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Appropriateness Criteria

Reference Study Type Patients/Events Study Objective(Purpose of Study) Study Results Study Quality
1. Roland CL. Soft Tissue Tumors of the Extremity. [Review]. Surg Clin North Am. 100(3):669-680, 2020 Jun. Review/Other-Dx N/A To focuses on the optimal workup of soft tissue masses including the indications for ultrasound and MRI, as well as use of preoperative core needle biopsy. No results state din the abstract. 4
2. Rochwerger A, Mattei JC. Management of soft tissue tumors of the musculoskeletal system. [Review]. Orthop Traumatol Surg Res. 104(1S):S9-S17, 2018 02. Review/Other-Dx N/A To discuss the management of soft tissue tumors of the musculoskeletal system. No results stated in the abstract. 4
3. Murphey MD, Kransdorf MJ. Staging and Classification of Primary Musculoskeletal Bone and Soft-Tissue Tumors According to the 2020 WHO Update, From the AJR Special Series on Cancer Staging. AJR Am J Roentgenol. 217(5):1038-1052, 2021 11. Review/Other-Dx N/A To discuss the WHO updated the classification of primary musculoskeletal tumors of soft tissue and bone No results stated in the abstract. 4
4. Roberts CC, Kransdorf MJ, Beaman FD, et al. ACR Appropriateness Criteria Follow-Up of Malignant or Aggressive Musculoskeletal Tumors. J. Am. Coll. Radiol.. 13(4):389-400, 2016 Apr. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for follow-up of malignant or aggressive musculoskeletal tumors. No results stated in abstract. 4
5. Fletcher C, Mertens F. The WHO Classification of Tumours Editorial Board. WHO Classification of Tumours. Soft Tissue and Bone Tumours. 5th ed: Lyon: IARC Press; 2020. Review/Other-Dx N/A To discuss the WHO Classification of Tumours. No results stated in the abstract. 4
6. Mankin HJ, Lange TA, Spanier SS. The hazards of biopsy in patients with malignant primary bone and soft-tissue tumors. J Bone Joint Surg Am. 1982;64(8):1121-1127. Review/Other-Dx 329 patients To describe the frequency with which problems with biopsy occur and the impact of these problems on the patient's course and ultimate outcome; And to offer some suggestions to physicians who care for such patients, to aid them in avoiding the hazards inherent in the biopsy procedure. Sixty (18.2 per cent) major errors in diagnosis and thirty four ( 10.3 per cent) non-representative or technically poor biopsies. Problems arose in the skin, soft tissue, or bone of the biopsy wounds of fifty-seven patients (17.3 per cent), and the optimum treatment plan had to be altered as a result of problems related to the biopsy in sixty patients (18.2 per cent). In fifteen patients (4.5 per cent) an unnecessary amputation was performed as a result of problems with the biopsy, and in twenty eight patients (8.5 per cent) the prognosis and outcome were considered to have been adversely affected. 4
7. Mankin HJ, Mankin CJ, Simon MA. The hazards of the biopsy, revisited. Members of the Musculoskeletal Tumor Society. J Bone Joint Surg Am. 1996;78(5):656-663. Review/Other-Dx 632 patients To re-examine the hazards of biopsies of connective-tissue tumors. The results were essentially the same as those in the earlier study. The rate of diagnostic error for the total series (in which cases from referring institutions and treatment centers were combined) was 17.8 percent. There was no significant difference in the rate of patients for whom a problem with the biopsy forced the surgeon to carry out a different and often more complex operation or to use adjunctive irradiation or chemotherapy (19.3 percent in the current study, compared with 18 percent in the previous one). There was also no significant differences in the percentage of patients who had a change in the outcome, such as the need for a more complex resection that resulted in disability, loss of function, local recurrence, or death, attributable to problems related to the biopsy (10.1 percent in the current study, compared with 8.5 percent in the 1982 study). Eighteen patients in the current study had an unnecessary amputation as a result of the biopsy, compared with fifteen in the previous study. Errors, complications, and changes in the course and outcome were two to twelve times greater (p < 0.001) when the biopsy was done in a referring institution instead of in a treatment center. 4
8. Lazarides AL, Kerr DL, Nussbaum DP, et al. Soft Tissue Sarcoma of the Extremities: What Is the Value of Treating at High-volume Centers? Clin Orthop Relat Res 2019;477:718-27. Review/Other-Dx 25406 To examine the association between facility volume and overall survival in patients with soft tissue sarcoma of the extremities.- 1) examine differences in the treatment characteristics of high- and low-volume facilities; (2) estimate the 5-year survival by facility volume; and (3) examine the association between facility volume and of traveling a further distance to a high-volume center and overall survival when controlling for confounding factors. When controlling for patient, tumor, and treatment characteristics in a multivariate proportional hazards analysis, patients treated at high-volume facilities had an overall lower risk of mortality than those treated at low-volume centers (hazard ratio, 0.81 [0.75-0.88], p < 0.001). Patients treated at high-volume centers were also less likely to have positive margins (odds ratio [OR], 0.59 [0.52-0.68], p < 0.001) and in patients who received radiation, those treated at high-volume centers were more likely to have radiation before surgery (40.5% versus 21.7%, p < 0.001); there was no difference in the type of surgery performed (resection versus amputation) (OR, 1.01 [0.84-1.23], p = 0.883). 4
