E2604. Out on a Limb: Preoperative Imaging Evaluation of Soft Tissue Sarcoma in Limb-Sparing Surgery
  1. Connie Liou; New York Presbyterian - Columbia University
  2. Collin Edwards; New York Presbyterian - Columbia University
  3. Tony Wong; New York Presbyterian - Columbia University
  4. Zohaib Ahmad; New York Presbyterian - Columbia University
Soft tissue sarcomas are rare, malignant tumors with a high mortality and a high propensity to metastasize. Traditionally, definitive surgical treatment was amputation, especially in cases of neurovascular involvement. However, recent advances in neoadjuvant therapy and nerve/vascular preservation and grafting allow for the limb in question to be salvaged. This limb-salvaging surgery allows for better functional outcomes compared to amputation. Imaging is a vital component in pre-operative evaluation allowing for full evaluation of osseous, muscular, vascular, and neuronal involvement. Alongside functional evaluation of the patient, the decision of amputation versus tumor resection can be made. Furthermore, magnetic resonance imaging (MRI) can be used after adjuvant therapy to assess response and subsequent prognosis after the limb-salvaging surgery. The purpose of this educational exhibit is to discuss the goals and criteria for limb-salvaging surgery and review the MRI imaging appearances and classifications necessary to plan a resection of soft tissue sarcomas.

Educational Goals / Teaching Points
The teaching points of this exhibit are to discuss the goals and criteria for limb-salvaging surgery, review the initial treatment methods including adjuvant therapy and incomplete resection, review the imaging approach to initial evaluation of a soft tissue sarcoma, delineate imaging appearances and changes after adjuvant therapy that inform prognosis, and delineate neurovascular involvement and classification that will inform the surgical approach.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
This exhibit will primarily involve the appearance of soft tissue sarcoma on MRI including a discussion on malignant involvement of the surrounding anatomy (osseous, muscular, vascular, and nerve). Key imaging findings will include changes in signal intensity, enhancement, and surrounding anatomical involvement after adjuvant therapy. These findings will specify the exact involvement of the adjacent vasculature and nerves.

Limb-salvaging surgery for soft tissue sarcoma can preserve a patient’s functional status. MRI can provide an indication for prognosis and a roadmap for surgical resection and reconstruction especially in the setting of vascular and nerve involvement.