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Post-operative imaging of soft tissue sarcomas.

James SL, Davies AM - Cancer Imaging (2008)

Bottom Line: The aim of follow-up imaging with any malignancy is to detect recurrence promptly so that treatment can be instigated at the earliest possible opportunity.The role of radiographs, computed tomography, magnetic resonance imaging and positron emission tomography is reviewed followed by a discussion on the imaging modalities useful in the detection of metastatic disease.Finally, we present a robust pathway that is suggested for the follow-up of patients with an extremity soft tissue sarcoma.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, The Royal Orthopaedic Hospital, Birmingham, B31 2AP, UK. steven.james@roh.nhs.uk

ABSTRACT
Soft tissue sarcomas are uncommon malignancies that have a high risk of local recurrence despite adequate initial surgery. The aim of follow-up imaging with any malignancy is to detect recurrence promptly so that treatment can be instigated at the earliest possible opportunity. In this review article, we discuss the imaging modalities that can be employed to detect local recurrence following surgery for an extremity soft tissue sarcoma. The role of radiographs, computed tomography, magnetic resonance imaging and positron emission tomography is reviewed followed by a discussion on the imaging modalities useful in the detection of metastatic disease. Finally, we present a robust pathway that is suggested for the follow-up of patients with an extremity soft tissue sarcoma.

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Related in: MedlinePlus

Post-operative seroma. Axial STIR, T1-weighted spin echo and contrast enhanced T1-weighted images with and without fat suppression. The STIR image shows a small focus of hyperintense signal with mass effect at the site of previous excision of a soft tissue sarcoma deep to the fascia lata. The contrast enhanced images show minor rim enhancement consistent with a small seroma best shown on the fat suppressed image.
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Figure 4: Post-operative seroma. Axial STIR, T1-weighted spin echo and contrast enhanced T1-weighted images with and without fat suppression. The STIR image shows a small focus of hyperintense signal with mass effect at the site of previous excision of a soft tissue sarcoma deep to the fascia lata. The contrast enhanced images show minor rim enhancement consistent with a small seroma best shown on the fat suppressed image.

Mentions: Post-operative seromas occur in approximately 17–19% of patients following surgery for soft tissue sarcoma and are more common in the lower extremity23,24. The typical appearances are of a homogeneous, fairly well-defined area of low to intermediate signal relative to muscle on T1- and high signal on T2-weighted sequences and rim enhancement on contrast enhanced images (Figs. 3 and 4)25. However, a spectrum of imaging findings may be identified secondary to organizing haematoma or granulation tissue. In the presence of blood products, areas of high signal may be identified on T1-weighted sequences and the seroma may demonstrate a heterogeneous signal on T2-weighted sequences (Fig. 5a). In addition, a feathery appearance may be identified on the inner margin of the seroma in approximately 10% of cases (Fig. 5b). These atypical seromas may occur in up to 25% of cases26. The seroma may have a smooth or irregular border and may be surrounded by mild soft tissue oedema23. The border of the seroma may demonstrate a low signal intensity margin on T2-weighted sequences due to the deposition of haemosiderin (Fig. 5b). The shape can be variable including round, oval, or angular in nature in the transverse plane and oval, elliptical or flame-shaped in the longitudinal plane22. Typically, the longitudinal extent of the seroma will exceed its transverse dimension (Figs. 3 and 5a). Follow-up studies demonstrate that these fluid collections may remain unchanged for considerable periods of time, although resolution usually occurs within 3–18 months23. Similarly, post-operative haematomas may be identified in a subacute phase in the weeks following surgery. An intermediate signal mass with a high signal rim is demonstrated on T1-weighted sequences due to the presence of extracellular methaemoglobin (Fig. 6)22.Figure 3


Post-operative imaging of soft tissue sarcomas.

James SL, Davies AM - Cancer Imaging (2008)

Post-operative seroma. Axial STIR, T1-weighted spin echo and contrast enhanced T1-weighted images with and without fat suppression. The STIR image shows a small focus of hyperintense signal with mass effect at the site of previous excision of a soft tissue sarcoma deep to the fascia lata. The contrast enhanced images show minor rim enhancement consistent with a small seroma best shown on the fat suppressed image.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2267691&req=5

Figure 4: Post-operative seroma. Axial STIR, T1-weighted spin echo and contrast enhanced T1-weighted images with and without fat suppression. The STIR image shows a small focus of hyperintense signal with mass effect at the site of previous excision of a soft tissue sarcoma deep to the fascia lata. The contrast enhanced images show minor rim enhancement consistent with a small seroma best shown on the fat suppressed image.
Mentions: Post-operative seromas occur in approximately 17–19% of patients following surgery for soft tissue sarcoma and are more common in the lower extremity23,24. The typical appearances are of a homogeneous, fairly well-defined area of low to intermediate signal relative to muscle on T1- and high signal on T2-weighted sequences and rim enhancement on contrast enhanced images (Figs. 3 and 4)25. However, a spectrum of imaging findings may be identified secondary to organizing haematoma or granulation tissue. In the presence of blood products, areas of high signal may be identified on T1-weighted sequences and the seroma may demonstrate a heterogeneous signal on T2-weighted sequences (Fig. 5a). In addition, a feathery appearance may be identified on the inner margin of the seroma in approximately 10% of cases (Fig. 5b). These atypical seromas may occur in up to 25% of cases26. The seroma may have a smooth or irregular border and may be surrounded by mild soft tissue oedema23. The border of the seroma may demonstrate a low signal intensity margin on T2-weighted sequences due to the deposition of haemosiderin (Fig. 5b). The shape can be variable including round, oval, or angular in nature in the transverse plane and oval, elliptical or flame-shaped in the longitudinal plane22. Typically, the longitudinal extent of the seroma will exceed its transverse dimension (Figs. 3 and 5a). Follow-up studies demonstrate that these fluid collections may remain unchanged for considerable periods of time, although resolution usually occurs within 3–18 months23. Similarly, post-operative haematomas may be identified in a subacute phase in the weeks following surgery. An intermediate signal mass with a high signal rim is demonstrated on T1-weighted sequences due to the presence of extracellular methaemoglobin (Fig. 6)22.Figure 3

Bottom Line: The aim of follow-up imaging with any malignancy is to detect recurrence promptly so that treatment can be instigated at the earliest possible opportunity.The role of radiographs, computed tomography, magnetic resonance imaging and positron emission tomography is reviewed followed by a discussion on the imaging modalities useful in the detection of metastatic disease.Finally, we present a robust pathway that is suggested for the follow-up of patients with an extremity soft tissue sarcoma.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, The Royal Orthopaedic Hospital, Birmingham, B31 2AP, UK. steven.james@roh.nhs.uk

ABSTRACT
Soft tissue sarcomas are uncommon malignancies that have a high risk of local recurrence despite adequate initial surgery. The aim of follow-up imaging with any malignancy is to detect recurrence promptly so that treatment can be instigated at the earliest possible opportunity. In this review article, we discuss the imaging modalities that can be employed to detect local recurrence following surgery for an extremity soft tissue sarcoma. The role of radiographs, computed tomography, magnetic resonance imaging and positron emission tomography is reviewed followed by a discussion on the imaging modalities useful in the detection of metastatic disease. Finally, we present a robust pathway that is suggested for the follow-up of patients with an extremity soft tissue sarcoma.

Show MeSH
Related in: MedlinePlus