9. Casali PG, Abecassis N, Aro HT, et al. Soft tissue and visceral sarcomas: ESMO-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 29(Suppl 4):iv51-iv67, 2018 10 01. Review/Other-Dx N/A To discuss the review of Soft tissue and visceral sarcomas. No results stated in the abstract. 4
10. Gartner L, Pearce CJ, Saifuddin A. The role of the plain radiograph in the characterisation of soft tissue tumours. Skeletal Radiol. 2009;38(6):549-558. Observational-Dx 1,058 patients To present the radiographic findings of a large series of soft tissue tumours referred to a specialist orthopaedic oncology service over a period of 8 years, highlighting the radiographic features. Of the cohort of 1,058 individuals with a proven soft tissue tumour, 454 had had a radiograph taken of the affected area. Of these, 281 (62%) patients had a positive radiographic finding. The most common findings were a visible soft tissue mass (n = 141), the presence of calcification (n = 76), fat (n = 32) and evidence of bone involvement (n = 62). More than one finding was sometimes present in the same patient. These findings were present in both benign and malignant tumours. 4
11. Kransdorf MJ, Murphey MD. Imaging of Soft-Tissue Musculoskeletal Masses: Fundamental Concepts. [Review]. Radiographics. 36(6):1931-1948, 2016 Oct. Review/Other-Dx N/A To address application of the current imaging methods to assessment of soft-tissue musculoskeletal masses, emphasizing fundamental concepts. No results stated in abstract. 4
12. Aparisi Gomez MP, Errani C, Lalam R, et al. The Role of Ultrasound in the Diagnosis of Soft Tissue Tumors. [Review]. Semin Musculoskelet Radiol. 24(2):135-155, 2020 Apr. Review/Other-Dx N/A To describe and illustrate the lesions with typical (diagnostic) US features. No results state din the abstract. 4
13. Wagner JM, Rebik K, Spicer PJ. Ultrasound of Soft Tissue Masses and Fluid Collections. [Review]. Radiol Clin North Am. 57(3):657-669, 2019 May. Review/Other-Dx N/A To provide provides an image-rich review of the sonographic features of common soft tissue masses, with emphasis on practical tips to accurately recognize important pathology. No results stated in the abstract, 4
14. Gruber L, Gruber H, Luger AK, Glodny B, Henninger B, Loizides A. Diagnostic hierarchy of radiological features in soft tissue tumours and proposition of a simple diagnostic algorithm to estimate malignant potential of an unknown mass. Eur J Radiol. 95:102-110, 2017 Oct. Observational-Dx Imaging features in 260 cases of STMs To quantify the diagnostic utility of imaging features in soft tissue masses (STMs) and to provide a ranked list of predictors for malignancy. The most predictive features (NV/OR in parentheses) were heterogeneous contrast-enhancement in ultrasound (297.9/15.1) and MRI (197.3/11.9), lesion roundness (209.8/5.5), diffusion restriction (175.8/9.3), cystic/necrotic intralesional areas (167.1/8.3), higher patient age (159.0/2.6), surrounding oedema (155.4/6.5) and intralesional Doppler hypervascularity (134.4/5.1). A simple 8-item checklist was highly predictive of malignancy in cases with at least 75% positive features (0.90 area under the ROC curve, 87.0% sensitivity, 84.5% specificity, 59.5% positive and 96.1% negative predictive value, 36.5 odds ratio) even in cases with only partial feature availability. 3
15. Jacobson JA, Middleton WD, Allison SJ, et al. Ultrasonography of Superficial Soft-Tissue Masses: Society of Radiologists in Ultrasound Consensus Conference Statement. [Review]. Radiology. 211101, 2022 Apr 12. Review/Other-Dx N/A To arrive at a consensus regarding the management of superficial soft-tissue masses imaged with US. No results stated in abstract. 4
16. Hung EHY, Griffith JF, Yip SWY, et al. Accuracy of ultrasound in the characterization of superficial soft tissue tumors: a prospective study. Skeletal Radiol. 49(6):883-892, 2020 Jun. Observational-Dx 823 patients To prospectively evaluate the accuracy of ultrasound in defining the specific nature of superficial soft tissue masses as well as determining malignancy. Histological correlation was present for 219 (26.6%) of the 823 masses. Compared with histology, the accuracy of clinical and ultrasound examination for determining specific tumor type was 25.6% and 81.2% respectively considering all differential diagnoses provided. Radiologists were "fully confident" with the ultrasound diagnosis in 585 (71.1%) of 823 masses overall. In this setting, when compared with histology, the diagnostic accuracy of ultrasound was 95.5%. When the radiologist was "not fully confident," accuracy was 41.3% for the first differential diagnosis and 60.9% for all differential diagnoses. Diagnostic accuracy improved with increasing radiologist experience. Sensitivity, specificity, positive predictive value, and negative predictive value of ultrasound for identifying malignant tumor were 93.3%, 97.9%, 45.2%, and 99.9% respectively. 2
