Zusammenfassung
Benigne Weichteiltumoren, Weichteilsarkome und tumorähnliche Läsionen der Weichteile sind zusammen relativ häufig und stellen aufgrund der enormen Vielzahl pathologischer Entitäten ein diagnostisches Problem dar. Das klinische Management von Patienten mit unklaren Weichteilläsionen macht eine enge Kooperation zwischen Radiologen, Pathologen und Orthopäden bzw. Chirurgen erforderlich, um Diagnose und Therapie im Rahmen eines zielgerichteten Gesamtkonzepts erarbeiten zu können.
Dieser Artikel gibt eine Übersicht über die Rolle der Magnetresonanztomographie (MRT) in der Diagnostik von Weichteiltumoren unter Berücksichtigung der Differenzialdiagnose benigner und maligner Läsionen, spezifischer Diagnosen und Fehlerquellen, des lokalen Stagings von Weichteilsarkomen und der postoperativen Verlaufsbeobachtung.
Abstract
Benign soft tissue tumors, soft tissue sarcomas and tumor-like lesions of the soft tissues are relatively common if taken together and represent a diagnostic problem due to the enormous number of pathologic entities. The clinical management of patients with suspected soft tissue lesions necessitates close cooperation between radiologists, pathologists, and orthopaedic surgeons to coordinate the diagnosis and therapy within the framework of a dedicated common concept.
This article reviews the role of MRI in the diagnosis of soft tissue tumors including the differential diagnosis of benign and malignant lesions, specific diagnoses and pitfalls, local staging of soft tissue sarcomas and postoperative follow-up.
Key words
Soft tissues, neoplasms - Neoplasms, musculoskeletal - Muscles, neoplasms - Sarcoma - Soft tissues, MRI - Magnetic resonance imaging (MRI), tissue characterization
Literatur
-
1 Weiss S W, Goldblum J R. Enzinger and Weiss’s Soft Tissue Tumors. 4th ed. St. Louis, London, Philadelphia, Sydney, Toronto; Mosby 2001
-
2 Campanacci M. Bone and soft tissue tumors. 2nd ed. Padua: Piccin Nuova Libraria. Wien, New York, Heidelberg; Springer 1999
-
3 Fletcher C DM, Unni K K, Mertens F. Pathology and genetics of tumours of soft tissue and bone. In: World Health Organization Classification of Tumours. Lyon; IARC Press 2002
-
4
Murphey M D, Kransdorf M J.
Soft tissue tumors.
Eur Radiol.
2001;
11(Suppl. 2)
249-258
-
5
Pisters P WT, Leung D HY, Woodruff J, Shi W, Brennan M F.
Analysis of prognostic factors in 1,041 patients with localized soft tissue sarcomas of the extremities.
J Clin Oncol.
1996;
14
1679-1689
-
6
Kransdorf M J.
Benign soft-tissue tumors in a large referral population: distribution of diagnosis by age, sex and location.
Am J Roentgenol.
1995;
164
395-402
-
7 Wörtler K. Knochen- und Weichteiltumoren. In: Rummeny EJ, Reimer P, Heindel W (Hrsg) Ganzkörper-MR-Tomographie. Stuttgart; Thieme 2002
-
8 Wörtler K. Tumoren und tumor-ähnliche Läsionen der Gelenke. In: Freyschmidt J, Stäbler A (Hrsg) Handbuch diagnostische Radiologie. Heidelberg; Springer: im Druck
-
9
Kransdorf M J, Jelinek J S, Moser R P.
Imaging of soft tissue tumors.
Radiol Clin North Am.
1993;
31
359-372
-
10
de Schepper A M, de Beuckeleer L, Vandevenne J, Somville J.
Magnetic resonance imaging of soft tissue tumors.
Eur Radiol.
2000;
10
213-222
-
11
Alexander A, Nazarin L, Feld R.
Superficial soft tissue masses suggestive of recurrent malignancy: sonographic localization and biopsy.
Am J Roentgenol.
1997;
169
1449-1451
-
12
Berquist T H, Ehman R L, King B F, Hodgman C G, Ilstrup D M.
Value of MR imaging in differentiating benign from malignant soft-tisuue masses: study of 95 lesions.
Am J Roentgenol.
1990;
155
1251-1255
-
13
Crim J R, Seeger L L, Yao L, Chandnani V, Eckardt J J.
