Inferring malignancy grade of soft tissue sarcomas from magnetic resonance imaging features: A systematic review.

PURPOSE: Systematic reviews on the grading of STS using MRI are lacking. This review analyses the role of different MRI features in inferring the histological grade of STS. MATERIALS AND METHODS: A systematic review was conducted and is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) checklist. The electronic databases of PubMed/MEDLINE were systematically searched for literature addressing the correlation of MRI findings in soft tissue sarcoma with tumor grade. As keywords "MRI", "magnetic resonance imaging", "sarcoma", "grade", "grading", and "FNCLCC" have been selected. RESULTS: 14 studies have been included in this systematic review. Tumor size (p = 0.015 (51 patients) to p = 0.81 (36 patients)), tumor margin (p < 0.001 (95 patients) to 0.93 (36 patients)), necrosis (p = 0.004 (50 patients) to p = 0.65 (95 patients)), peritumoral edema (p = 0.002 (130 patients) to p = 0.337 (40 patients)), contrast enhancement (p < 0.01 (50 patients) to 0.019 (51 patients)) and polycyclic/multilobulated tumor configuration (p = 0.008 (71 patients)) were significantly associated with STS malignancy grade in most of the included studies. Heterogeneity in T2w images (p = 0.003 (130 patients) to 0.202 (40 patients)), signal intensity in T1w images/ hemorrhage (p = 0.02 (130 patients) to 0.5 (31 patients)), peritumoral contrast enhancement (p < 0.001 (95 patients) to 0.253 (51 patients)) and tumoral diffusion restriction (p = 0.01 (51 patients) to 0.53 (52 patients)) were regarded as significantly associated with FNCLCC grade in some of the studies which investigated these features. Most other MRI features were not significant. CONCLUSION: Several MRI features, such as tumor size, necrosis, peritumoral edema, peritumoral contrast enhancement, intratumoral contrast enhancement, and polycyclic/multilobulated tumor configuration may indicate the malignancy grade of STS. However, further studies are needed to gain consensus.

Bone regeneration in critical-size defects of the mandible using biomechanically adapted CAD/CAM hybrid scaffolds: An in vivo study in miniature pigs.

The study aimed to analyze bone regeneration in critical-size defects using hybrid scaffolds biomechanically adapted to the specific defect and adding the growth factor rhBMP-2. For this animal study, ten minipigs underwent bilateral defects in the corpus mandibulae and were subsequently treated with novel cylindrical hybrid scaffolds. These scaffolds were designed digitally to suit the biomechanical requirements of the mandibular defect, utilizing finite element analysis. The scaffolds comprised zirconium dioxide-tricalcium phosphate (ZrO2-TCP) support struts and TCP foam ceramics. One scaffold in each animal was loaded with rhBMP-2 (100 µg/cm³), while the other served as an unloaded negative control. Fluorescent dyes were administered every 2 weeks, and computed tomography (CT) scans were conducted every 4 weeks. Euthanasia was performed after 3 months, and samples were collected for examination using micro-CT and histological evaluation of both hard and soft tissue. Intravital CT examinations revealed minor changes in radiographic density from 4 to 12 weeks postoperatively. In the group treated with rhBMP-2, radiographic density shifted from 2513 ± 128 (mean ± SD) to 2606 ± 115 Hounsfield units (HU), while the group without rhBMP-2 showed a change from 2430 ± 131 to 2601 ± 67 HU. Prior to implantation, the radiological density of samples measured 1508 ± 30 mg HA/cm³, whereas post-mortem densities were 1346 ± 71 mg HA/cm³ in the rhBMP-2 group and 1282 ± 91 mg HA/cm³ in the control group (p = 0.045), as indicated by micro-CT measurements. The histological assessment demonstrated successful ossification in all specimens. The newly formed bone area proportion was significantly greater in the rhBMP-2 group (48 ± 10%) compared with the control group without rhBMP-2 (42 ± 9%, p = 0.03). The mean area proportion of remaining TCP foam was 23 ± 8% with rhBMP-2 and 24 ± 10% without rhBMP-2. Successful bone regeneration was accomplished by implanting hybrid scaffolds into critical-size mandibular defects. Loading these scaffolds with rhBMP-2 led to enhanced bone regeneration and a uniform distribution of new bone formation within the hybrid scaffolds. Further studies are required to determine the adaptability of hybrid scaffolds for larger and potentially segmental defects in the maxillofacial region.

