Browsing by Author "Arkun R."

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    Primary tumors of the spine
    (Thieme Medical Publishers, Inc., 2014) Orguc S.; Arkun R.
    Spinal tumors consist of a large spectrum of various histologic entities. Multiple spinal lesions frequently represent known metastatic disease or lymphoproliferative disease. In solitary lesions primary neoplasms of the spine should be considered. Primary spinal tumors may arise from the spinal cord, the surrounding leptomeninges, or the extradural soft tissues and bony structures. A wide variety of benign neoplasms can involve the spine including enostosis, osteoid osteoma, osteoblastoma, aneurysmal bone cyst, giant cell tumor, and osteochondroma. Common malignant primary neoplasms are chordoma, chondrosarcoma, Ewing sarcoma or primitive neuroectodermal tumor, and osteosarcoma. Although plain radiographs may be useful to characterize some spinal lesions, magnetic resonance imaging is indispensable to determine the extension and the relationship with the spinal canal and nerve roots, and thus determine the plan of management. In this article we review the characteristic imaging features of extradural spinal lesions. Copyright © 2014 by Thieme Medical Publishers, Inc.
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    Tumor-like Lesions of Bone and Soft Tissues and Imaging Tips for Differential Diagnosis
    (Thieme Medical Publishers, Inc., 2020) Örgüç S.; Arkun R.
    In the musculoskeletal system, tumor-like lesions may present similar imaging findings as bone and soft tissue tumors and can be defined as tumors on radiologic examinations. Misinterpretation of the imaging findings can lead to inappropriate clinical management of the patient. There is still some debate regarding the pathophysiology and origin of tumor-like lesions that include congenital, developmental, inflammatory, infectious, metabolic, reactive, posttraumatic, post-therapeutic changes, and some miscellaneous entities causing structural changes. Although tumor-like lesions are historically defined as non-neoplastic lesions, some of them are classified as real neoplasms. We discuss a spectrum of entities mimicking tumors of bone and soft tissues that include various non-neoplastic diseases and anatomical variants based on imaging findings. © 2020 BMJ Publishing Group. All rights reserved.
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    Soft tissue tumor imaging in adults: European Society of Musculoskeletal Radiology–Guidelines 2024: imaging immediately after neoadjuvant therapy in soft tissue sarcoma, soft tissue tumor surveillance, and the role of interventional radiology
    (Springer Science and Business Media Deutschland GmbH, 2024) Noebauer-Huhmann I.-M.; Vilanova J.C.; Papakonstantinou O.; Weber M.-A.; Lalam R.K.; Nikodinovska V.V.; Sanal H.T.; Lecouvet F.E.; Navas A.; Martel-Villagrán J.; de Rooy J.W.J.; Fritz J.; Verstraete K.; Grieser T.; Szomolanyi P.; Chaudhary S.; Sconfienza L.M.; Tagliafico A.S.; Afonso P.D.; Albtoush O.M.; Aringhieri G.; Arkun R.; Aström G.; Bazzocchi A.; Botchu R.; Breitenseher M.; Dalili D.; Davies M.; de Jonge M.C.; Mete B.D.; Gielen J.L.M.A.; Hide G.; Isaac A.; Ivanoski S.; Mansour R.M.; Mccarthy C.; Muntaner-Gimbernat L.; O’Donnell P.; Örgüç Ş.; Rennie W.J.; Resano S.; Robinson P.; Ter Horst S.A.J.; van Langevelde K.; Wörtler K.; Koelz M.; Panotopoulos J.; Windhager R.; Fueger B.J.; Schmid M.; Vanhoenacker F.M.
    Objectives: An update of the first European Society of Musculoskeletal Radiology (ESSR) consensus on soft tissue tumor imaging in 2015 became necessary due to technical advancements, further insights into specific entities, and the revised WHO classification (2020) and AJCC staging system (2017). The third part of the revised guidelines covers algorithms and techniques beyond initial imaging: (1) Imaging after neoadjuvant therapy in soft tissue sarcoma, (2) sarcoma surveillance, and (3) special aspects, including surveillance of non-malignant entities and the role of interventional radiology. Materials and methods: A validated Delphi method based on peer-reviewed literature was used to derive consensus among a panel of 46 specialized musculoskeletal radiologists from 12 European countries. Statements that had undergone interdisciplinary revision were scored online by level of agreement (0 to 10) during two iterative rounds that could result in either ‘group consensus,’ ‘group agreement,’ or ‘lack of agreement.’ Results: The three sections contain 47 statements with comments. Group consensus was reached in 91.5%, group agreement in 6.4%, lack of agreement in 2.1%. In sarcoma, imaging immediately after neoadjuvant therapy is pivotal for determining the therapy effects and for resection-planning; surveillance should include imaging at fixed grade- and type-dependent intervals. In general, MRI is the method of choice for loco-regional surveillance of soft tissue sarcomas, and chest CT to assess metastatic disease. Interventional radiology has a role, especially in oligometastatic disease, palliative tumor control and local recurrences. Conclusion: Strategies for standardized soft tissue tumor imaging regarding therapy control, surveillance, and useful interventional procedures are provided. Key Points: Question An ESSR consensus update on soft tissue tumor imaging regarding surveillance became necessary due to technical advancements, further entity-specific insights, and revised WHO- and AJCC-classifications. Findings Imaging immediately after neoadjuvant therapy in soft tissue sarcoma is pivotal. Post-therapeutic surveillance should include imaging at regular intervals, stratified for tumor grade and type. Clinical relevance The updated ESSR soft tissue tumor imaging guidelines aim to provide best practice expert consensus for standardized imaging, to support radiologists in their decision-making, and to improve examination comparability, both in individual patients and in future studies on individualized strategies. © The Author(s) 2024.
