MRI has been criticized as having many false-positive results, leading to unnecessary procedures and emotional distress [82]. A retrospective single-institution study of 11 local recurrences in 124 patients with soft tissue sarcoma found MRI had a positive predictive value of only 42% with 11 false-positive examinations in this cohort and advocated for clinical surveillance only [83]. However, the Park et al [77] larger single-institution studies found a positive predictive value of 93%. Postcontrast imaging has been shown to add benefit in evaluation of soft tissue tumors to differentiate benign versus malignant lesions [68]. A more recent retrospective study assessing the added value of postcontrast MRI showed contrast improved reader confidence even for experienced readers and improved accuracy of a more inexperienced reader from 65% to 72% [67]. MRI Area of Interest Without IV Contrast MRI used as surveillance of the primary soft tissue tumor site is the mainstay for evaluating local recurrence. Few studies regarding the diagnostic utility of MRI for local recurrence of soft tissue sarcomas have been published in recent years, likely given its widespread adoption clinically. MRI is useful not only for asymptomatic surveillance but also if a clinical area of concern at the resection site develops. MRI is often requested before surgery and radiation when local recurrence is established. A retrospective single-institution study by Park et al [77] of 325 patients with extremity sarcoma with a local recurrence rate of 11% found MRI detected 60% of those patients with recurrence not identified clinically or with US. Those with MRI detected local recurrence trended towards better survival but this did not reach statistical significance. MRI has been criticized as having many false-positive results leading to unnecessary procedures and emotional distress [82].
Malignant or Aggressive Primary Musculoskeletal Tumor Staging And Surveillance PCAs. MRI has been criticized as having many false-positive results, leading to unnecessary procedures and emotional distress [82]. A retrospective single-institution study of 11 local recurrences in 124 patients with soft tissue sarcoma found MRI had a positive predictive value of only 42% with 11 false-positive examinations in this cohort and advocated for clinical surveillance only [83]. However, the Park et al [77] larger single-institution studies found a positive predictive value of 93%. Postcontrast imaging has been shown to add benefit in evaluation of soft tissue tumors to differentiate benign versus malignant lesions [68]. A more recent retrospective study assessing the added value of postcontrast MRI showed contrast improved reader confidence even for experienced readers and improved accuracy of a more inexperienced reader from 65% to 72% [67]. MRI Area of Interest Without IV Contrast MRI used as surveillance of the primary soft tissue tumor site is the mainstay for evaluating local recurrence. Few studies regarding the diagnostic utility of MRI for local recurrence of soft tissue sarcomas have been published in recent years, likely given its widespread adoption clinically. MRI is useful not only for asymptomatic surveillance but also if a clinical area of concern at the resection site develops. MRI is often requested before surgery and radiation when local recurrence is established. A retrospective single-institution study by Park et al [77] of 325 patients with extremity sarcoma with a local recurrence rate of 11% found MRI detected 60% of those patients with recurrence not identified clinically or with US. Those with MRI detected local recurrence trended towards better survival but this did not reach statistical significance. MRI has been criticized as having many false-positive results leading to unnecessary procedures and emotional distress [82].