Achilles tendon and enthesis assessment using ultrashort echo time magnetic resonance imaging (UTE-MRI) T1 and magnetization transfer (MT) modeling in psoriatic arthritis.

The purpose of this study is to investigate the use of ultrashort echo time (UTE) magnetic resonance imaging (MRI) techniques (T1 and magnetization transfer [MT] modeling) for imaging of the Achilles tendons and entheses in patients with psoriatic arthritis (PsA) compared with asymptomatic volunteers. The heels of twenty-six PsA patients (age 59 ± 15 years, 41% female) and twenty-seven asymptomatic volunteers (age 33 ± 11 years, 47% female) were scanned in the sagittal plane with UTE-T1 and UTE-MT modeling sequences on a 3-T clinical scanner. UTE-T1 and macromolecular proton fraction (MMF; the main outcome of MT modeling) were calculated in the tensile portions of the Achilles tendon and at the enthesis (close to the calcaneus bone). Mann-Whitney-U tests were used to examine statistically significant differences between the two cohorts. UTE-T1 in the entheses was significantly higher for the PsA group compared with the asymptomatic group (967 ± 145 vs. 872 ± 133 ms, p < 0.01). UTE-T1 in the tendons was also significantly higher for the PsA group (950 ± 145 vs. 850 ± 138 ms, p < 0.01). MMF in the entheses was significantly lower in the PsA group compared with the asymptomatic group (15% ± 3% vs. 18% ± 3%, p < 0.01). MMF in the tendons was also significantly lower in the PsA group compared with the asymptomatic group (17% ± 4% vs. 20% ± 5%, p < 0.01). Percentage differences in MMF between the asymptomatic and PsA groups (-16.6% and -15.0% for the enthesis and tendon, respectively) were higher than the T1 differences (10.8% and 11.7% for the enthesis and tendon, respectively). The results suggest higher T1 and lower MMF in the Achilles tendons and entheses in PsA patients compared with the asymptomatic group. This study highlights the potential of UTE-T1 and UTE-MT modeling for quantitative evaluation of entheses and tendons in PsA patients.

Primary synovial sarcoma on MRI - a case series and review of the literature.

Purpose: Simple MRI features are mandatory to facilitate the diagnostics of synovial sarcomas, especially for radiolo-gists outside multidisciplinary sarcoma centres. In this case-series and review, we investigate the main appearance of synovial sarcoma on MRI. Material and methods: Fifteen histologically proven primary synovial sarcomas who underwent MRI at 2 different sarcoma centres were included in this case series. Patients and their primary synovial sarcomas were examined for age, localization, mean tumour size (in mm), histological grade (G - according to the Fédération Nationale des Centres de Lutte Contre Le Cancer [FNCLCC]), configuration, T2 signal intensity, presence/absence of "triple sign", heterogeneity/homogeneity, borders (well-defined or infiltrative), and intensity of contrast enhancement on MRI. Additionally, a comprehensive literature review to identify observational studies, reviews, and case-reports assessing MRI features of primary synovial sarcoma was performed. Results: The mean age of the patients was 47.6 years (SD: 17.2). The mean size of primary synovial sarcoma was 59.3 mm (SD: 42). Primary synovial sarcomas were significantly most often multilobulated (n = 12, p < 0.01), heterogeneous (n = 10), and infiltrative (n = 9). Additionally, 3 other primary synovial sarcomas showed the following configurations: ovoid/nodular (n = 2) and fascicular (n = 1). Ovoid/nodular synovial sarcomas were solely depicted as homogeneous with well-defined borders. All tumours showed T2 hyperintense signal and presented with marked contrast enhancement. Conclusions: Primary synovial sarcomas are mainly multilobulated, heterogeneous, and infiltrative tumours. In minor cases, ovoid/nodular or fascicular configurations occur. Knowing the main appearance of synovial sarcoma can help facilitate the diagnostics of primary synovial sarcomas.

Fatty Degeneration of the Autochthonous Muscles Is Significantly Associated with Incidental Non-Traumatic Vertebral Body Fractures of the Lower Thoracic Spine in Elderly Patients.

