Soft tissue tumor imaging in adults: European Society of Musculoskeletal Radiology-Guidelines 2023-overview, and primary local imaging: how and where?

OBJECTIVES: Early, accurate diagnosis is crucial for the prognosis of patients with soft tissue sarcomas. To this end, standardization of imaging algorithms, technical requirements, and reporting is therefore a prerequisite. Since the first European Society of Musculoskeletal Radiology (ESSR) consensus in 2015, technical achievements, further insights into specific entities, and the revised WHO-classification (2020) and AJCC staging system (2017) made an update necessary. The guidelines are intended to support radiologists in their decision-making and contribute to interdisciplinary tumor board discussions. MATERIALS AND METHODS: A validated Delphi method based on peer-reviewed literature was used to derive consensus among a panel of 46 specialized musculoskeletal radiologists from 12 European countries. Statements were scored online by level of agreement (0 to 10) during two iterative rounds. Either "group consensus," "group agreement," or "lack of agreement" was achieved. RESULTS: Eight sections were defined that finally contained 145 statements with comments. Overall, group consensus was reached in 95.9%, and group agreement in 4.1%. This communication contains the first part consisting of the imaging algorithm for suspected soft tissue tumors, methods for local imaging, and the role of tumor centers. CONCLUSION: Ultrasound represents the initial triage imaging modality for accessible and small tumors. MRI is the modality of choice for the characterization and local staging of most soft tissue tumors. CT is indicated in special situations. In suspicious or likely malignant tumors, a specialist tumor center should be contacted for referral or teleradiologic second opinion. This should be done before performing a biopsy, without exception. CLINICAL RELEVANCE: The updated ESSR soft tissue tumor imaging guidelines aim to provide best practice expert consensus for standardized imaging, to support radiologists in their decision-making, and to improve examination comparability both in individual patients and in future studies on individualized strategies. KEY POINTS: • Ultrasound remains the best initial triage imaging modality for accessible and small suspected soft tissue tumors. • MRI is the modality of choice for the characterization and local staging of soft tissue tumors in most cases; CT is indicated in special situations. Suspicious or likely malignant tumors should undergo biopsy. • In patients with large, indeterminate or suspicious tumors, a tumor reference center should be contacted for referral or teleradiologic second opinion; this must be done before a biopsy.

Groove pancreatitis: a rare cause of severe gastric dilation.

A 57-year-old male with a history of chronic pancreatitis related to heavy smoking and alcohol abuse was evaluated in the emergency department due to a 3-day history of epigastric pain and postprandial vomiting. Abdominal computed tomography (CT) was performed and revealed a severe gastric dilation that reached the pelvis. There was a marked concentric mural thickening at the duodenal level and an intramural cysts that caused a narrowing of the light and a retrograde gastric dilation. There were no findings suggestive of chronic pancreatitis. A diagnosis was made of duodenal obstruction due to groove pancreatitis with severe secondary gastric dilatation.

Osteoblastomatosis: an unusual diagnosis and treatment.

Osteoblastomatosis (OBLT), also referred to as multifocal osteoblastoma (OB), is an unusual and recently described entity consisting of multifocal tumors histologically consistent with osteoblastoma and osteoid osteoma (OO) but radiologically mimicking a vascular bone lesion. OBLT treatment is based on aggressive procedures, such as amputation, en bloc resection, and chemotherapy. Only one previously reported case was successfully treated following a multimodal approach consisting of curettage, cryotherapy, intravenous bisphosphonates, and radiofrequency ablation. We present a case of OBLT that may have been cured by CT-guided percutaneous radiofrequency ablation.

Computer modelling of RF ablation in cortical osteoid osteoma: Assessment of the insulating effect of the reactive zone.

PURPOSE: The aim was to study by computer simulations the insulating role of the reactive zone surrounding a cortical osteoid osteoma (OO) in terms of electrical and thermal performance during radiofrequency ablation (RFA). MATERIAL AND METHODS: We modelled a cortical OO consisting of a nidus (10 mm diameter) enclosed by a reactive zone. The OO was near a layer of cortical bone 1.5 mm thick. Trabecular bone partially surrounds the OO and there was muscle around the cortical bone layer. We modelled RF ablations with a non-cooled-tip 17-gauge needle electrode (300 s duration and 90 °C target temperature). Sensitivity analyses were conducted assuming a reactive zone electrical conductivity value (σrz) within the limits of the cortical and trabecular bone, i.e. 0.02 S/m and 0.087 S/m, respectively. In this way we were really modelling the different degrees of osteosclerosis associated with the reactive zone. RESULTS: The presence of the reactive zone drastically reduced the maximum temperature reached outside it. The temperature drop was proportional to the thickness of the reactive zone: from 68 °C when it was absent to 44 °C when it is 7.5 mm thick. Higher nidus conductivity values (σn) implied higher temperatures, while lower temperatures meant higher σrz values. Changing σrz from 0.02 S/m to 0.087 S/m reduced lesion diameters from 2.4 cm to 1.8 cm. CONCLUSIONS: The computer results suggest that the reactive zone plays the role of insulator in terms of reducing the temperature in the surrounding area.

