Search Our Scientific Publications & Authors

AJR Am J Roentgenol 2021 Apr 14. Epub 2021 Apr 14.

Professor of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota and Consultant, Department of Radiology, Mayo Clinic, Phoenix, Arizona.

Staging of primary musculoskeletal bone and soft tissue tumors is most commonly performed using the AJCC and the Enneking or Musculoskeletal Tumor Society (MSTS) staging systems. Radiologic imaging is integral in achieving adequate musculoskeletal neoplastic staging by defining lesion extent and identifying regional lymph node involvement and distant metastatic disease. Additional important features in surgical planning, though not distinct components of the staging systems, include cortical involvement, joint invasion, and neurovascular encasement; these features are optimally evaluated by MRI. Read More

Cancer 2018 10 15;124(19):3868-3875. Epub 2018 Oct 15.

University of Toronto Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada.

Background: Soft-tissue sarcomas (STSs) are a heterogeneous group of malignant tumors that can be difficult to treat. This is particularly true after incomplete or unplanned excisions and especially for patients with American Joint Committee on Cancer stage III tumors, who are at high risk for relapse. Numerous studies have shown that an inadequate sarcoma excision is associated with a worse prognosis. Read More

Magn Reson Imaging Clin N Am 2018 Nov;26(4):571-579

Radiology Department, Clínica de Diagnóstico por Imagem (CDPI)/DASA, Avenida das Américas, 4666, sala 301B, Centro Médico BarraShopping, CDPI, Barra da Tijuca, Rio de Janeiro, RJ CEP: 22640-102, Brazil; Radiology Department, Alta Excelência Diagnóstica/DASA, Avenida das Américas, 4666, sala 301B, Centro Médico BarraShopping, CDPI, Barra da Tijuca, Rio de Janeiro, RJ CEP: 22640-102, Brazil; Radiology Department, Universidade Federal Fluminense, Av Marques do Paraná, 303, Centro, Niterói, RJ CEP: 24020-071, Brazil.

Neoplastic musculoskeletal lesions are heterogeneous tumors with variable outcomes that require a precise diagnosis and delivery of optimal, specific treatment. Advanced MR imaging techniques can help differentiate and characterize musculoskeletal soft tissue tumors and are the method of choice for detection, evaluation, local staging, and surgical planning. MR imaging-ultrasound fusion is the process of combining relevant information from 2 methods into a single image that is more informative than the images obtained separately. Read More

J Am Coll Radiol 2018 May;15(5S):S189-S197

Panel Chair, University of Kentucky, Lexington, Kentucky.

Imaging is an integral component of the evaluation of patients with a suspected soft-tissue mass. Imaging can not only confirm the presence of a mass but can provide essential information necessary for diagnosis, local staging, and biopsy planning. Although the objectives of the evaluation have not changed, the choices available for imaging of musculoskeletal masses have evolved dramatically in recent years. Read More

Eur J Surg Oncol 2017 Aug 7;43(8):1385-1392. Epub 2017 Jun 7.

Department of Plastic Surgery, and Breast Surgery Unit, Comprehensive Cancer Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.

Breast lymphomas comprise a rare group of malignant breast tumors. Among these, a new entity has emerged as a potentially under-diagnosed disease. Breast implant-associated anaplastic large cell lymphoma (BI-ALCL) most often manifests as a late periprosthetic effusion between 1 and 10 years after the implantation of silicone or saline-filled breast prostheses. Read More

Surg Clin North Am 2016 Oct;96(5):963-76

Department of Radiology, University of South Florida Morsani College of Medicine, 12901 Bruce B Downs Blvd, Tampa, FL 33612, USA; Department of Orthopedics/Sports Medicine, University of South Florida Morsani College of Medicine, 12901 Bruce B Downs Blvd, Tampa, FL 33612, USA; Moffitt Cancer Center, Tampa, FL, USA; Department of Surgery, University of South Florida Morsani College of Medicine, 12901 Bruce B Downs Blvd, Tampa, FL 33612, USA.

Diagnostic imaging plays an important role in evaluation and treatment planning of patients with musculoskeletal tumors. This article discusses various imaging modalities available in the work-up, staging, and surveillance of patients with primary bone and soft tissue neoplasms. A systematic approach to initial evaluation of newly suspected bone lesions and soft tissue masses is presented. Read More

Adv Otorhinolaryngol 2016 12;78:83-94. Epub 2016 Apr 12.

