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Magnetic Resonance Imaging of Soft-Tissue Tumors: Determinate and Indeterminate Lesions
Derek F. Papp, MD; A. Jay Khanna, MD; Edward F. McCarthy, MD; John A. Carrino, MD, MPH; Adam J. Farber, MD; Frank J. Frassica, MD
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2007 Oct 01;89(suppl 3):103-115. doi: 10.2106/JBJS.G.00711
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The evaluation of patients with soft-tissue masses must be done in a systematic fashion to prevent management errors. Although most soft-tissue masses (approximately 99%) are benign, an error in the management of a soft-tissue sarcoma can lead to limb loss or adversely affect survival1. Before magnetic resonance imaging became easily available, physicians relied on the patient's history, physical examination, conventional radiographs, and computed tomography scans for decision-making. These modalities often were insufficient for establishing a definitive diagnosis. The patient's history alone cannot provide enough information for a diagnosis and, in fact, may be misleading. For example, lesions identified after a traumatic episode are not necessarily traumatic in origin; only half of soft-tissue sarcomas are painful at presentation2, and the growth rate may not assist in the diagnosis (slow-growing lesions can be malignant or benign). Similarly, although a patient may present with systemic symptoms, the lack of systemic symptoms does not exclude malignancy. Physical examination may provide some clues that may suggest malignancy, but none are pathognomonic. Conventional radiography and computed tomography are not specific enough in differentiating benign and malignant soft-tissue masses. If one relies solely on these modalities, biopsy often is necessary for diagnosis and management. Biopsy is associated with several hazards, including neurovascular injury, hematoma formation, and delayed wound-healing.
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