17. Hung EH, Griffith JF, Ng AW, Lee RK, Lau DT, Leung JC. Ultrasound of musculoskeletal soft-tissue tumors superficial to the investing fascia. AJR Am J Roentgenol. 202(6):W532-40, 2014 Jun. Observational-Dx 714 ultrasound examinations including 247 tumors with a pathologic diagnosis. To evaluate the diagnostic accuracy of ultrasound in assessing musculoskeletal soft-tissue tumors superficial to the investing fascia. Overall the accuracy of ultrasound examination for assessing superficial soft-tissue masses was 79.0% when all differential diagnoses were considered and 77.0% when only the first differential diagnosis was considered. The sensitivity and specificity of the first ultrasound diagnosis were 95.2% and 94.3%, respectively, for lipoma; 73.0% and 97.7% for vascular malformation; 80.0% and 95.4% for epidermoid cyst; and 68.8% and 95.2% for nerve sheath tumor. Reduced observer awareness of specific tumor entities tended to contribute to underdiagnosis more than poor specificity of ultrasound findings. Most tumors (236/247, 96%) were benign. The sensitivity and specificity of ultrasound for identifying malignant superficial soft-tissue tumors was 94.1% and 99.7%, respectively. 3
18. Goldman LH, Perronne L, Alaia EF, et al. Does Magnetic Resonance Imaging After Diagnostic Ultrasound for Soft Tissue Masses Change Clinical Management? J Ultrasound Med 2021;40:1515-22. Observational-Dx 92 patients To evaluate whether a follow-up magnetic resonance imaging (MRI) scan performed after initial ultrasound (US) to evaluate soft tissue mass (STM) lesions of the musculoskeletal system provides additional radiologic diagnostic information and alters clinical management Ninety-two patients underwent MRI after US for STM evaluations. Final pathologic results were available in 42 cases. Samples were obtained by surgical excision or open biopsy (n = 34) or US-guided core biopsy (n = 8). The most common pathologic diagnoses were nerve sheath tumors (n = 9), lipomas (n = 5), and leiomyomas (n = 5). Imaging review showed that the subsequent MRI did not change the working diagnosis in 73% of cases, and the subsequent MRI was not considered to narrow the differential diagnosis in 68% of cases. There was slight inter-reader agreement for the diagnostic utility of MRI among individual cases (? = 0.10) between the 3 readers. 2
19. Carra BJ, Bui-Mansfield LT, O'Brien SD, Chen DC. Sonography of musculoskeletal soft-tissue masses: techniques, pearls, and pitfalls. [Review]. AJR Am J Roentgenol. 202(6):1281-90, 2014 Jun. Review/Other-Dx N/A To review the appropriate use of ultrasound in the workup of soft-tissue masses of the extremities. No results stated in abstract. 4
20. De Marchi A, Prever EBD, Cavallo F, et al. Perfusion pattern and time of vascularisation with CEUS increase accuracy in differentiating between benign and malignant tumours in 216 musculoskeletal soft tissue masses. Eur J Radiol. 84(1):142-150, 2015 Jan. Observational-Dx 216 patienst To hypothesised that perfusion patterns and vascularisation time could improve the accuracy of Contrast Enhanced Ultrasound (CEUS) in discriminating malignant tumours from benign lesions. CEUS pattern 6 (inhomogeneous perfusion), arterial uptake and location in the lower limb were associated with high risk of malignancy. CEUS pattern has PPV 77%, rapidity of vascularisation PPV 69%; location in the limbs is the most sensitive indicator, but NPV 52%, PPV 65%. The combination of CEUS-pattern and vascularisation has 74% PPV, 60% NPV, 70% sensitivity. No correlation with size and location in relation to the deep fascia was found. 2
21. Gruber L, Loizides A, Luger AK, et al. Soft-Tissue Tumor Contrast Enhancement Patterns: Diagnostic Value and Comparison Between Ultrasound and MRI. AJR Am J Roentgenol. 208(2):393-401, 2017 Feb. Observational-Dx 255 patients To assess and compare contrast-enhanced ultrasound and MRI patterns in the diagnosis of soft-tissue masses. Homogeneous CE patterns were highly specific for benignity, and inhomogeneous CE was moderately specific for malignancy in both ultrasound and MRI. A combination of homogeneous and inhomogeneous CE patterns led to 88.3% and 88.7% sensitivity, 66.7% and 59.7% specificity, 73.4% and 68.2% correct classification, 54.6% and 47.8% positive predictive value, 92.6% and 92.7% negative predictive value, 2.65 and 2.20 positive likelihood ratio, and 0.18 and 0.19 negative likelihood ratio for contrast-enhanced ultrasound and contrast-enhanced MRI. Cases with homogeneous CE in either ultrasound or MRI also were predominantly benign. The occurrence of inhomogeneous CE in malignant lesions increased with size. 2
22. Loizides A, Peer S, Plaikner M, Djurdjevic T, Gruber H. Perfusion pattern of musculoskeletal masses using contrast-enhanced ultrasound: a helpful tool for characterisation? Eur Radiol 2012;22:1803-11. Review/Other-Dx 54 patients To report 54 patients with histologically evaluated musculoskeletal masses who underwent grey-scale and contrast-enhanced ultrasound (CEUS), followed by ultrasound-guided biopsy. To hypothesise that the definition of a CEUS-based enhancement pattern improves the characterisation of tumour malignancy. The single event probability for malignancy was 0% for the P1 and P4 perfusion patterns, and 60% for P2 and 80% for P3. The best combined sensitivity (89%) and specificity (85%) was achieved in a "three-feature combination" of size >3.3 cm, mass location below the superficial fascia and either P2 or P3 perfusion pattern with a PPV of 86% and NPV of 88%. 4
