast-Enhanced MR Imaging for Soft Tissue Sarcomas.

Dynamic contrast-enhanced magnetic resonance imaging has recently emerged as an important method for evaluating soft tissue sarcomas for biopsy localization, chemotherapeutic response, and long-term follow-up because of its ability to detect viable tumor. This article presents the basic principles of contrast kinetics in soft tissue sarcomas after bolus injection of contrast agent and discusses the current postprocessing methods (subtraction, first-pass image and time-intensity curves with region of interest, and color-encoded techniques) used to display these dynamic studies. Because of its excellent temporal resolution, dynamic MR imaging can delineate the early uptake of contrast agent in sarcomas within seconds after injection, almost synchronous with arterial enhancement, and thereby differentiate the rapidly enhancing viable tumor from the nonenhancing necrotic tumor and the late enhancing changes after surgery, radiation therapy, and chemotherapy.

Imaging evaluation of the response of high-grade osteosarcoma and Ewing sarcoma to chemotherapy with emphasis on dynamic contrast-enhanced magnetic resonance imaging.

Response of high-grade osteosarcoma and Ewing sarcoma to preoperative chemotherapy can significantly affect the surgical approach to patients with these tumors and their disease-free survival. This article presents the findings and limitations of different imaging modalities (radiography, angiography, sonography, scintigraphy, and magnetic resonance [MR] imaging and spectroscopy) for evaluating this chemotherapeutic response. Particular emphasis is given to the currently most effective modality--dynamic contrast-enhanced MR imaging.

Dynamic contrast-enhanced MRI with subtraction of aggressive soft tissue tumors after resection.

Objective: To report the application of dynamic contrast-enhanced subtraction MRI for detecting recurrences in aggressive or malignant soft tissue tumors.

Design: The imaging studies consisted of static (T1- and T2-weighted spin-echo) acquisitions, followed by dynamic conventional spin-echo short TR/TE images (at 45 s, 1 min 30 s and 5 min) after a bolus of intravenous contrast medium. Contrast images were subtracted from the precontrast scan on the console.

Primary tumors of the musculoskeletal system.

The excellent soft-tissue contrast and multiplanar imaging capabilities of MR imaging have led to its emergence as the most significant advance in the imaging of musculoskeletal tumors. MR imaging is the modality of choice for local staging, evaluating response to preoperative chemotherapy, and long-term follow-up in bone tumors. MR imaging is the most effective modality for both primary staging of soft-tissue malignancy and detecting recurrences.

Can clinical data help to screen patients with lymphoma for MR imaging of bone marrow?

Background: Previous studies have suggested combining magnetic resonance (MR) imaging and biopsy in patients with lymphoma but association between MR results and clinical symptoms have never been investigated. The purpose of this retrospective study was to better delineate patients profiles requiring bone marrow (BM) imaging in lymphoma.

Material And Methods: 50 MR studies and blind biopsies (BB) were reviewed in 40 patients with lymphoma.

Periosteal Ewing sarcoma.

Purpose: To evaluate the imaging and histopathologic findings and clinical course of patients with periosteal Ewing sarcoma (PES).

Materials And Methods: Conventional radiographs, computed tomographic (CT) scans, and magnetic resonance (MR) images in 10 adolescents and one adult were evaluated for the extent and character of PES.

Results: Ten of 11 masses were in the proximal extremities and one in the fibula; nine were diaphyseal and two, metadiaphyseal.

MR imaging in the follow-up of malignant and aggressive soft-tissue tumors: results of 511 examinations.

Purpose: To present magnetic resonance (MR) imaging findings from 511 follow-up examinations of aggressive soft-tissue tumors.

Materials And Methods: One hundred eighty-two patients with aggressive soft-tissue tumours underwent postoperative T1- and T2-weighted imaging; 41 also underwent 51 gadolinium-enhanced T1-weighted examinations, and five underwent dynamic gadolinium-enhanced subtraction imaging.

Results: Twenty-four of 25 patients (101 of 102 examinations) without high signal intensity (HSI) at T2-weighted imaging had no recurrence.

Aggressive fibrous dysplasia of the maxillary sinus.

Fibrous dysplasia is usually a slowly progressive, benign disease that develops over several years and presents with deformity or mild symptomatology. Five of 34 patients (ages 4-21 years), who were subsequently diagnosed histologically as having fibrous dysplasia of the maxillary sinus, rapidly developed soft tissue masses of the malar region over a period of less than 4 months with accompanying pain (2 patients) and nasal obstruction and exophthalmos (2 patients). Each was clinically suspected of having a sarcoma; two had been thought to have an "osteofibrosarcoma" on initial biopsy at outside hospitals.

Assessment of breast cancer recurrence with contrast-enhanced subtraction MR imaging: preliminary results in 26 patients.

Local relapse was suspected in 26 women treated conservatively for breast cancer. All women underwent routine magnetic resonance (MR) imaging and a dynamic MR subtraction study after injection of gadolinium-tetraazacyclododecanetetra-acetic acid. Twelve women had no local relapse.

Bone metastases as the presenting manifestation of rhabdomyosarcoma in childhood.

Rarely, rhabdomyosarcoma can present with bone pain and bone lesions on radiographs without evidence of a primary tumor. Of 428 children with biopsy-proven rhabdomyosarcoma, four presented with radiographic evidence of bone metastases, but no primary tumor was found on subsequent evaluation. On radiographs, these metastases, located most commonly in the metaphyses of the extremities and in the spine, displayed a destructive or diffusely permeative pattern without sclerotic margins and mimicked the more common neuroblastoma.

Extraskeletal mesenchymal chondrosarcoma.

Among seven patients with extraskeletal mesenchymal chondrosarcoma (EMC), three children (aged 3-6 years) developed EMC in a central location and four adults (aged 38-54 years) developed EMC in both central and peripheral sites. Conventional radiography and tomography and computed tomography (CT) depicted EMC as a soft-tissue mass with ring, arc, stippled, and highly opaque calcifications in four patients. Contrast-enhanced CT showed lobulation and peripheral tumoral enhancement, sometimes with central low-attenuation areas.

Epidermoid cysts of testes and role of sonography.

Four patients with histologically proved epidermoid cysts of the testicle were managed with radical orchiectomy. High-resolution testicular sonography demonstrated similar findings in all cases, but these findings were not specific and did not preclude other malignant or teratomatous lesions. The lack of both unique clinical features and specific sonographic findings would suggest that extreme caution must be used if wedge resection or enucleation is contemplated for a patient with presumed epidermoid cyst.