[CT-guided radiofrequency ablation of non-small cell lung cancer]. / Ablación por radiofrecuencia guiada por tomografía computarizada en el carcinoma de pulmón no microcítico.

UNLABELLED: FUNDAMENTAL AND OBJECTIVE: To present the first experiences with a series of consecutive cases of patients with non-small cell lung cancer (NSCLC) treated with radiofrequency ablation (RFA), considering its clinical applicability, effectiveness and safety. PATIENTS AND METHODS: Descriptive study performed from June 2003 to March 2009, with a series of consecutive cases of patients with NSCLC treated with RFA, selected according to well-defined inclusion criteria, in different stages of the disease. The variables studied were local recurrence, complications, staging, demographic and procedure-related variables. Local control was assessed in posterior controls according to CT morphology criteria and/or lesion enhancement after intravenous contrast. Survival curves were estimated. Statistical analysis was performed with SPSS version 15.0 application. RESULTS: We studied 15 patients (46-88 years), diagnosed with NSCLC in different stages, in a total of 22 sessions. After 1 year of follow up, 75% of lesions showed no local recurrence (15). The progression-free survival and disease-free survival in localized stage at one year were 81,3% and 75% respectively. In 8 of 22 sessions there were post-procedure complications (36.36%). Of all complications (14), 28.5% were pneumothorax, 21.4% alveolar hemorrhage and 7.1% pulmonary infarction. CONCLUSION: ARF is clinically useful in the treatment of patients with inoperable NSCLC, considering the high percentage of local control and few major complications, being thus a plausible, effective and safe therapeutic alternative.

Diagnostic validity of helical CT compared to ultrasonography in renal-ureteral colic.

OBJECTIVES: Helical CT without contrast is currently being evaluated for the diagnosis of renoureteral colic. Ureteral obstruction and other pathologies with similar symptoms can be rapidly identified. This study intends to evaluate the validity of CTh for these patients and to compare it with the ultrasound technique in order to consider the CTh as an efficient diagnostic alternative for these pathologies. METHODS: A diagnostic evaluation study was carried out between January 2004 and December 2006 in patients with persistent renoureteral colic after standard care. They were blindly evaluated by ultrasound and CTh, maintaining the follow up until the "gold standard" confirmation. Qualitative variables were described by frequency and 95%CI and quantitative variables by position and dispersion measures. The Chi2 test was used to compare qualitative variables. Validity indicators and 95% CI were calculated and compared with McNemar test. RESULTS: 124 patients were studied. Lithiasis and the other diagnosis had frequencies of 59.7% and 40.3% respectively. The percentage of lithiasis obtained by ultrasound (92) was 22.8% and by CTh (124) was 59.7%. Validity indicators for CTh were superior to 95%, with 100% sensitivity and positive predictive value. Ultrasound specificity and positive predictive value were 100%, but sensitivity was only 29.6% (p<0.05). CONCLUSION: CTh can be considered a good alternative diagnostic technique in the renoureteral colic management.

Usefulness of X-rays in the Differential Diagnosis of Hypophosphataemic Rickets.

Rickets and osteomalacia are two related conditions linked by the lack of mineralization of bone tissue due to a disturbance of calcium and phosphate homeostasis. Some of the most characteristic features of rickets are skeletal deformities, fractures, linear and continuous periosteal reaction, and enlargement of the metaphyseal space in an irregular and frayed form. However, these radiological findings are not exclusive to these diseases, but may also originate in children who were born prematurely or in those who have suffered physical abuse or an accident. Hence, it is important to establish a differential diagnosis. All these observations can be evidenced by radiological images using a simple X-ray. The aim of this article is to show the main radiological findings that can be found in rickets and how to establish a differential diagnosis of X-linked hypophosphataemic (XLH) rickets.

Percutaneous radiofrequency ablation in osteoid osteoma: Tips and tricks in special scenarios.

OBJECTIVES: To define specific characteristics of osteoid osteomas treated with radiofrequency ablation, that may benefit from special technical recommendations. METHODS: Retrospective analysis of all radiofrequency ablations performed by our group from January 2001 to March 2015. A descriptive study was conducted. We compared our results with the available literature to determine the most frequent special scenarios. RESULTS: 207 radiofrequency ablations were performed in 200 patients. We defined the following scenarios: osteoid osteomas located in the spine, close to neurovacular structures, osteoid osteomas in small bones (hands and feet), intra-articular, deeply located or superficial and lesions with extensive periosteal reaction. CONCLUSIONS: The scenarios defined required special considerations and technical variations. Implementing the different tips and tricks shown in the article, the most complex osteoid osteomas could be successfully ablated.