La radiologia medica

, Volume 124, Issue 4, pp 243–252 | Cite as

Advanced magnetic resonance imaging (MRI) of soft tissue tumors: techniques and applications

  • Federico Bruno
  • Francesco Arrigoni
  • Silvia Mariani
  • Alessandra Splendiani
  • Ernesto Di Cesare
  • Carlo Masciocchi
  • Antonio BarileEmail author


Imaging evaluation of soft tissue tumors is important for the diagnosis, staging, and follow-up. Magnetic resonance imaging (MRI) is the preferred imaging modality due to its multiplanarity and optimal tissue contrast resolution. However, standard morphological sequences are often not sufficient to characterize the exact nature of the lesion, addressing the patient to an invasive bioptic examination for the definitive diagnosis. The recent technological advances with the development of functional MRI modalities such as diffusion-weighted imaging, dynamic contrast-enhanced perfusion imaging, magnetic resonance spectroscopy, and diffusion tensor imaging with tractography have implemented the multiparametricity of MR to evaluate in a noninvasive manner the biochemical, structural, and metabolic features of tumor tissues. The purpose of this article is to review the state of the art of these advanced MRI techniques, with focus on their technique and clinical application.


MRI Soft tissue tumors DWI Spectroscopy DTI 


Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.


  1. 1.
    Beaman FD, Jelinek JS, Priebat DA (2013) Current imaging and therapy of malignant soft tissue tumors and tumor-like lesions. Semin Musculoskelet Radiol 17:168–176. CrossRefGoogle Scholar
  2. 2.
    Barile A, Conti L, Lanni G et al (2013) Evaluation of medial meniscus tears and meniscal stability: weight-bearing MRI vs arthroscopy. Eur J Radiol 82:633–639. CrossRefGoogle Scholar
  3. 3.
    Barile A, Lanni G, Conti L et al (2013) Lesions of the biceps pulley as cause of anterosuperior impingement of the shoulder in the athlete: potentials and limits of MR arthrography compared with arthroscopy. Radiol Med 118:112–122. CrossRefGoogle Scholar
  4. 4.
    Salvati F, Rossi F, Limbucci N et al (2008) Mucoid metaplastic-degeneration of anterior cruciate ligament. J Sports Med Phys Fitness 48:483–487Google Scholar
  5. 5.
    Mariani S, La Marra A, Arrigoni F et al (2015) Dynamic measurement of patello-femoral joint alignment using weight-bearing magnetic resonance imaging (WB-MRI). Eur J Radiol 84:2571–2578. CrossRefGoogle Scholar
  6. 6.
    Barile A, Bruno F, Mariani S et al (2017) Follow-up of surgical and minimally invasive treatment of Achilles tendon pathology: a brief diagnostic imaging review. Musculoskelet Surg 101:51–61. CrossRefGoogle Scholar
  7. 7.
    Barile A, Bruno F, Arrigoni F et al (2017) Emergency and trauma of the ankle. Semin Musculoskelet Radiol 21:282–289. CrossRefGoogle Scholar
  8. 8.
    Zappia M, Castagna A, Barile A et al (2017) Imaging of the coracoglenoid ligament: a third ligament in the rotator interval of the shoulder. Skeletal Radiol 46:1101–1111. CrossRefGoogle Scholar
  9. 9.
    Barile A, Arrigoni F, Bruno F et al (2017) Computed tomography and MR imaging in rheumatoid arthritis. Radiol Clin N Am. Google Scholar
  10. 10.
    Limbucci N, Rossi F, Salvati F et al (2010) Bilateral suprascapular nerve entrapment by glenoid labral cysts associated with rotator cuff damage and posterior instability in an amateur weightlifter. J Sports Med Phys Fitness 50:64–67Google Scholar
  11. 11.
    Costa FM, Canella C, Gasparetto E (2011) Advanced magnetic resonance imaging techniques in the evaluation of musculoskeletal tumors. Radiol Clin N Am 49:1325–1358. CrossRefGoogle Scholar
  12. 12.
    Bancroft L, Pettis C, Wasyliw C (2013) Imaging of benign soft tissue tumors. Semin Musculoskelet Radiol 17:156–167. CrossRefGoogle Scholar