The successful treatment of salivary gland malignancies originating in the parotid gland begins with rigorous and thorough surgical management coupled with the directed and appropriate potential adjuvant use of radiation therapy and chemotherapy. The anatomic complexity of the region in relation to the facial nerve and adjoining neurovascular and musculoskeletal structures requires sound surgical planning and decision making based on preoperative and intraoperative findings. The clinical presentation of parotid malignancy is summarized, as well as the further evaluations that are performed, including imaging and tissue biopsy. Read More

World J Surg Oncol 2016 Apr 5;14:104. Epub 2016 Apr 5.

Department of Orthopaedics, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.

Background: The purpose of this study was to discuss the clinical results which related to the location of giant cell tumors (GCTs) in the pelvis so as to determine the ideal surgical treatment protocol.

Methods: We report 29 cases who accepted surgical treatment from five clinical centers during the last 12 years. All patients were divided into three groups according to tumor locations, and they were also classified into two groups in light of surgical treatments. Read More

J Bone Joint Surg Am 2015 Apr;97(7):597-603

Department of Orthopaedic Surgery, Musculoskeletal Oncology Division, University of Miami Miller School of Medicine, 1400 NW 12th Avenue, Fourth floor, Room 4036, Miami, FL 33136. E-mail address for J. Pretell-Mazzini: E-mail address for M.D. Barton Jr.: E-mail address for S.A. Conway: E-mail address for H.T. Temple:

➤ Biopsy, staging, preoperative imaging and planning, as well as surgical treatment of soft-tissue sarcomas, are best carried out in specialized sarcoma centers, with the support of a multidisciplinary tumor board.➤ Tumor bed excision is recommended after most unplanned excisions, with a goal of obtaining complete tumor removal with an appropriately wide margin of resection.➤ The surgical resection area tends to be more extensive during tumor bed excision than during primary resection because of the need to resect potential areas of contamination, resulting in the need for more reconstructive procedures (flaps and skin grafts) and wider radiation fields. Read More

Eur Radiol 2015 Jul 11;25(7):2041-8. Epub 2015 Jan 11.

Department of Biomedical Imaging and Image-guided Therapy, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria,

Objectives: To test the feasibility and accuracy of MR-guided soft tissue tumour biopsy at 3T, using the dynamic contrast-enhanced (DCE) information from staging MRI for intralesional targeting.

Methods: After obtaining written informed consent for this institutional review board-approved study, 53 patients with suspected soft tissue tumours prospectively underwent preoperative staging MRI at 3T, including DCE, and subsequent MR-guided core needle biopsy. In 44/53 cases, DCE was heterogeneous and was used for intralesional biopsy targeting. Read More

Trials 2013 Jun 22;14:187. Epub 2013 Jun 22.

Department Physical Therapy, University of Granada, Granada, Spain.

Background: Breast cancer survivors suffer physical impairment after oncology treatment. This impairment reduces quality of life (QoL) and increase the prevalence of handicaps associated to unhealthy lifestyle (for example, decreased aerobic capacity and strength, weight gain, and fatigue). Recent work has shown that exercise adapted to individual characteristics of patients is related to improved overall and disease-free survival. Read More

Semin Musculoskelet Radiol 2013 Apr 14;17(2):189-202. Epub 2013 May 14.

Musculoskeletal Section, Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA.

This article reviews the basics of image-guided intervention of musculoskeletal neoplasms. Image-guided procedures are playing an ever-increasing role in the diagnosis, staging, and treatment of musculoskeletal tumors. The successful handling of these lesions necessitates a multidisciplinary approach, with the radiologist working closely with the orthopedic oncologic surgeon, medical oncologist, radiation oncologist, and pathologist to ensure that the procedure is performed in a way that maximizes the chance of definitive diagnosis and/or the treatment effect while minimizing potential complications. Read More

Eur J Radiol 2013 Dec 29;82(12):2083-91. Epub 2011 Dec 29.

Department of Orthopaedic Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy. Electronic address:

The appropriate diagnosis and treatment of bone tumors requires close collaboration between different medical specialists. Imaging plays a key role throughout the process. Radiographic detection of a bone tumor is usually not challenging. Read More

Semin Ultrasound CT MR 2011 Oct;32(5):433-41

Section of Musculoskeletal Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA.

Sarcomas are the most common nonhematologic primary malignancies of bones in the pelvis. Chondrosarcoma, osteosarcoma, and Ewing's sarcoma are the most common sarcomas to originate from the pelvic bones. Various imaging modalities such as magnetic resonance imaging and computed tomography play an important role in the detection, characterization, and staging of these lesions. Read More

J Hand Surg Am 2010 Sep;35(9):1479-84

Department of Surgery, Orthopaedic Surgery Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.

