 This document is specific to malignant or aggressive primary tumors of bone or soft tissue origin. This document specifically does not pertain to 1) metastatic disease to bone or soft tissues, 2) primary tumors of spine or neuroaxis origin, 3) primary tumors of head or neck origin, 4) intraabdominal or retroperitoneal tumors, 5) primary tumors of skin origin, and 6) plasma cell or other hematologic disorders that involve bone (ie, multiple myeloma). The variants in this document assume a diagnosis of a primary malignant or aggressive bone or soft tissue tumor has already been established. This document does not address the evaluation of chemotherapy or radiation therapy effectiveness or issues of cost-effectiveness and radiation dose. Special Imaging Considerations Hardware reconstruction is often needed following limb-sparing surgery for the management of bone tumors and occasionally for soft tissue tumors. This hardware creates artifact and limits evaluation of the adjacent structures with traditional CT, PET/CT, and MRI sequences and techniques. Although metal artifact can negatively impact CT, PET/CT, and/or MRI image quality, this document assumes metal artifact can be minimized with current metal artifact reduction protocols. There may still be instances where metal artifact cannot be sufficiently suppressed, and CT, PET/CT, and/or MRI become of limited benefit. In these cases, deviations from the variant recommendations may be necessary and should be informed by the clinical experience and expertise of the treatment team. aResearch Author, Mayo Clinic Florida, Jacksonville, Florida. bDiagnostic Imaging Associates, Chesterfield, Missouri. cPanel Chair, Mayo Clinic, Jacksonville, Florida. dPanel Vice-Chair, Wake Forest University School of Medicine, Winston Salem, North Carolina. eThe Johns Hopkins University School of Medicine, Baltimore, Maryland.
Malignant or Aggressive Primary Musculoskeletal Tumor Staging And Surveillance PCAs.  This document is specific to malignant or aggressive primary tumors of bone or soft tissue origin. This document specifically does not pertain to 1) metastatic disease to bone or soft tissues, 2) primary tumors of spine or neuroaxis origin, 3) primary tumors of head or neck origin, 4) intraabdominal or retroperitoneal tumors, 5) primary tumors of skin origin, and 6) plasma cell or other hematologic disorders that involve bone (ie, multiple myeloma). The variants in this document assume a diagnosis of a primary malignant or aggressive bone or soft tissue tumor has already been established. This document does not address the evaluation of chemotherapy or radiation therapy effectiveness or issues of cost-effectiveness and radiation dose. Special Imaging Considerations Hardware reconstruction is often needed following limb-sparing surgery for the management of bone tumors and occasionally for soft tissue tumors. This hardware creates artifact and limits evaluation of the adjacent structures with traditional CT, PET/CT, and MRI sequences and techniques. Although metal artifact can negatively impact CT, PET/CT, and/or MRI image quality, this document assumes metal artifact can be minimized with current metal artifact reduction protocols. There may still be instances where metal artifact cannot be sufficiently suppressed, and CT, PET/CT, and/or MRI become of limited benefit. In these cases, deviations from the variant recommendations may be necessary and should be informed by the clinical experience and expertise of the treatment team. aResearch Author, Mayo Clinic Florida, Jacksonville, Florida. bDiagnostic Imaging Associates, Chesterfield, Missouri. cPanel Chair, Mayo Clinic, Jacksonville, Florida. dPanel Vice-Chair, Wake Forest University School of Medicine, Winston Salem, North Carolina. eThe Johns Hopkins University School of Medicine, Baltimore, Maryland.