PURPOSE: We investigated loco-regional degenerative changes' association with incidentally found non-traumatic vertebral body fractures of the lower thoracic and lumbar spine in older patients. Methods: The patient collective included patients in the age range of 50 to 90 years. Vertebral bodies from T7 to L5 were included. Vertebral body fractures were classified according to Genant. The following loco-regional osseous and extra-osseous degenerative changes were included: osteochondrosis, spondylarthritis, facet joint asymmetries, spondylolisthesis, scoliosis as well as fatty degeneration and asymmetry of the autochthonous back muscles. Patients with traumatic and tumor-related vertebral body fractures were excluded. Non-traumatic fractures of the lower thoracic and lumbar spine were evaluated separately. The Mann-Whitney U-test was used, and relative risks (RRs) were calculated for statistics. Pearson's correlations (Rs) were used to correlate grades of degenerative changes and fracture severities. Results: 105 patients were included. Fatty deposits in the autochthonous muscles of the lower thoracic and the lumbar spine were associated with non-traumatic vertebral body fractures in the lower thoracic spine (p = 0.005, RR = 4.92). In contrast, muscle fatness of the autochthonous muscles was not a risk factor for lumbar spine fractures (p = 0.157, RR = 2.04). Additionally, we found a moderate correlation between fatty degeneration of the autochthonous muscles and the severity of fractures in the lower thoracic spine (RR = 0.34, p < 0.001). The other degenerative changes did not present any significant difference or correlation between the evaluated groups. Conclusions: Fatty degeneration of the autochthonous spinal musculature is associated with incidentally found non-traumatic fractures of the lower thoracic spine.

Clinical evaluation of white matter lesions on 3D inversion recovery ultrashort echo time MRI in multiple sclerosis.

Background: We clinically evaluated the quality of white matter lesions (WML) of the cerebrum on 3D inversion recovery ultrashort echo time (IR-UTE) magnetic resonance imaging (MRI) in multiple sclerosis (MS) patients. Methods: Forty-nine patients with MS were included in this study. A 3T MRI scanner was used. Two radiologists (readers) evaluated the quality of WML on IR-UTE images using a three-point Likert scale (1-good quality, 2-moderate quality, 3-insufficient quality). They also rated other WML-related factors potentially influencing WML quality using another three-point Likert scale (1-no/minor impact, 2-moderate impact, 3-high impact). Another reader rated the presence of WML on IR-UTE to evaluate the diagnostic value (right/false positive and false negative) of IR-UTE in detecting WML. Signal intensity ratios (SIRs) derived from WML signal intensities and WML sizes were also determined and analyzed. Results: Two hundred and seventy-five MS lesions were evaluated. 87% of the lesions were rated Likert 1 on IR-UTE (P<0.01). WML rated Likert 2 and 3 presented near the grey matter (GM) in 58% of the cases (n=21), with 14 lesions being ≤2 mm (P=0.03). 62.5% of the WML rated Likert 2/3 were in the temporal lobe (P=0.02). The mean SIR of WML on IR-UTE was 1.14±0.22, while the mean SIR on fluid-attenuated inversion recovery (FLAIR) was 6.97±1.88. There was no significant correlation of SIRs between IR-UTE and FLAIR (R=0.14, P=0.245). 92.4% of the WML were correctly detected on IR-UTE (n=254). 19 out of the 21 false positive/negative rated WML were located near the GM or in the temporal lobe. WML presented 7.7% smaller in mean on IR-UTE compared to FLAIR. Factors affecting WML quality with a moderate or high impact (Likert 2 and 3) were not found. Conclusions: Most WML are clearly detectable on IR-UTE sequences. The main limitations are WML in the temporal lobe and near the GM.

Detection of iron oxide nanoparticle (IONP)-labeled stem cells using quantitative ultrashort echo time imaging: a feasibility study.