23. Manaster BJ.. Soft-tissue masses: optimal imaging protocol and reporting. [Review]. AJR Am J Roentgenol. 201(3):505-14, 2013 Sep. Review/Other-Dx N/A To discuss optimal imaging protocols and reporting of soft-tissue masses. No results stated in abstract. 4
24. von Mehren M, Randall RL, Benjamin RS, et al. Soft Tissue Sarcoma, Version 2.2018, NCCN Clinical Practice Guidelines in Oncology. J. Natl. Compr. Cancer Netw.. 16(5):536-563, 2018 05. Review/Other-Dx N/A To address the management of soft tissue sarcoma in adults. No results stated in abstract. 4
25. Sherman CE, O'Connor MI. Musculoskeletal tumor imaging: an orthopedic oncologist perspective. [Review]. Semin Musculoskelet Radiol. 17(2):221-6, 2013 Apr. Review/Other-Dx N/A To discuss an orthopedic oncologist perspective on musculoskeletal tumor imaging. No results stated in the abstract. 4
26. Wilke BK, Goulding KA, Sherman CE, Houdek MT. Soft Tissue Tumors: Diagnosis, Treatment, and Follow-up from the Orthopedic Oncologist Perspective. Radiol Clin North Am 2022;60:253-62. Review/Other-Tx N/A To present the information that is critical in the decision-making process for orthopedic oncologists to help facilitate a multidisciplinary approach to dealing with these rare mesenchymal tumors. No results stated in abstract. 4
27. Lakkaraju A, Sinha R, Garikipati R, Edward S, Robinson P. Ultrasound for initial evaluation and triage of clinically suspicious soft-tissue masses. Clin Radiol. 64(6):615-21, 2009 Jun. Observational-Dx 358 consecutive patients To evaluate the efficacy of ultrasound as a first-line investigation in patients with a clinical soft-tissue mass. Two hundred and eighty-four of the 358 (79%) lesions were classified as benign (categories 1-5). On follow-up 15 of the 284 patients were re-referred but none (284/284) had a malignancy on follow-up (24-30 months). Overall at ultrasound 33 lesions were larger than 5 cm, 42 lesions were deep to deep fascia with 20 showing both features. In this subgroup of 95 patients there were six malignant tumours with the rest benign. Seventy-three of the 358 patients underwent MRI; the results of which indicated that there were 60 benign or non-tumours, 10 possible sarcomas, and three indeterminate lesions. Overall six of 12 (6/358, 1.68% of total patients) lesions deemed to represent possible sarcomas on imaging were sarcomas. Ultrasound is an effective diagnostic triage tool for the evaluation of soft-tissue masses referred from primary care. 3
28. Griffith JF, Yip SWY, Hung EHY, et al. Accuracy of ultrasound in the characterisation of deep soft tissue masses: a prospective study. Eur Radiol. 30(11):5894-5903, 2020 Nov. Observational-Dx 137 patients To investigate the accuracy of ultrasound in characterising the type of mass and likelihood of malignancy in deep soft tissue masses. Compared with histology, clinical and ultrasound accuracy for characterising the type of mass were 47% and 88% respectively when all differential diagnoses were considered. The radiologist was fully confident regarding the type of 436 (75%) of 579 masses and, in this setting, for those cases that could be compared with histology, diagnostic accuracy was 96%. For the remaining masses, where the radiologist was not fully confident, accuracy compared with histology was 58% for the first differential diagnosis and 80% for all differential diagnoses. For identifying malignancy, sensitivity, specificity, and positive and negative predictive value of ultrasound were 97%, 58%, 67%, and 99% respectively. Ultrasound alone was considered sufficient for diagnostic workup in over half of all deep soft tissue masses. 2
29. Mayerson JL, Scharschmidt TJ, Lewis VO, Morris CD. Diagnosis and Management of Soft-tissue Masses. J Am Acad Orthop Surg 2014;22:742-50. Review/Other-Dx N/A To discuss the Diagnosis and Management of Soft-tissue Masses No results stated in the abstract. 4
30. Subhawong TK, Fishman EK, Swart JE, Carrino JA, Attar S, Fayad LM. Soft-tissue masses and masslike conditions: what does CT add to diagnosis and management? AJR Am J Roentgenol. 2010;194(6):1559-1567. Review/Other-Dx N/A This article provides an overview of the CT evaluation of soft-tissue masses, emphasizing a differential diagnosis based on these CT features. No results stated in abstract. 4
31. Holz JA, Alkadhi H, Laukamp KR, et al. Quantitative accuracy of virtual non-contrast images derived from spectral detector computed tomography: an abdominal phantom study. Sci Rep 2020;10:21575. Review/Other-Dx N/A To  investigate the quantitative accuracy of VNC attenuation images considering different parameters for acquisition and reconstruction. Conventional and VNC images were reconstructed and analyzed based on regions of interest (ROI). Mean and standard deviation were recorded and differences in attenuation between corresponding base materials and VNC was calculated (VNCerror). Statistic analysis included ANOVA, Wilcoxon test and multivariate regression analysis. Overall, the VNCerror was - 1.4 ± 6.1 HU. While radiation dose, kernel setting, and denoising level did not influence VNCerror significantly, phantom size, iodine content and base material had a significant effect (e.g. S vs. M: - 1.2 ± 4.9 HU vs. - 2.1 ± 6.0 HU; 0.0 mg/ml vs. 5.0 mg/ml: - 4.0 ± 3.5 HU vs. 5.1 ± 5.0 HU and 35-HU-base vs. 54-HU-base: - 3.5 ± 4.4 HU vs. 0.7 ± 6.5; all p = 0.05). The overall accuracy of VNC images from SDCT is high and independent from dose, kernel, and denoising settings; however, shows a dependency on patient size, base material, and iodine content; particularly the latter results in small, yet, noticeable differences in VNC attenuation. 4