Purpose: Diagnosis of a soft tissue sarcoma of the hand is at times made only in retrospect after marginal excision of a presumed benign soft tissue mass. Magnetic resonance imaging (MRI) helps determine the presence of residual disease and the extent of contamination caused by marginal excision of unsuspected soft tissue sarcomas and assists in the planning of definitive treatment with surgery and radiotherapy when required. We sought to determine the accuracy of MRI in detecting residual sarcoma after marginal excision. Read More

Semin Musculoskelet Radiol 2007 Sep;11(3):246-60

Department of Radiology, Mayo Clinic, Jacksonville, Florida 32224-3899, USA.

Recent advances in PET technology and applications have led to a proliferation in PET and PET/CT imaging, allowing correlation of both physiologic and anatomic information. This has also led to new and innovative ways to utilize PET imaging for the evaluation of musculoskeletal neoplasm. Currently, the most widely utilized musculoskeletal application of F-18 FDG-PET imaging is for the detection and characterization of osseous metastatic disease. Read More

Instr Course Lect 2004 ;53:639-44

Department of Orthopedic Surgery, University of Florida, Gainesville, Florida, USA.

The biopsy of a musculoskeletal lesion is an important event, the outcome of which guides patient management and helps determine patient prognosis. The principles of biopsy include complete radiologic staging before the biopsy, thorough prebiopsy planning including consultation with the pathologist and radiologist, determining the most appropriate method of biopsy (fine needle, core needle, open surgical biopsy), placing the biopsy tract appropriately, and making sure the biopsy tract can be removed at the time of resection, avoiding contamination of uninvolved structures, avoiding transverse incisions, preventing pathologic fracture, handling biopsy tissue appropriately, and considering referral before biopsy. The common errors of biopsy include sampling errors, postbiopsy hematomas, the use of transverse incisions, tumor implantation, and the treatment of an unsuspected sarcoma with prophylactic fixation. Read More

Orthopade 2001 Aug;30(8):528-39

Klinik für Orthopädie und Sportorthopädie, TU-München, Klinikum rechts der Isar, Ismaninger Strasse 22, 81675 München.

Musculoskeletal neoplasms are rare, and both the medical history and complaints of the patients are usually uncharacteristic and of limited information. After a clinical evaluation and biplane conventional radiography, the clinician must classify the patient as having a nonprogressive or progressive primary benign, primary malignant, or metastatic bone tumor. In the case of a probably benign, nonprogressive bone tumor, the patient has to be observed continuously or an additional biopsy should be performed. Read More

Radiol Clin North Am 2001 Jul;39(4):701-20

Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri, USA.

The role of MR imaging in the evaluation of children with large, deep, or infiltrative soft tissue masses is to characterize and determine the extent of the lesion for treatment planning. There are a small number of soft tissue tumors with MR imaging appearances characteristic enough to allow a specific diagnosis, obviating biopsy. In the remaining cases with nonspecific imaging appearances, MR imaging is used for anatomic staging, but tissue sampling is still required for determining histology and grading. Read More

Eur J Radiol 2000 Jun;34(3):229-46

Department of Magnetic Resonance/MR/-1K 12 I.B., University Hospital Gent, De Pintelaan 185, B-9000, Gent, Belgium.

Magnetic resonance imaging is an important modality for the imaging evaluation of musculoskeletal tumors. Although there is general agreement on the value of unenhanced MR in detection, diagnosis and staging, intravenous use of gadolinium-contrast media (gd-CM) is indicated in selected cases. The purpose of this article is to review the basic pharmacokinetic principles and imaging techniques for static and dynamic contrast-enhanced MR imaging and to highlight the most important indications for administration of gd-CM in patients with musculsokeletal tumors and tumor-like lesions: adding specificity in tissue characterization, staging of local extent and biopsy planning, monitoring preoperative chemotherapy and detection of recurrence. Read More

Curr Opin Rheumatol 2000 Jan;12(1):77-83

Department of Pathology, Leiden University Medical Centre, The Netherlands.

Rheumatologists may be incidentally confronted by bone and soft tissue lesions presenting in and around joints that require early recognition and appropriate referral. The diagnostic and therapeutic management of patients with musculoskeletal tumors is critically dependent on a multidisciplinary approach. Advances, particularly in the fields of histopathology, molecular (cyto)genetics and radiologic imaging techniques, have resulted in significant improvements in reaching a correct (differential) diagnosis, essential for implementing optimal treatment modalities. Read More

AJR Am J Roentgenol 1999 Dec;173(6):1663-71

Department of Radiology, University of Virginia Health System, Charlottesville 22908, USA.