Background: In this study, we investigated the feasibility of quantitative ultrashort echo time (qUTE) magnetic resonance (MR) imaging techniques in the detection and quantification of iron oxide nanoparticle (IONP)-labeled stem cells. Methods: A stem cell phantom containing multiple layers of unlabeled or labeled stem cells with different densities was prepared. The phantom was imaged with quantitative UTE (qUTE) MR techniques [i.e., UTE-T1 mapping, UTE-T2* mapping, and UTE-based quantitative susceptibility mapping (UTE-QSM)] as well as with a clinical T2 mapping sequence on a 3T clinical MR system. For T1 mapping, a variable flip angle (VFA) method based on actual flip angle imaging (AFI) technique was utilized. For T2* mapping and UTE-QSM, multiple images with variable, interleaved echo times including UTE images and gradient recalled echo (GRE) images were used. For UTE-QSM, the phase information from the multi-echo images was utilized and processed using a QSM framework based on the morphology-enabled dipole inversion (MEDI) algorithm. The qUTE techniques were also evaluated in an ex vivo experiment with a mouse injected with IONP-labeled stem cells. Results: In the phantom experiment, the parameters estimated with qUTE techniques showed high linearity with respect to the density of IONP-labeled stem cells (R2>0.99), while the clinical T2 parameter showed impaired linearity (R2=0.87). In the ex vivo mouse experiment, UTE-T2* mapping and UTE-QSM showed feasibility in the detection of injected stem cells with high contrast, whereas UTE-T1 and UTE-T2* showed limited detection. Overall, UTE-QSM demonstrated the best contrast of all, with other methods being subjected more to a confounding factor due to different magnetic susceptibilities of various types of neighboring tissues, which creates inhomogeneous contrast that behaves similar to IONP. Conclusions: In this study, we evaluated the feasibility of a series of qUTE imaging techniques as well as conventional T2 mapping for the detection of IONP-labeled stem cells in vitro and ex vivo. UTE-QSM performed superior amongst other qUTE techniques as well as conventional T2 mapping in detecting stem cells with high contrast.

Percutaneous thoraco-lumbar-sacral pedicle screw placement accuracy results from a multi-center, prospective clinical study using a skin marker-based optical navigation system.

STUDY DESIGN: Prospective multi-center study. OBJECTIVE: The study aimed to evaluate the accuracy of pedicle screw placement using a skin marker-based optical surgical navigation system for minimal invasive thoraco-lumbar-sacral pedicle screw placement. METHODS: The study was performed in a hybrid Operating Room with a video camera-based navigation system integrated in the imaging hardware. The patient was tracked with non-invasive skin markers while the instrument tracking was via an on-shaft optical marker pattern. The screw placement accuracy assessment was performed by three independent reviewers, using the Gertzbein grading. The screw placement time as well as the staff and patient radiation doses was also measured. RESULTS: In total, 211 screws in 39 patients were analyzed for screw placement accuracy. Of these 32.7% were in the thoracic region, 59.7% were in the lumbar region, and 7.6% were in the sacral region. An overall accuracy of 98.1% was achieved. No screws were deemed severely misplaced (Gertzbein grading 3). The average time for screw placement was 6 min and 25 secs (± 3 min 33 secs). The average operator radiation dose per subject was 40.3 µSv. The mean patient effective dose (ED) was 11.94 mSv. CONCLUSION: Skin marker-based ON can be used to achieve very accurate thoracolumbarsacral pedicle screw placements.

Does the primary soft-tissue sarcoma configuration predict configuration of recurrent tumors on magnetic resonance imaging?

BACKGROUND: Soft-tissue sarcomas (STS) are rare malignancies of the soft tissue. PURPOSE: To assess whether the magnetic resonance imaging (MRI) configuration of primary STS can predict the configuration of a recurring tumor and whether the MRI configuration of multiple recurrences differs in one and the same patient. MATERIAL AND METHODS: Thirty-nine patients with histologically proven recurrent STS were included in this retrospective study and underwent pre- and post-treatment MRI. Three main configurations of primary and recurrent tumors were identified: polycyclic/multilobulated; ovoid/nodular; and streaky. RESULTS: Sixty recurrent lesions were detected: 34 ovoid/nodular; 15 polycyclic/multilobulated; and 11 streaky. Five recurrences were multifocal and eight were bifocal. Of 39 patients, 28 (71.8%) presented one recurrence within the MRI follow-up period (P = 0.006); in 10 patients (25.6%), up to three different configurations of recurring STS were identified in one patient. Recurrences of polycyclic/multilobulated primaries were mostly ovoid/nodular (48%; P = 0.003) or polycyclic/multilobulated (37%; P = 0.014), and recurring ovoid/nodular STS significantly most often showed the same configuration as the primary tumor (85%; P < 0.001). Primary STS with a streaky configuration recurred in all three configurations in roughly equal proportions. Homogeneity/heterogeneity and tumor borders are significantly associated with the configuration of recurrences. CONCLUSION: Primary STS configuration may help predict recurrent tumor configuration when the primary STS had a polycyclic/multilobulated or ovoid/nodular configuration. However, recurrent STS configuration can also differ from primary STS configuration, especially when the primary STS had a streaky configuration, rendering recurrent STS difficult to predict. Different configurations of recurrent STS in one and the same patient are common.

Distinct Behavior of Traumatic versus Nontraumatic Intracerebral Hematomas: Different Biology or Impact of Age?