32. Panicek DM, Gatsonis C, Rosenthal DI, et al. CT and MR imaging in the local staging of primary malignant musculoskeletal neoplasms: Report of the Radiology Diagnostic Oncology Group. Radiology. 1997;202(1):237-246. Experimental-Dx 316 patients To assess the relative accuracies of CT and MRI in the local staging of primary malignant bone and soft-tissue tumors. The CT images were obtained with and without contrast. No contrast was used in the MR images. There was no statistically significant difference between CT and MRI in determining tumor involvement of muscle, bone, joints, or neurovascular structures. The combined interpretation of CT and MRI did not statistically significantly improve accuracy. Inter-reader variability was similar for both modalities. 2
33. van Rijswijk CS, Geirnaerdt MJ, Hogendoorn PC, et al. Soft-tissue tumors: value of static and dynamic gadopentetate dimeglumine-enhanced MR imaging in prediction of malignancy. Radiology. 2004; 233(2):493-502. Observational-Dx 140 consecutive patients To prospectively evaluate static and dynamic contrast enhanced MRI relative to non-enhanced MRI in differentiation of benign from malignant soft-tissue lesions and to evaluate which MRI parameters are most predictive of malignancy. Static and dynamic contrast-enhanced MRI improved differentiation of benign and malignant soft-tissue masses compared to non-contrast MRI. 1
34. Boruah DK, Gogoi B, Patni RS, Sarma K, Hazarika K. Added Value of Diffusion-Weighted Magnetic Resonance Imaging in Differentiating Musculoskeletal Tumors Using Sensitivity and Specificity: A Retrospective Study and Review of Literature. Cureus 2021;13:e12422. Observational-Dx 73 patients To evaluate the diagnostic efficacies of diffusion-weighted imaging along with the conventional MRI sequences for differentiating benign and malignant musculoskeletal tumors using sensitivity and specificity. Of 73 patients with musculoskeletal tumors (benign=20, malignant = 53), 47 patients were bone tumors (benign=12, malignant=35) and 26 patients were soft tissue tumors (benign=eight, malignant=18). Mean ADC value of benign bone tumor was 1.257±0.327[SD] x 10-3mm2/s and malignant was 0.951 ± 0.177[SD] x 10-3mm2/s. The mean ADC value of benign soft tissue tumor was 1.603±0.444[SD] x 10-3mm2/s and malignant was 1.036 ± 0.186[SD] x 10-3mm2/s. The cut-off mean ADC value was 1.058 x 10-3mm2/s for differentiating benign from malignant bone tumor with a sensitivity of 83.3%, specificity of 66.7% and accuracy of 78.7% while the cut-off mean ADC value of 1.198 x 10-3mm2/s for differentiating benign from malignant soft tissue tumors with a sensitivity of 83.3%, specificity of 87.5% and accuracy of 84.6%. 2
35. Choi YJ, Lee IS, Song YS, Kim JI, Choi KU, Song JW. Diagnostic performance of diffusion-weighted (DWI) and dynamic contrast-enhanced (DCE) MRI for the differentiation of benign from malignant soft-tissue tumors. J Magn Reson Imaging. 50(3):798-809, 2019 09. Observational-Dx 73 patients To evaluate the diagnostic efficacies of DWI and DCE MRI for the differentiation of malignant and benign soft-tissue tumors. Seventy-three cases were malignant and 63 benign. Age (mean ages of benign/malignant tumors, 51.75/61.86 years; P = 0.0002) and gender (F:M = 40:23 [benign], F:M = 28:45 [malignant], P = 0.003) influenced the distinction between benign and malignant. Sizes, margins, neurovascular bundle involvement, peritumoral edema, and heterogeneity of the tumors on conventional MR images and DCE parameters (Ktrans , Kep , Ve , and iAUC, and TCC plots) obtained from focal region of interest within a narrow volume of interest significantly differentiated benign and malignant lesions (all P < 0.0001, except Ve [P = 0.0004]). For DWI with ADC mapping, all ADC values and visually signal drops were also significant (P < 0.0001). 2
36. Lee JH, Kim HS, Yoon YC, et al. Characterization of small, deeply located soft-tissue tumors: Conventional magnetic resonance imaging features and apparent diffusion coefficient for differentiation between non-malignancy and malignancy. PLoS One 2020;15:e0232622. Observational-Dx 95 patients To compare magnetic resonance imaging (MRI) parameters of small, deeply located non-malignant and malignant soft-tissue tumors (STTs). Interobserver agreement on ADC measurement was almost perfect. On univariable analysis, the malignant group showed a significantly larger size, lower ADC, and higher incidence of all qualitative MRI parameters for all STTs. Size (p = 0.012, odds ratio [OR] 2.57), ADC (p = 0.041, OR 3.85), and the tail sign (p = 0.009, OR 6.47) were independently significant on multivariable analysis. For non-myxoid, non-hemosiderin STTs, age, size, ADC, frequency of infiltration, lobulation, and the tail sign showed significant differences between non-malignancy and malignancy on univariable analysis. Only ADC (p = 0.032, OR 142.86) retained its independence on multivariable analysis. For myxoid STTs, only size and tail sign were significant on univariable analysis without independent significance. 2
