Riley Geoffrey M, Steffner Robert, Kwong Steven, Chin Alexander, Boutin Robert D
From the Departments of Radiology (G.M.R., R.D.B.) and Orthopedic Surgery (R.S.), Stanford University Medical Center, 300 Pasteur Dr, Stanford, CA 94305-5105; Department of Radiology, The Permanente Medical Group, Oakland, Calif (S.K.); and Department of Radiation Oncology, Stanford Cancer Institute, Stanford, Calif (A.C.).
Radiographics. 2024 Jun;44(6):e230086. doi: 10.1148/rg.230086.
MRI serves as a critical step in the workup, local staging, and treatment planning of extremity soft-tissue masses. For the radiologist to meaningfully contribute to the management of soft-tissue masses, they need to provide a detailed list of descriptors of the lesion outlined in an organized report. While it is occasionally possible to use MRI to provide a diagnosis for patients with a mass, it is more often used to help with determining the differential diagnosis and planning of biopsies, surgery, radiation treatment, and chemotherapy (when provided). Each descriptor on the list outlined in this article is specifically aimed to assist in one or more facets of the overall approach to soft-tissue masses. This applies to all masses, but in particular sarcomas. Those descriptors are useful to help narrow the differential diagnosis and ensure concordance with a pathologic diagnosis and its accompanying grade assignment of soft-tissue sarcomas. These include a lesion's borders and shape, signal characteristics, and contrast enhancement pattern; the presence of peritumoral edema and peritumoral enhancement; and the presence of lymph nodes. The items most helpful in assisting surgical planning include a lesion's anatomic location, site of origin, size, location relative to a landmark, relationship to adjacent structures, and vascularity including feeding and draining vessels. The authors provide some background information on soft-tissue sarcomas, including their diagnosis and treatment, for the general radiologist and as a refresher for radiologists who are more experienced in tumor imaging. RSNA, 2024 See the invited commentary by Murphey in this issue.
磁共振成像（MRI）是四肢软组织肿块检查、局部分期及治疗规划中的关键步骤。为了让放射科医生能对软组织肿块的管理做出有意义的贡献，他们需要在一份条理清晰的报告中提供病变描述符的详细清单。虽然偶尔可以用MRI为有肿块的患者提供诊断，但它更多地用于帮助确定鉴别诊断以及活检、手术、放射治疗和化疗（若适用）的规划。本文列出的清单中的每个描述符都专门旨在协助软组织肿块整体处理方法的一个或多个方面。这适用于所有肿块，尤其是肉瘤。这些描述符有助于缩小鉴别诊断范围，并确保与软组织肉瘤的病理诊断及其伴随的分级一致。这些包括病变的边界和形状、信号特征以及对比增强模式；瘤周水肿和瘤周强化的存在情况；以及淋巴结的存在情况。在协助手术规划方面最有帮助的项目包括病变的解剖位置、起源部位、大小、相对于一个标志物的位置、与相邻结构的关系以及血管情况，包括供血和引流血管。作者为普通放射科医生提供了一些关于软组织肉瘤的背景信息，包括其诊断和治疗，也供在肿瘤成像方面经验更丰富的放射科医生复习。RSNA，2024 见本期Murphey的特邀评论。