  13. 13.
    Teixeira PAG, Beaumont M, Gabriela H et al (2015) Advanced techniques in musculoskeletal oncology: perfusion, diffusion, and spectroscopy. Semin Musculoskelet Radiol 19:463–474. CrossRefGoogle Scholar
  14. 14.
    Masciocchi C, Conti L, D'Orazio F et al (2012) Errors in musculoskeletal MRI. In: Errors in radiology. Springer, Italia. Google Scholar
  15. 15.
    Subhawong TK, Jacobs MA, Fayad LM (2014) Insights into quantitative diffusion-weighted MRI for musculoskeletal tumor imaging. Am J Roentgenol 203:560–572. CrossRefGoogle Scholar
  16. 16.
    Russo F, Mazzetti S, Grignani G et al (2012) In vivo characterisation of soft tissue tumours by 1.5-T proton MR spectroscopy. Eur Radiol 22:1131–1139. CrossRefGoogle Scholar
  17. 17.
    Masciocchi C, Lanni G, Conti L et al (2012) Soft-tissue inflammatory myofibroblastic tumors (IMTs) of the limbs: potential and limits of diagnostic imaging. Skelet Radiol 41:643–649. CrossRefGoogle Scholar
  18. 18.
    Buchbender C, Heusner TA, Lauenstein TC et al (2012) Oncologic PET/MRI, part 2: bone tumors, soft-tissue tumors, melanoma, and lymphoma. J Nucl Med 53:1244–1252. CrossRefGoogle Scholar
  19. 19.
    Genovese E, Canì A, Rizzo S et al (2011) Comparison between MRI with spin-echo echo-planar diffusion-weighted sequence (DWI) and histology in the diagnosis of soft-tissue tumours. Radiol Med 116:644–656. CrossRefGoogle Scholar
  20. 20.
    Aszmann OC (2015) Diffusion tensor tractography for the surgical management of peripheral nerve sheath tumors. Neurosurg Focus 39:1–6. Google Scholar
  21. 21.
    Subhawong TK, Wilky BA (2015) Value added. Curr Opin Oncol 27:323–331. CrossRefGoogle Scholar
  22. 22.
    Drapé JL (2013) Advances in magnetic resonance imaging of musculoskeletal tumours. Orthop Traumatol Surg Res 99:S115–S123. CrossRefGoogle Scholar
  23. 23.
    Soldatos T, Fisher S, Karri S et al (2015) Advanced MR imaging of peripheral nerve sheath tumors including diffusion imaging theodoros. Semin Musculoskelet Radiol 19:179–190CrossRefGoogle Scholar
  24. 24.
    Van Rijswijk CSP, Kunz P, Hogendoorn PCW et al (2002) Diffusion-weighted MRI in the characterization of soft-tissue tumors. J Magn Reson Imaging 15:302–307. CrossRefGoogle Scholar
  25. 25.
    Pozzi G, Albano D, Messina C et al (2017) Solid bone tumors of the spine: diagnostic performance of apparent diffusion coefficient measured using diffusion-weighted MRI using histology as a reference standard. J Magn Reson Imaging 47:1034–1042CrossRefGoogle Scholar
  26. 26.
    Dietrich O, Raya JG, Sommer J et al (2005) A comparative evaluation of a RARE-based single-shot pulse sequence for diffusion-weighted MRI of musculoskeletal soft-tissue tumors. Eur Radiol 15:772–783. CrossRefGoogle Scholar
  27. 27.
    Khoo MMY, Tyler PA, Saifuddin A, Padhani AR (2011) Diffusion-weighted imaging (DWI) in musculoskeletal MRI: a critical review. Skelet Radiol 40:665–681CrossRefGoogle Scholar
  28. 28.
    Oka K, Yakushiji T, Sato H et al (2011) Usefulness of diffusion-weighted imaging for differentiating between desmoid tumors and malignant soft tissue tumors. J Magn Reson Imaging 33:189–193. CrossRefGoogle Scholar
  29. 29.
    Ahlawat S, Fayad LM (2015) De novo assessment of pediatric musculoskeletal soft tissue tumors: beyond anatomic imaging. Pediatrics 136:e194–e202. CrossRefGoogle Scholar
  30. 30.
    Lee SY, Jee WH, Jung JY et al (2016) Differentiation of malignant from benign soft tissue tumours: use of additive qualitative and quantitative diffusion-weighted MR imaging to standard MR imaging at 3.0 T. Eur Radiol 26:743–754. CrossRefGoogle Scholar
  31. 31.