37. Lee SK, Jee WH, Jung CK, Chung YG. Multiparametric quantitative analysis of tumor perfusion and diffusion with 3T MRI: differentiation between benign and malignant soft tissue tumors. Br J Radiol. 93(1115):20191035, 2020 Nov 01. Observational-Dx 67 patients To evaluate multiparametric MRI for differentiating benign and malignant soft tissue tumors. ADC and D were significantly lower in malignant than benign soft tissue tumors (1170 ± 488 vs 1472 ± 349 µm2/s; 1132 ± 500 vs 1415 ± 374 µm2/s; p < 0.05). Ktrans, Kep, Ve, and iAUC were significantly different between malignant and benign soft tissue tumors (0.209 ± 0.160 vs 0.092 ± 0.067 min-1; 0.737 ± 0.488 vs 0.311 ± 0.230 min-1; 0.32 ± 0.17 vs 0.44 ± 0.28; 0.23 ± 0.14 vs 0.12 ± 0.09, p < 0.05, respectively). ADC (0.752), D (0.742), and Kep (0.817) had high AUCs. Subgroup analysis showed that only Ktrans, and iAUC were significantly different in myxoid tumors, while, ADC, D, Ktrans, Kep, and iAUC were significantly different in non-myxoid tumor for differentiating benign and malignant tumors. D, Kep, and iAUC were the most significant parameters predicting malignant soft tissue tumors. 2
38. Bruno F, Arrigoni F, Mariani S, et al. Advanced magnetic resonance imaging (MRI) of soft tissue tumors: techniques and applications. [Review]. Radiol Med (Torino). 124(4):243-252, 2019 Apr. Review/Other-Dx N/A To review the state of the art of these advanced MRI techniques, with focus on their technique and clinical application. No results stated in the abstract. 4
39. Dodin G, Salleron J, Jendoubi S, et al. Added-value of advanced magnetic resonance imaging to conventional morphologic analysis for the differentiation between benign and malignant non-fatty soft-tissue tumors. Eur Radiol. 31(3):1536-1547, 2021 Mar. Observational-Dx 288 patients To evaluate the added value of DWI, qualitative proton MR spectroscopy (H-MRS) and dynamic contrast-enhanced perfusion (DCE-P) to conventional MRI in differentiating benign and malignant non-fatty soft tissue tumors (NFSTT). There were 104 (36.1%) malignant and 184 (63.9%) benign tumors. Conventional MRI analysis classified 99 tumors for R1 and 135 for R2 as benign or malignant, an accuracy for the identification of malignancy of 87.9% for R1 and 83.7% for R2, respectively. There were 189 indeterminate tumors for R1. For these tumors, the combination of DWI and H-MRS yielded the best accuracy for malignancy identification (77.4%). DWI alone provided the best sensitivity (91.8%) while the combination of DCE-P, DWI, and H-MRS yielded the best specificity (100%). The reproducibility of the advanced imaging parameters was considered good to excellent (Kappa and ICC > 0.86). An advanced MRI evidence-based evaluation algorithm was proposed allowing to characterize 28.1 to 30.1% of indeterminate non-myxoid tumors. 2
40. Saifuddin A, Siddiqui S, Pressney I, Khoo M. The incidence and diagnostic relevance of chemical shift artefact in the magnetic resonance imaging characterisation of superficial soft tissue masses. Br J Radiol. 93(1108):20190828, 2020 Apr. Observational-Dx 128 patients To determine the incidence and diagnostic relevance of CSA in a consecutive series of superficial soft tissue masses referred to a specialist musculoskeletal sarcoma service. 128 patients fulfilled the inclusion criteria [63 males, 65 females; mean age = 50.6 years (7-96 years)]. CSA was present in 50 cases (39.1%) overall, but in 39 (41.5%) of 94 cases with histological diagnosis. There was no statistically significant relationship to any assessed variable apart from relationship to the deep fascia, CSA being more frequent in lesions contacting the fascia compared to lesions contacting both skin and fascia (p-value 0.02). In particular, the presence of CSA did not allow differentiation between non-malignant and malignant lesions. 2
41. Pezeshk P, Alian A, Chhabra A. Role of chemical shift and Dixon based techniques in musculoskeletal MR imaging. Eur J Radiol 2017;94:93-100. Review/Other-Dx N/A To review the various options for fat suppression and present focused discussion of the role of CSI and Dixon techniques for musculoskeletal MR imaging. No results stated in the abstract. 4
42. Valenzuela RF, Madewell JE, Kundra V, Costelloe CM. 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. Semin Ultrasound CT MR 2021;42:215-27. Review/Other-Dx N/A To discuss that functional imaging can add valuable information to conventional imaging in the settings of tumor characterization and treatment response assessment. To discuss 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 No results stated in the abstract. 4