Diagnosis of soft-tissue masses with MR imaging: can benign masses be differentiated from malignant ones?.
Radiology.
1992;
185
581-586
-
14
Hermann G, Abdelwahab I, Miller T, Klein M, Lewis M.
Tumour and tumour-like conditions of the soft tissue: magnetic resonance imaging features differentiating benign from malignant masses.
Br J Radiol.
1992;
65
14-20
-
15
Ma L D, Frassica F J, Scott W W, Fishman E K, Zerhouni E A.
Differentiation of benign and malignant musculoskeletal tumors: potential pitfalls with MR imaging.
RadioGraphics.
1995;
15
349-366
-
16
Moulton J S, Blebea J S, Dunco D M, Braley S E, Bisset G S, Emery K H.
MR imaging of soft-tissue masses: diagnostic efficacy and value of distinguishing between benign and malignant lesions.
Am J Roentgenol.
1995;
164
1191-1199
-
17
Sundaram M, Sharafuddin M J.
MR imaging of benign soft-tissue masses.
Magn Reson Imaging Clin N Am.
1995;
3
609-627
-
18
May D A, Good R B, Smith D K, Parsons T W.
MR imaging of musculoskeletal tumors and tumor mimickers with intravenous gadolinium: experience with 242 patients.
Skeletal Radiol.
1997;
26
2-15
-
19
Ma L D, McCarthy E F, Bluemke D A, Frassica F J.
Differentiation of benign from malignant musculoskeletal lesions using MR imaging: pitfalls in MR evaluation of lesions with a cystic appearance.
Am J Roentgenol.
1998;
170
1251-1258
-
20
Blacksin M F, Siegel J R, Benevenia J, Aisner S C.
Synovial sarcoma: frequency of nonaggressive MR characteristics.
J Comput Assist Tomogr.
1997;
21
785-789
-
21
Gaynor J J, Tan C C, Casper E S, Collin C F, Friedrich C, Shiu M, Hajdu S I, Brennan M F.
Refinement of clinicopathologic staging for localized soft tissue sarcoma of the extremity: a study of 423 adults.
J Clin Oncol.
1992;
10
1317-1329
-
22
Brennan M F.
Management of extremity soft tissue sarcoma.
Am J Surg.
1989;
158
71-8
-
23
Eilber F R, Giuliano A E, Huth J. et al .
High grade soft tissue sarcoma of the extremity: UCLA experience with limb salvage.
Prog Clin Biol Res.
1985;
201
58-74
-
24
Lewis J J, Leung D, Heslin M, Woodruff J M, Brennan M F.
Association of local recurrence with subsequent survival in extremity soft tissue sarcoma.
J Clin Oncol.
1997;
15
646-652
-
25
Beltran J, Simon D C, Katz W, Weis L D.
Increased MR signal intensity in skeletal muscle adjacent to malignant tumors: pathologic correlation and clinical relevance.
Radiology.
1987;
162
251-255
-
26
Elias D A, White L M, Simpson D J, Kandel R A, Tomlinson G, Bell R S, Wunder J S.
Osseous invasion by soft-tissue sarcoma: assessment with MR imaging.
Radiology.
2003;
229
145-152
-
27
Saifuddin A.
The accuracy of imaging in the local staging of appendicular osteosarcoma.
Skeletal Radiol.
2002;
31
191-201
-
28
Swan J S, Grist T M, Sproat I A, Heiner J P, Wiersma S R, Heisey D M.
Musculoskeletal neoplasms: preoperative evaluation with MR angiography.
Radiology.
1995;
194
519-524
-
29
Davies A M, Mehr A, Parsonage S, Evans N, Grimer R J, Pynsent P B.
MR imaging in the assessment of residual tumour following inadequate primary excision of soft tissue sarcomas.
Eur Radiol.
2004;
14
506-513
-
30
Baur A, Huber A, Arbogast S. et al .
Diffusion-weighted imaging of tumor recurrencies and posttherapeutical soft-tissue changes in humans.
Eur Radiol.
2001;
11
828-833
Priv.-Doz. Dr. med. Klaus Wörtler
Institut für Röntgendiagnostik, Technische Universität München, Klinikum rechts der Isar
Ismaninger Strasse 22 · 81675 München
Phone: +49(0)089 4140 2696
Fax: +49(0)89 4140 4834
Email: woertler@roe.med.tu-muenchen.de