A thorough understanding of compartmental anatomy is essential for accurate staging of a suspected musculoskeletal tumor with MR imaging and for avoiding potentially devastating biopsy-related complications. Imaging-guided, percutaneous needle biopsy is a safe and cost-effective technique but requires careful planning in conjunction with the surgeon who will perform the definitive surgery because it constitutes the final step in the staging process and the first step in surgical therapy. Read More

Orthop Clin North Am 1996 Jul;27(3):473-81

Department of Orthopaedic Surgery, University of Louisville, Kentucky, USA.

This review has outlined the surgical staging of benign and malignant musculoskeletal neoplasms. Based on their unique natural history, these neoplasms behave in a predictable fashion. The surgical staging system assigns progressively higher degrees of risks to the neoplasms based on their surgical grade, their anatomic location, and the presence or absence of metastases. Read More

Magn Reson Imaging Clin N Am 1995 Nov;3(4):577-90

Department of Orthopaedic Surgery, University of Florida, College of Medicine, Gainesville, USA.

The management of patients with soft-tissue masses necessitates careful assessment and appropriate use of investigational tools to obtain a diagnosis. The interaction among surgeons, radiologists, and pathologists allows adequate staging of soft-tissue tumors and better planning of the definitive treatment. The ability of MR imaging to maximize contrast between normal and tumor tissues in any desired plane makes it usually the best cross-sectional imaging modality in the preoperative staging of soft-tissue masses. Read More

Magn Reson Imaging Clin N Am 1995 Nov;3(4):563-76

Department of Musculoskeletal Imaging, Mayo Graduate School of Medicine, USA.

MR imaging is the technique of choice for detection, characterization, and staging of soft-tissue neoplasms. MR examinations need to be tailored to each patient based upon the patient's size and anatomic region of interest so that optimal information is obtained. Technique is critical. Read More

Hematol Oncol Clin North Am 1995 Jun;9(3):571-604

Department of Radiologic Sciences, University of Texas Health Science Center at Houston, USA.

Imaging plays an important role in the diagnosis, staging, treatment planning, and post-treatment monitoring of bone and soft-tissue sarcomas. Plain radiography should be the initial imaging undertaken for patients who present with pain or a mass that may represent a musculoskeletal tumor. This is especially true of bony lesions, in which plain radiography remains the most specific noninvasive means of determining the aggressiveness of a lesion and establishing a working differential diagnosis. Read More

Spine (Phila Pa 1976) 1993 Aug;18(10):1292-7

University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario.

Fourteen patients were treated surgically for soft-tissue sarcoma arising in the paraspinal muscles. Eleven patients received adjuvant irradiation administered before or after resection. In describing the treatment and outcomes of these patients, a new classification of paraspinal soft-tissue sarcoma is introduced that is based on the anatomic relationship of the tumor to the spinal lamina and the epidural space. Read More

Orthop Clin North Am 1991 Jan;22(1):87-103

Kaiser-Permanente Medical Center, San Francisco, California.

Advances in prosthesis design, the use of allografts, and a systematic approach to the staging and surgical treatment of musculoskeletal tumors have made limb salvage possible in the proximal femoral region. With the use of effective adjuvant therapy, limb salvage is now an option for the majority of patients presenting with locally invasive neoplasms in this area. The increase in functional outcome is sufficient to warrant serious consideration of limb salvage over the corresponding amputation. Read More

Radiol Clin North Am 1986 Jun;24(2):259-67

MRI has been shown to be very useful in the work-up of musculoskeletal neoplasms. The lack of ionizing radiation, the superb contrast resolution, and the ability to directly scan the sagittal and coronal planes make MRI a very attractive imaging mode for treatment planning. With spin-echo MRI, maximum contrast between tumor and fatty tissues generally occurs with short TR and TE times (T1-weighted images). Read More

West J Med 1985 Dec;143(6):793-803

Magnetic resonance imaging has far-reaching real and possible clinical applications. Its usefulness has been best explored and realized in the central nervous system, especially the posterior fossa and brain stem, where most abnormalities are better identified than with computed tomography. Its lack of ionizing radiation and extreme sensitivity to normal and abnormal patterns of myelination make magnetic resonance imaging advantageous for diagnosing many neonatal and pediatric abnormalities. Read More