43. Bischoff M, Bischoff G, Buck A, et al. Integrated FDG-PET-CT: its role in the assessment of bone and soft tissue tumors. Arch Orthop Trauma Surg. 130(7):819-27, 2010 Jul. Observational-Dx 80 patients To evaluate prospectively, whether integrated 2-deoxy-2-[(18)F]fluoro-D: -glucose positron emission tomography-computed tomography (FDG-PET-CT) is more accurate for determination musculoskeletal tumors compared with separate interpretation of CT and FDG-PET, because most of the current clinical data come from patients studied with PET. Assuming that equivocal lesions are benign, performance of diagnostic tests was as follows: sensitivity, specificity and accuracy for CT alone was 81, 84, 83%, for PET 71, 82, 76, and for PET-CT 80, 83 and 86%. Assuming that equivocal lesions are malignant, sensitivity, specificity, and accuracy for CT was 61, 100, 70%, for PET 69, 100, 79, and for PET-CT 69, 100 and 79%. Combined FDG-PET-CT reliably differentiates soft tissue and bone tumors from benign lesions. The value of the information provided by FDG-PET-CT for planning surgical procedures must be evaluated in further studies. 3
44. Shin DS, Shon OJ, Han DS, Choi JH, Chun KA, Cho IH. The clinical efficacy of (18)F-FDG-PET/CT in benign and malignant musculoskeletal tumors. Ann Nucl Med. 22(7):603-9, 2008 Aug. Observational-Dx 91 patients To analyze the clinical efficacy of FDG-PET/CT in a relatively large group of patients with musculoskeletal tumors. Final diagnosis revealed 19 benign soft tissue tumors (mean SUV(max) 4.7), 27 benign bone tumors (5.1), 25 malignant soft tissue tumors (8.8), and 20 malignant bone tumors (10.8). There was a significant difference in SUV(max) between benign and malignant musculoskeletal tumors in total (P<0.002), soft tissue tumors (P<0.05), and bone tumors (P<0.02). Sensitivity, specificity, and diagnostic accuracy were 80%, 65.2%, and 73% in total with cutoff SUV(max) 3.8, 80%, 68.4%, and 75% in the soft tissue tumors with cutoff SUV(max) 3.8, and 80%, 63%, and 70% in the bone tumors with cutoff SUV(max) 3.7. 3
45. Chen B, Feng H, Xie J, Li C, Zhang Y, Wang S. Differentiation of soft tissue and bone sarcomas from benign lesions utilizing 18F-FDG PET/CT-derived parameters. BMC Medical Imaging. 20(1):85, 2020 07 25. Observational-Dx 7 patients To evaluate the usefulness of 18F-fluorodeoxyglucose (18F-FDG) PET/CT-derived parameters to differentiate soft tissue sarcoma (STS) and bone sarcoma (BS) from benign lesions. Univariate analysis results revealed that tumor size, SUVmax, MTV, TLG, and HF of 18F-FDG PET/CT imaging in the STS and BS group were all higher than in the benign lesions group (all P values were < 0.01). The differences in the visual characteristics between the two groups were also all statistically significant (P < 0.05). However, the multivariate regression model only included SUVmax and HF as independent risk factors, for which the odds ratios were 1.135 (95%CI: 1.026 ~ 1.256, P = 0.014) and 7.869 (95%CI: 2.119 ~ 29.230, P = 0.002), respectively. The regression model was constructed using the following expression: Logit (P) = - 2.461 + 0.127SUVmax + 2.063HF. The area under the ROC was 0.860, which was higher than SUVmax (0.744) and HF (0.790). The diagnostic performance of the regression model was superior to those of individual parameters and conventional imaging. 2
46. Benz MR, Dry SM, Eilber FC, et al. Correlation between glycolytic phenotype and tumor grade in soft-tissue sarcomas by 18F-FDG PET. J Nucl Med. 2010; 51(8):1174-1181. Observational-Dx 102 patients To evaluate the correlation between glycolytic phenotype and tumor grade in soft-tissue sarcomas by 18F-FDG PET. More than 90% of STSs (93/102) exhibited a strong glycolytic phenotype (SUVmax, 2.7-52.2 g/mL). Tumor SUVmax differed significantly among tumor grades (P < 0.001 for the 3- and 2-tier grading systems). The FNCLCC and 2-tier grading systems predicted tumor grade with similar accuracy (area under the curve, 0.83 and 0.85, respectively; P = 0.35). SUVmax differed significantly among histologic subtypes (P = 0.03) in the entire population but not when high-grade STSs were analyzed separately (P = 0.31). The tumor glycolytic phenotype correlated significantly with histologic grade as determined by both the FNCLCC and 2-tier (high vs. low) grading systems. (18)F-FDG PET cannot be used to reliably distinguish among grade 2 and 3 STSs (by FNCLCC) and the various subtypes. 3
47. Kubo T, Furuta T, Johan MP, Ochi M. Prognostic significance of (18)F-FDG PET at diagnosis in patients with soft tissue sarcoma and bone sarcoma; systematic review and meta-analysis. [Review]. Eur J Cancer. 58:104-11, 2016 May. Observational-Dx 514 patients To provide an up-to-date and unprecedented summary of the prognostic value of (18)F-FDG PET at diagnosis in soft tissue sarcoma (STS) and bone sarcoma (BS). A total of six studies comprising 514 patients with STS and BS were considered for the meta-analysis. The pooled HR for overall survival was 1.22 (95% confidence interval: 1.03-1.46), suggesting that high SUVmax predicts a significantly shorter overall survival period than low SUVmax (P = 0.03). Additional subgroup analyses using patients with STS alone showed that high SUVmax might predict poorer overall survival than low SUVmax (P = 0.004), although only two studies consisting of 96 patients were included. The overall quality of the included studies evaluated by the NOS assessment was adequate. 2
