FDG-PET/CT Area of Interest Although FDG-PET/CT is not typically used as the next imaging study for the characterization of a soft tissue mass, PET/CT imaging maximum standard uptake value can be useful for differentiating between benign and malignant musculoskeletal masses. When combined with anatomic data provided by CT, FDG-PET/CT can be useful in distinguishing aggressive soft tissue tumors from benign lesions [43-45]. Benz et al [46] showed that FDG-PET can be used to determine a tumor glycolytic phenotype in sarcomas, which correlates significantly with histologic grade. Fused FDG-PET/CT images can be used to plan biopsy, targeting areas with more metabolic activity that may give higher diagnostic yield. Furthermore, a meta-analysis found that FDG-PET can be a helpful tool for predicting outcome in patients with soft tissue sarcoma [47]. Lastly, FDG-PET/CT is an excellent modality to detect metastatic disease and assess treatment response [48]. Despite these benefits, FDG-PET/CT does not usually play a role in the initial assessment of a soft tissue mass. Image-Guided Biopsy Area of Interest The literature does not support the use of image-guided biopsy as the next step in evaluation following nondiagnostic radiographs or US of a soft tissue mass. If MRI is contraindicated, characterization of the mass using Soft Tissue Masses CT with IV contrast should routinely be performed before biopsy [29]. In fact, the National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology for Soft Tissue Sarcoma state that biopsy should be performed only after adequate imaging [24]. Image-Guided Fine Needle Aspiration Area of Interest The literature does not support the use of image-guided fine needle aspiration as the next step in evaluation following nondiagnostic radiographs or US of a soft tissue mass. If MRI is contraindicated, characterization of the mass using CT with IV contrast should routinely be performed before biopsy [29].
Soft Tissue Masses. FDG-PET/CT Area of Interest Although FDG-PET/CT is not typically used as the next imaging study for the characterization of a soft tissue mass, PET/CT imaging maximum standard uptake value can be useful for differentiating between benign and malignant musculoskeletal masses. When combined with anatomic data provided by CT, FDG-PET/CT can be useful in distinguishing aggressive soft tissue tumors from benign lesions [43-45]. Benz et al [46] showed that FDG-PET can be used to determine a tumor glycolytic phenotype in sarcomas, which correlates significantly with histologic grade. Fused FDG-PET/CT images can be used to plan biopsy, targeting areas with more metabolic activity that may give higher diagnostic yield. Furthermore, a meta-analysis found that FDG-PET can be a helpful tool for predicting outcome in patients with soft tissue sarcoma [47]. Lastly, FDG-PET/CT is an excellent modality to detect metastatic disease and assess treatment response [48]. Despite these benefits, FDG-PET/CT does not usually play a role in the initial assessment of a soft tissue mass. Image-Guided Biopsy Area of Interest The literature does not support the use of image-guided biopsy as the next step in evaluation following nondiagnostic radiographs or US of a soft tissue mass. If MRI is contraindicated, characterization of the mass using Soft Tissue Masses CT with IV contrast should routinely be performed before biopsy [29]. In fact, the National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology for Soft Tissue Sarcoma state that biopsy should be performed only after adequate imaging [24]. Image-Guided Fine Needle Aspiration Area of Interest The literature does not support the use of image-guided fine needle aspiration as the next step in evaluation following nondiagnostic radiographs or US of a soft tissue mass. If MRI is contraindicated, characterization of the mass using CT with IV contrast should routinely be performed before biopsy [29].