BACKGROUND AND STUDY AIMS: Patients with large intracerebral hematomas (ICH) may demonstrate different demographics and underlying brain and systemic diseases, as well as different radiologic courses and distinct outcomes. It remains unclear whether their different behavior attributes to a different biology of the ICH or to the asymmetric characteristics of the two populations. To analyze and adjust for potential sources of selection and treatment bias, our study compared age-matched patients with traumatic and nontraumatic ICH in a single cohort diagnosed and treated in the same surgical department. MATERIAL AND METHODS: We analyzed 135 consecutive patients with traumatic (n = 90) or spontaneous ICH (n = 45) undergoing treatment at a surgical intensive care unit of an urban university hospital. We documented their differences before and after adjustment for age in terms of demographics, the therapies applied, their radiologic (i.e., volume and rate of ICH expansion [HE]) and clinical (patients' outcome at 30 days) course, the length of hospital and ICU stay, as well as the hospital costs. RESULTS: Patients with traumatic ICH demonstrated more favorable clinical and radiologic characteristics at admission, that is, higher Glasgow Coma Scale score (p < 0.001), less frequently dilated pupil (p = 0.028), lower Charlson Comorbidity Index (p < 0.001), smaller ICH volume (p < 0.001), noneloquent (p < 0.001) or nonintraventricular (p = 0.003) ICH locations, as well as underwent fewer neurosurgical interventions (p < 0.001) and showed a better outcome (p = 0.041), defined as Glasgow Outcome Scale 4 and 5. After adjustment for age, no different outcomes were observed. Of note, elderly patients on novel oral anticoagulants (NOACs) were more likely to develop an HE compared with those on vitamin K antagonists (VKAs, p = 0.05) after traumatic brain injury (TBI) but not after spontaneous ICH. CONCLUSION: Our data reveal a significant heterogeneity within the traumatic series. Whereas younger patients show an excellent outcome, the elderly population of the traumatic cases demonstrates a poor outcome similar to that of the nontraumatic cohort. HE under NOACs rather than under VKAs is more likely in the elderly after TBI. Larger prospective trials are warranted to elucidate the potential individual underlying molecular mechanisms for the development of an ICH and HE in these diseases.

Diagnostic value of MRI for detecting recurrent soft-tissue sarcoma in a long-term analysis at a multidisciplinary sarcoma center.

BACKGROUND: Soft-tissue sarcomas (STS) are rare tumors of the soft tissue. Recent diagnostic studies on STS mainly dealt with only few cases of STS and did not investigate the post-therapeutic performance of MRI in a routine clinical setting. Therefore, we assessed the long-term diagnostic accuracy of MRI for detecting recurrent STS at a multidisciplinary sarcoma center. METHODS: In all, 1055 postoperative follow-up MRIs of 204 patients were included in the study. MRI follow-up scans were systematically reviewed for diagnostic values (true-positive/-negative and false-positive/-negative results) in detecting recurrences. Pathological reports and follow-up MRIs were set as baseline references. RESULTS: The median age of the patients was 55.3 ± 18.2 years. Of the patients, 34.8% presented with recurrences. Here, 65 follow-up scans were true positive, 23 false positive, 6 false negative, and 961 true negative. The overall sensitivity and specificity of MRI for detecting recurrences were 92 and 98%, respectively, with an accuracy of 97%. For intramuscular lesions and after surgery alone the sensitivity was higher (95 and 97%, respectively) than for subcutaneous lesions and surgery with additional radiation therapy (83 and 86%, respectively), at similarly high specificities (96-98%). The 6 false-negative results were found in streaky (n = 2) and small ovoid/nodular (n = 4) recurring lesions. The false-positive lesions imitated streaky (n = 14), ovoid/nodular (n = 8), and polycyclic/multilobulated recurring tumors (n = 1). All false-positive results were found in patients in whom the primary tumors were polycyclic/multilobulated in appearance. CONCLUSION: MRI shows a high diagnostic accuracy for detecting recurrent STS, with a high sensitivity and specificity. The diagnostic accuracy decreases in subcutaneous lesions and after surgery with radiation therapy, compared to intramuscular lesions and surgery alone. Radiologists should pay particular attention to streaky and small ovoid/nodular recurring lesions and patients with polycyclic/multilobulated primary tumors.

Configuration of soft-tissue sarcoma on MRI correlates with grade of malignancy.