48. Jackson T, Mosci C, von Eyben R, et al. Combined 18F-NaF and 18F-FDG PET/CT in the Evaluation of Sarcoma Patients. Clin Nucl Med. 40(9):720-4, 2015 Sep. Observational-Dx 21 patients To report the sensitivity and specificity of the combined 18F-FDG/18F-NaF PET/CT (combined PET/ CT) versus individual 18F-FDG PET/CTand 18F-NaF PET/CT scans for detecting skeletal and extraskeletal metastases in the initial and/or subsequent treatment strategies in patients with newly diagnosed or recurring STS and BS. A total of 13 patients had metastatic disease on F-NaF PET/CT, F-FDG PET/CT, and combined F-NaF/F-FDG PET/CT. Skeletal disease was more extensive on the F-NaF PET/CT scan than on the F-FDG PET/CT in 3 patients, whereas in 1 patient, F-FDG PET/CT showed skeletal disease and the F-NaF PET/CT was negative. Extraskeletal lesions were detected on both F-FDG and combined F-NaF/F-FDG PET/CT in 20 patients, with 1 discordant finding in the lung. 3
49. Bamberg F, Dierks A, Nikolaou K, Reiser MF, Becker CR, Johnson TR. Metal artifact reduction by dual energy computed tomography using monoenergetic extrapolation. Eur Radiol. 2011;21(7):1424-1429. Observational-Dx 31 patients To assess the performance and diagnostic value of a dual energy CT approach to reduce metal artefacts in subjects with metallic implants. Image quality was rated superior to the standard image in 29/31 high energy reconstructions; the diagnostic value was rated superior in 27 patients. Image quality and diagnostic value scores improved significantly from 3.5 to 2.1 and from 3.6 to 1.9, respectively. In several examinations decisive diagnostic features were only discernible in the high energy reconstructions. The density of the artefacts decreased from -882 to -341 HU. 3
50. D'Angelo T, Cicero G, Mazziotti S, et al. Dual energy computed tomography virtual monoenergetic imaging: technique and clinical applications. Br J Radiol 2019;92:20180546. Review/Other-Dx N/A To explain the technical background of VMI and noise-optimized VMI+ algorithms and to give an overview of useful clinical applications of the VMI technique in DECT of various body regions. No results stated in the abstract. 4
51. Peltola EK, Koskinen SK. Dual-energy computed tomography of cruciate ligament injuries in acute knee trauma. Skeletal Radiology. 44(9):1295-301, 2015 Sep. Observational-Dx 18 patients To examine dual-energy computed tomography (DECT) in evaluating cruciate ligament injuries. A total of 18 patients who had an acute knee trauma, DECT and MRI were found. On MRI, six patients had an ACL rupture. DECT's sensitivity and specificity to detect ACL rupture were 79% and 100%, respectively. The DECT vs. MRI intra- and interobserver proportions of agreement for ACL rupture were excellent or good (kappa values 0.72-0.87). Only one patient had a PCL rupture. In GSI images, the optimal keV level was 63 keV. GSI of 40-140 keV was considered to be the best evaluation protocol in the majority of cases. 3
52. Reagan AC, Mallinson PI, O'Connell T, et al. Dual-energy computed tomographic virtual noncalcium algorithm for detection of bone marrow edema in acute fractures: early experiences. J Comput Assist Tomogr. 2014;38(5):802-805. Review/Other-Dx 4 cases To report initial experiences with the use of a DECT bonemarrow algorithm to assess for bone marrow edema. No results stated in abstract. 4
53. Chen H, Jia M, Xu W. Malignant bone tumor intramedullary invasion: evaluation with dual-energy computed tomography in a rabbit model. J Comput Assist Tomogr. 2015;39(1):70-74. Observational-Dx 30 New Zealand white rabbits To investigate the usefulness of dual-energy computed tomography (CT) spectral imaging for differentiating intramedullary microscopic invasion from simple marrow edema in a rabbit VX2 carcinoma model. The slope of the spectral curve in the transition area (7.78 +/- 3.40) was significantly greater than that in the macroscopic tumor area (3.71 +/- 2.15) and smaller than that in the normal marrow area (12.88 +/- 4.12) (P < 0.001). Regarding the transition area, the slope of the spectral curve of the microscopic tumor invasion zone (10.87 +/- 2.69) was greater than that of the simple bone marrow edema zone (5.84 +/- 2.11) (P < 0.001). 3
54. Sun X, Shao X, Chen H. The value of energy spectral CT in the differential diagnosis between benign and malignant soft tissue masses of the musculoskeletal system. Eur J Radiol. 84(6):1105-8, 2015 Jun. Observational-Dx 100 patients To explore the value of energy spectral CT in the differential diagnosis between benign and malignant tumor of the musculoskeletal system. The spectral curve of benign group was gradually falling type with a mean slope of 0.75 ± 0.30, that of malignant group was sharply falling type with a mean slope of 1.64 ± 1.00, and that of borderline group was a falling type between the above two groups with a mean slope of 1.34 ± 0.45. The differences of slopes between benign and malignant group, benign and borderline group were of statistical significance (P<0.05) respectively. The spectral curves of 3 cases of lipoma showed arc shaped rising type with a mean slope of -2.00. 2
55. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. Review/Other-Dx N/A To provide evidence-based guidelines on exposure of patients to ionizing radiation. No abstract available. 4
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