MR Imaging of Bone and Soft Tissue Sarcoma: Significance of MRI in Planning Surgical Margins and Check Points in Clinical Evaluation

Abstract

Limb salvage surgery has had almost as many successful results as amputation surgery for bone and soft tissue sarcoma. This is attributable to the standardization of procedure for wide resection based on the theory of the “barrier” which has an ability to prevent tumor penetration [1–3]. A critical area for concern is ensuring that resection is performed using the smallest surgical margin consistent with safety, to preserve good function of the affected extremity. However, in many cases, the lesion may have already extended beyond the adjacent region (extra-compartment lesion), i.e., stage IIB of Enneking’s criteria [2]. For the lesion adjacent to a major neurovascular bundle, it may be impossible to secure a “curative margin” corresponding to the criteria of the Evaluation Method of Surgical Margin for Musculoskeletal Sarcoma of the Japanese Orthopaedic Association Musculoskeletal Tumor Committee (JOA criteria) [1]. This type of case requires some kind of reliable method of preoperative imaging in order to determine the margin of tumor extension referred to by the sub-type of histology as well as to measure the effectiveness of adjuvant therapy at the planning stage of a limb salvage operation.