Stevenson J D, Watson J J, Cool P, Cribb G L, Jenkins J P R, Leahy M, Gregory J J
Greater Manchester and Oswestry Sarcoma Service, Department of Orthopaedics, The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, SY10 7AG, UK.
Greater Manchester and Oswestry Sarcoma Service, Department of Orthopaedics, Central Manchester University Hospitals NHS Foundation Trust, Oxford Road, Manchester, M13 9WL, UK.
Eur J Surg Oncol. 2016 Apr;42(4):574-80. doi: 10.1016/j.ejso.2015.12.011. Epub 2016 Jan 13.
Myxoid liposarcomas (MLS) are a subgroup of soft-tissue sarcomas which have a propensity for extra-pulmonary metastases. Conventional radiological staging of soft-tissue sarcomas consists of chest radiographs (CXR) and thoracic computed tomography (CT) for possible chest metastases, supplemented by magnetic resonance imaging (MRI) for local disease. The optimal radiological modality to detect extra-pulmonary metastases for systemic staging has not been proven. We reviewed the efficacy of Whole-Body MRI (WBMRI) for this purpose. 33 WBMRI and simultaneous CT scans were performed in 28 patients suffering from MLS between 2007 and 2015. 38 metastases were identified in seven patients via WBMRI. Osseous lesions predominated (spine, pelvis, chest-wall and long bones), followed by soft-tissue and abdominal lesions. Of the 29 soft-tissue or osseous metastases that were within the field-of-view of the simultaneous CT scans, five soft-tissue and zero osseous metastases were identified using CT. Metastatic disease was detected in three patients solely using WBMRI, which directly influenced their management. WBMRI is a useful adjunct in the detection of extra-pulmonary metastatic disease, which directly alters patient management. WBMRI has demonstrated an ability to identify more sites of metastatic disease compared to CT. WBMRI should be used in two situations. Firstly, at diagnosis where ablative treatment will be required e.g. amputation, when the diagnosis of occult metastasis would change treatment planning. Secondly, at diagnosis of relapse to confirm if it is a solitary site of relapse prior to consideration of metastectomy.
黏液样脂肪肉瘤（MLS）是软组织肉瘤的一个亚组，容易发生肺外转移。软组织肉瘤的传统放射学分期包括胸部X线片（CXR）和胸部计算机断层扫描（CT）以检查可能的胸部转移，同时辅以磁共振成像（MRI）评估局部病变。尚未证实用于全身分期检测肺外转移的最佳放射学方法。我们为此目的回顾了全身MRI（WBMRI）的有效性。2007年至2015年间，对28例黏液样脂肪肉瘤患者进行了33次WBMRI和同步CT扫描。通过WBMRI在7例患者中发现了38处转移。骨病变占主导（脊柱、骨盆、胸壁和长骨），其次是软组织和腹部病变。在同步CT扫描视野内的29处软组织或骨转移中，CT仅发现了5处软组织转移，未发现骨转移。仅使用WBMRI在3例患者中检测到转移性疾病，这直接影响了他们的治疗管理。WBMRI是检测肺外转移性疾病的有用辅助手段，可直接改变患者的治疗管理。与CT相比，WBMRI已证明有能力识别更多的转移病灶部位。WBMRI应在两种情况下使用。首先，在诊断时，如果需要进行消融治疗（如截肢），隐匿性转移的诊断会改变治疗计划。其次，在复发诊断时，在考虑进行转移灶切除术之前，确认是否为孤立性复发部位。