BACKGROUND: The aim of the study was to assess whether the configuration of primary soft-tissue sarcoma (STS) on MRI correlates with the grade of malignancy. PATIENTS AND METHODS: 71 patients with histologically proven STS were included. Primary STS were examined for configuration, borders, and volume on MRI. The tumors were divided into high-grade (G3), intermediate-grade (G2) and low-grade (G1) STS according to the grading system of the French Federation of Cancer Centers Sarcoma Group (FNCLCC). RESULTS: 30 high-grade, 22 intermediate-grade and 19 low-grade primary STS lesions were identified. High- and intermediate-grade (G3/2) STS significantly most often appeared as polycyclic/multilobulated tumors (p < 0.001 and p = 0.002, respectively). Low-grade (G1) STS mainly showed an ovoid/nodular or streaky configuration (p = 0.008), and well-defined borders. The appearance of high-, intermediate- and low-grade STS with an ovoid/nodular configuration were mainly the same on MRI. All streaky G3/2 sarcoma and 17 of 20 patients with polycyclic/multilobulated G3 sarcoma showed infiltrative borders. High-grade streaky and polycyclic/multilobulated STS are larger in volume, compared to intermediate- and low-grade STS. CONCLUSIONS: Configuration of STS on MRI can indicate the grade of malignancy. Higher-grade (G2/3) STS most often show a polycyclic/multilobulated configuration, while low-grade STS are mainly ovoid/nodular or streaky. Infiltrative behavior might suggest higher-grade STS in streaky and polycyclic/multilobulated STS.

Long-term diagnostic value of MRI in detecting recurrent aggressive fibromatosis at two multidisciplinary sarcoma centers.

PURPOSE: To assess the diagnostic accuracy of MRI in detecting recurrent aggressive fibromatosis (AF) during long-term follow-up at two multidisciplinary sarcoma centers. METHODS: Seventy-nine patients from two sarcoma centers were included in this IRB-approved study and were examined postoperatively using 1.5-T MRI. MRI follow-up scans were reviewed for true-positive/-negative and false-positive/-negative results. Available pathological reports and MRI follow-ups were set as reference. RESULTS: The median age of the patients was 38.1 ±â€¯15.3 years. Of the patients 27.9 % showed recurrent AF lesions. The most common localizations of AF were the axilla/shoulder (n = 15) and the thigh (n = 11). From 498 postoperative MRI follow-ups, 24 true-positive, 16 false-positive, 6 false-negative, and 452 true-negative MRI follow-ups were identified. The overall sensitivity and specificity for detecting recurrent AF was 80 % and 97 %, respectively. There was no significant difference in the diagnostic accuracy at the two sarcoma centers. All false-negative results were found in small lesions. False-positive results mostly mimicked streaky (n = 10) and small ovoid/nodular (n = 5) lesions. The configuration of recurrent AF was significantly most often fascicular (50 %; p = 0.001-0.005). CONCLUSION: MRI shows a high long-term diagnostic value in detecting AF recurrences. Nevertheless, radiologists should pay close attention when lesions are small, as they may remain undetected. Although the configuration of recurrent AF is most often fascicular, recurrences may also appear in different shapes.

Systematic analysis of post-treatment soft-tissue edema and seroma on MRI in 177 sarcoma patients.

PURPOSE: To assess post-treatment subcutaneous edema, muscle edema, and seroma in MRI after soft-tissue sarcoma (STS) resection with regard to muscle involvement of STS and therapy. METHODS: In all, 177 patients were included and received 1.5-T MRI follow-up examinations after treatment. Post-treatment changes were classified according to type of therapy (therapy 1-surgery; therapy 2-surgery with radiation therapy) and primary tumor localization in soft tissue (localization 1, subcutaneous tissue; localization 2, muscle involvement). Subcutaneous and muscle edema were divided into three grades: grade 0, absence of edema; grade 1, low-to-moderate edema; and grade 2, high-grade edema. RESULTS: The mean age of the patients was 55.7 ± 18.2 years and the mean volume of the resected primary STS was 321.5 cm3. After therapy 1 of a sarcoma in localization 1, patients significantly more often showed low-grade subcutaneous tissue edema and an absence of muscle edema (p < 0.001) than high-grade edema. The risk for grade 2 subcutaneous tissue and muscle edema significantly increased with a tumor in localization 2 (RR = 2.58, p = 0.016 and RR = 15, p = 0.0065/RR = 2.05 , p = 0.021, respectively) and after therapy 2 (RR = 15, p = 0.0087 and RR = 2.05, p < 0.0001, respectively). Of the patients with sarcoma in localization 2, 88% developed grade 2 muscle edema after therapy 2; 40% of the patients developed post-treatment seroma. The risk for seroma is significantly higher after surgery and radiation therapy than after surgery alone (p < 0.001). CONCLUSION: High-grade postoperative subcutaneous and muscle edema are significantly associated with muscle involvement of primary STS both in patients with and without radiation therapy. The risk for seroma is significantly higher after surgery with additional radiation therapy than after surgery alone.