    Pekcevik Y, Kahya MO, Kaya A (2015) Characterization of soft tissue tumors by diffusion-weighted imaging. Iran J Radiol 12:1–6. CrossRefGoogle Scholar
  32. 32.
    Demehri S, Belzberg A, Blakeley J, Fayad LM (2014) Conventional and functional MR imaging of peripheral nerve sheath tumors: initial experience. Am J Neuroradiol 35:1615–1620. CrossRefGoogle Scholar
  33. 33.
    Jeon JY, Chung HW, Lee MH, Lee SH, Shin MJ (2016) Usefulness of diffusion-weighted MR imaging for differentiating between benign and malignant superficial soft tissue tumors and tumor-like lesions. Br Inst Radiol 89:20150929CrossRefGoogle Scholar
  34. 34.
    Oka K, Yakushiji T, Sato H et al (2008) Ability of diffusion-weighted imaging for the differential diagnosis between chronic expanding hematomas and malignant soft tissue tumors. J Magn Reson Imaging 28:1195–1200. CrossRefGoogle Scholar
  35. 35.
    Barile A, Bruno F, Mariani S et al (2017) What can be seen after rotator cuff repair: a brief review of diagnostic imaging findings. Musculoskelet Surg. Google Scholar
  36. 36.
    De Filippo M, Pesce A, Barile A et al (2017) Imaging of postoperative shoulder instability. Musculoskelet Surg 101:15–22CrossRefGoogle Scholar
  37. 37.
    Barile A, Regis G, Masi R et al (2007) Patologia neoplastica muscoloscheletrica: esperienza preliminare con RM perfusionale. Radiol Med 112:550–561. CrossRefGoogle Scholar
  38. 38.
    Park MY, Jee W-H, Kim SK et al (2013) Preliminary experience using dynamic MRI at 3.0 Tesla for evaluation of soft tissue tumors. Korean J Radiol 14:102–109. CrossRefGoogle Scholar
  39. 39.
    Barile A, Sabatini M, Iannessi F et al (2004) Pigmented villonodular synovitis (PVNS) of the knee joint: magnetic resonance imaging (MRI) using standard and dynamic paramagnetic contrast media. Report of 52 cases surgically and histologically controlled. Radiol Med 107:356–366Google Scholar
  40. 40.
    van Rijswijk CSP, Geirnaerdt MJA, Hogendoorn PCW et al (2004) Soft-tissue tumors: value of static and dynamic gadopentetate dimeglumine-enhanced MR imaging in prediction of malignancy. Radiology 233:493–502. CrossRefGoogle Scholar
  41. 41.
    Zoccali C, Rossi B, Zoccali G et al (2015) A new technique for biopsy of soft tissue neoplasms: a preliminary experience using MRI to evaluate bleeding. Minerva Med 106:117–120Google Scholar
  42. 42.
    Liu X, Ekholm S, Tian W, et al (2006) Preliminary application study of MR perfusion imaging and diffusion tensor imaging in tumor like lesions in the cervical spinal cord. In: Proceedings 14th scientific meeting international society for magnetic resonance in medicine, p 985Google Scholar
  43. 43.
    Moukaddam H, Pollak J, Haims AH (2009) MRI characteristics and classification of peripheral vascular malformations and tumors. Skelet Radiol 38:535–547. CrossRefGoogle Scholar
  44. 44.
    Fayad L, Deshmukh S, Subhawong T, Carrino J (2014) Role of MR spectroscopy in musculoskeletal imaging. Indian J Radiol Imaging 24:210. CrossRefGoogle Scholar
  45. 45.
    Thawait GK, Subhawong TK, Tatizawa Shiga NY, Fayad LM (2014) “Cystic”-appearing soft tissue masses: what is the role of anatomic, functional, and metabolic MR imaging techniques in their characterization? J Magn Reson Imaging 39:504–511. CrossRefGoogle Scholar
  46. 46.
    Kasprian G, Amann G, Panotopoulos J et al (2015) Peripheral nerve tractography in soft tissue tumors: a preliminary 3-tesla diffusion tensor magnetic resonance imaging study. Muscle Nerve 51:338–345. CrossRefGoogle Scholar

Copyright information

© Italian Society of Medical Radiology 2019

Authors and Affiliations

  1. 1.Department of Biotechnology and Applied Clinical Sciences, S. Salvatore HospitalUniversity of L’AquilaL’AquilaItaly

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