Preliminary Diagnosis: Sarcoma

I. What imaging technique is first-line for this diagnosis?

Plain radiography.

II. Describe the advantages and disadvantages of this technique for diagnosing sarcoma.

Advantages

  • Highly portable and quick imaging modality that exposes patients to negligible ionizing radiation.

  • Offers exquisite visualization of the surrounding osseous structures and any mineralized structures.

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Disadvantages

  • Limited in sensitivity and specificity in evaluating the surrounding soft tissues.

  • Limited in evaluating for any secondary complications.

III. What are the contraindications for the first-line imaging technique?

No specific contraindications to plain radiography exist. Some institutions may require consent for pregnant women.

IV. What alternative imaging techniques are available?

  • CT imaging with IV contrast

  • MR imaging with IV contrast

V. Describe the advantages and disadvantages of the alternative techniques for diagnosing sarcoma.

CT imaging with IV contrast
Advantages

  • Offers exquisite detail of the surrounding soft tissues and osseous structures.

  • CT imaging with contrast helps evaluate for any enhancing neoplastic tissue and any secondary complications.

  • Relatively quick imaging modality compared to MR imaging.

  • Helps guide treatment, therapy, and guided percutaneous biopsy.

Disadvantages

  • Exposes patients to ionizing radiation.

MR imaging with IV contrast
Advantages

  • Highly sensitive and specific in evaluating the surrounding soft tissue.

  • MR imaging better details the extent of soft tissue tumor extension and infiltration than other imaging modalities.

Disadvantages

  • Expensive.

  • Time consuming.

  • Limited in evaluating the surrounding osseous structures.

  • May be subject to motion and susceptibility weighted artifact, degrading image quality.

VI. What are the contraindications for the alternative imaging techniques?

CT imaging with IV contrast

  • May be contraindicated in pregnant patients.

  • CT imaging with contrast may be contraindicated in patients with abnormal renal function and/or those not on an adequate dialysis regimen.

  • Contrast may be contraindicated in patients with a contrast allergy.

MR imaging with IV contrast

  • Contraindicated in patients with non-MR compatible hardware.

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