Appearance of recurrent dermatofibrosarcoma protuberans in postoperative MRI follow-up.

PURPOSE: To analyze the appearance of recurrent dermatofibrosarcoma protuberans (DFSP) in postoperative MRI follow-up and to assess the occurrence of postoperative soft tissue changes detected in MRI. METHODS: A total of 464 MRI follow-up scans of 32 patients with histologically proven diagnosis of DFSP were analyzed. MR imaging was performed using a 1.5T MRI system. Recurrent DFSP was examined for signal intensity, contrast behavior, appearance, and extent in MRI. RESULTS: The mean age of the patients was 44,5±17,1 years. Recurrences of DFSP occurred 26±23.3 months after primary tumor resection in the mean (Min.: 9, Max.: 60). In 25% of the patients (n = 8), recurrences of DFSP were detected. Recurrent DFSP most often showed a nodular and homogeneous configuration with well-defined borders and marked contrast enhancement, and a hyperintense signal in PD-weighted and turbo inversion recovery magnitude sequences. All recurrences were well detected in the follow-up MRIs regardless of the performed plastic surgery procedure. Lateral and depth margins had no significant impact on the local recurrence rate. In all, 88% of the patients developed subcutaneous tissue edema (p < 0.01), followed by muscle edema (34%, p = 0.02), and postoperative seroma (22%). CONCLUSION: Recurrent DFSP mainly appear uniform and clearly delimitable on MRI as nodular, homogeneous, and well-defined lesions with marked contrast enhancement. Therefore, MRI is a valuable tool for postsurgical follow-up. Nearly all patients develop subcutaneous edema after the resection of DFSP.

Malignant peripheral nerve sheath tumours in magnetic resonance imaging: primary and recurrent tumour appearance, post-treatment changes, and metastases.

PURPOSE: To analyse the appearance of primary and recurrent malignant peripheral nerve sheath tumours (MPNSTs) in magnetic resonance imaging (MRI) with a focus on configuration, and to assess the occurrence of loco-regional post-treatment changes and metastases during post-treatment follow-up. MATERIAL AND METHODS: Twenty patients with histologically proven MPNST underwent post-treatment 1.5 T MRI. Primary and recurrent MPNSTs were examined for configuration, contrast enhancement, extent, and signal intensity in MRI. Loco-regional post-treatment changes and information on metastases were extracted from the follow-up. RESULTS: MPNSTs occurred most often in the extremities (p = 0.006). Twenty per cent (n = 4) of the patients developed recurrences, with a total of 24 lesions. Recurrent MPNSTs were significantly smaller than primary MPNSTs (p = 0.003). Primary MPNSTs mostly occurred unifocally as multilobulated or ovoid and heterogeneous lesions with mostly well-defined borders. Recurrent MPNSTs purely occurred multifocally as mostly nodular (p < 0.001), multilobulated, or ovoid lesions. 80%, 65% and 30% of the patients showed post-treatment subcutaneous oedema (p = 0.002 to 0.03), muscle oedema (p = 0.02), and seroma, respectively. Twenty-five per cent (n = 5) of patients presented metastases during follow-up. The relative risk in patients with recurrences to develop lung or lymph node metastases is eightfold (p = 0.056). CONCLUSIONS: While primary MPNSTs mostly appear unifocally as multilobulated or ovoid lesions, recurrent MPNSTs purely occur multifocally as mostly nodular lesions. Subcutaneous and muscle oedema are very common loco-regional post-treatment changes. Patients with recurrences have a higher risk for lung and lymph node metastases.

Configuration of Primary and Recurrent Aggressive Fibromatosis on Contrast-Enhanced MRI with an Evaluation of Potential Risk Factors for Recurrences in MRI Follow-Up.

PURPOSE: To analyze the appearance of primary and recurrent aggressive fibromatosis (AF) on MRI with a focus on configuration and to determine potential risk factors for recurrences detected on MRI follow-up scans. METHODS: From 79 consecutive patients with histologically proven diagnosis of AF, 39 patients underwent a minimum of four 1.5 T MRI follow-up scans after resection of primary AF between 2008 and 2018. The primary and recurrent tumors were radiographically examined for configuration, limitation and extent on MRI. Epidemiological data and loco-regional subcutaneous edema, muscle edema and post-operative seroma were included. RESULTS: The mean age of the patients was 39 ±â€Š2.6 years. Primary and recurrent AF most often occurred in the thigh. The main appearance of primary AF was significantly most often fascicular (p = 0.001-0.01) with heterogeneous and marked contrast enhancement. 21 % (n = 8) of the patients developed recurrences of AF. A fascicular configuration with homogeneous/heterogeneous contrast enhancement was the main appearance of recurrent AF, but recurrent AF appeared nodular, polycyclic, ovoid or streaky/flat as well. Recurrent AF significantly most often occurred within the first 9 months after primary tumor resection (p = 0.009), especially in patients up to 25 years of age (RR = 6.1; 95 % CI: 1.8-20.9; p = 0.004). The cases of recurrent AF were altogether significantly smaller than the primary tumors (p = 0.001). Post-treatment subcutaneous and muscle edema were present in 77 % and 56 %, respectively. Patients with muscle edema after primary tumor resection had a significantly higher risk for AF recurrences (relative risk ratio (RR) = 1.8; 95 % CI: 1.16-2.8; p = 0.0096). There was no significant difference detected in patients with complete or incomplete resection of the primary tumor. CONCLUSION: Primary and recurrent aggressive fibromatosis has a mostly fascicular configuration, but may appear ovoid, nodular, streaky/flat or polycyclic as well. High risks for tumor recurrences are detected for patients up to 25 years of age, patients within the first 9 post-operative months and patients with muscle edema after primary tumor resection. KEY POINTS: · Primary aggressive fibromatosis mostly has a fascicular configuration with heterogeneous contrast enhancement. · Recurrent aggressive fibromatosis usually has a fascicular configuration with heterogeneous/homogeneous contrast enhancement. · Patients within the first 9 post-operative months and up to 25 years of age have a significantly higher risk for recurrences. · Muscle edema after resection of primary aggressive fibromatosis is associated with a significantly higher risk for recurrences. CITATION FORMAT: · Sedaghat S, Surov A, Krohn S et al. Configuration of Primary and Recurrent Aggressive Fibromatosis on Contrast-Enhanced MRI with an Evaluation of Potential Risk Factors for Recurrences in MRI Follow-Up. Fortschr Röntgenstr 2020; 192: 448 - 457.

Endemic influences of political regimes, healthcare systems, and preferences on the frequencies and incidences of nephropathies in eastern Saxony, Germany
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INTRODUCTION: The possible confounding influence of investigator-related preferences, available histological techniques, and healthcare systems on the frequencies and incidences of primary and secondary nephropathies was evaluated in this long-term observation. MATERIALS AND METHODS: The observation time from 1983 to 2010 was divided in regard to the political regimes: a) prior to and after German reunification: German Democratic Republic (GDR, period 1 from 1983 to 1990)/Federal Republic of Germany (FRG, period 2 from 1990 to 2010); and the two heads of the division of nephrology, b) conductor 1 (1983 - 2006) and conductor 2 (2006 - 2010). 467 kidney biopsies at the University Hospital of Leipzig were included in our analysis. RESULTS: In period 1, due to the unavailability of immunofluorescence methods, mesangioproliferative glomerulonephritis (MesP) was the most dominating nephropathy. In period 2, IgA nephropathy (IgAN) was the most common nephropathy (17%). IgAN was followed by crescentic glomerulonephritis (13%), hypertensive nephropathy (10%), minimal-change disease, and membranous glomerulonephritis (each 9%). From period 1 to period 2, MesP/IgAN (62% to 16%), membranoproliferative glomerulonephritis and postinfectious glomerulonephritis decreased significantly (p < 0.05). IgAN decreased significantly (p < 0.05) from conductor 1 to conductor 2 (21% to 6%), while diabetic nephropathy significantly increased. Focal-segmental glomerulosclerosis (FSGS) had the highest incidence rate with 1.0, followed by IgAN with 0.8 (per 100,000 per year). CONCLUSION: In a nearly ethnically identical cohort, we have demonstrated that confounding factors, e.g., healthcare systems and preferences of conductors, have a strong influence - more than 10-fold variance - on frequency and incidence on the spectrum of nephropathies.
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