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    Soft tissue tumor imaging in adults: European Society of Musculoskeletal Radiology-Guidelines 2023—overview, and primary local imaging: how and where?
    (Springer Science and Business Media Deutschland GmbH, 2024) Noebauer-Huhmann I.-M.; Vanhoenacker F.M.; Vilanova J.C.; Tagliafico A.S.; Weber M.-A.; Lalam R.K.; Grieser T.; Nikodinovska V.V.; de Rooy J.W.J.; Papakonstantinou O.; Mccarthy C.; Sconfienza L.M.; Verstraete K.; Martel-Villagrán J.; Szomolanyi P.; Lecouvet F.E.; Afonso D.; Albtoush O.M.; Aringhieri G.; Arkun R.; Aström G.; Bazzocchi A.; Botchu R.; Breitenseher M.; Chaudhary S.; Dalili D.; Davies M.; de Jonge M.C.; Mete B.D.; Fritz J.; Gielen J.L.M.A.; Hide G.; Isaac A.; Ivanoski S.; Mansour R.M.; Muntaner-Gimbernat L.; Navas A.; O´Donnell P.; Örgüç Ş.; Rennie W.; Resano S.; Robinson P.; Sanal H.T.; Ter Horst S.A.J.; van Langevelde K.; Wörtler K.; Koelz M.; Panotopoulos J.; Windhager R.; Bloem J.L.
    Objectives: Early, accurate diagnosis is crucial for the prognosis of patients with soft tissue sarcomas. To this end, standardization of imaging algorithms, technical requirements, and reporting is therefore a prerequisite. Since the first European Society of Musculoskeletal Radiology (ESSR) consensus in 2015, technical achievements, further insights into specific entities, and the revised WHO-classification (2020) and AJCC staging system (2017) made an update necessary. The guidelines are intended to support radiologists in their decision-making and contribute to interdisciplinary tumor board discussions. Materials and methods: A validated Delphi method based on peer-reviewed literature was used to derive consensus among a panel of 46 specialized musculoskeletal radiologists from 12 European countries. Statements were scored online by level of agreement (0 to 10) during two iterative rounds. Either “group consensus,” “group agreement,” or “lack of agreement” was achieved. Results: Eight sections were defined that finally contained 145 statements with comments. Overall, group consensus was reached in 95.9%, and group agreement in 4.1%. This communication contains the first part consisting of the imaging algorithm for suspected soft tissue tumors, methods for local imaging, and the role of tumor centers. Conclusion: Ultrasound represents the initial triage imaging modality for accessible and small tumors. MRI is the modality of choice for the characterization and local staging of most soft tissue tumors. CT is indicated in special situations. In suspicious or likely malignant tumors, a specialist tumor center should be contacted for referral or teleradiologic second opinion. This should be done before performing a biopsy, without exception. Clinical relevance: The updated ESSR soft tissue tumor imaging guidelines aim to provide best practice expert consensus for standardized imaging, to support radiologists in their decision-making, and to improve examination comparability both in individual patients and in future studies on individualized strategies. Key Points: • Ultrasound remains the best initial triage imaging modality for accessible and small suspected soft tissue tumors. • MRI is the modality of choice for the characterization and local staging of soft tissue tumors in most cases; CT is indicated in special situations. Suspicious or likely malignant tumors should undergo biopsy. • In patients with large, indeterminate or suspicious tumors, a tumor reference center should be contacted for referral or teleradiologic second opinion; this must be done before a biopsy. © The Author(s) 2023.
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    Giant Cell Tumor of the Spine
    (Springer Science and Business Media Deutschland GmbH, 2024) Orguc S.; Açar Ç.R.; Arkun R.
    Giant cell tumor (GCT) of the spine is a rare condition characterized by locally aggressive osteolytic tumors. While GCTs commonly occur in the epiphysiometaphysis of long bones, spinal lesions are relatively uncommon. The pathologic features of GCTs involve a vascularized stroma composed of spindle-shaped mononuclear cells and multinucleated giant cells. Although GCTs are typically considered benign, approximately 10% may exhibit malignant behavior. Spinal GCTs can present with pain, weakness, and neurological deficits due to compression of neural elements. Imaging techniques such as conventional radiography, computed tomography (CT), magnetic resonance imaging (MRI), and PET/CT can help in diagnosis and staging. The solid portions of GCTs typically demonstrate low signal intensity on T2-weighted images (WI) and intermediate signal intensity on T1-WI, due to the presence of collagen within the fibrous components and hemosiderin deposition. Treatment typically involves complete resection of the tumor, preferably with en bloc resection for better prognosis. However, surgery may be challenging due to the soft and easily ruptured nature of GCTs. In cases where complete surgical resection is not feasible or the tumor exhibits aggressive behavior, adjuvant treatments such as radiotherapy may be considered to control local disease progression, while the use of denosumab has shown promise in reducing tumor size and inhibiting osteolysis in unresectable or recurrent giant cell tumors of the spine. Histopathological verification is essential for a definitive diagnosis, and differential diagnoses include other bone tumors and cystic lesions. Various classification systems exist to assess the aggressiveness and guide treatment decisions, although their correlation with local recurrence and metastases is uncertain. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023.
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    Soft tissue tumor imaging in adults: whole-body staging in sarcoma, non-malignant entities requiring special algorithms, pitfalls and special imaging aspects. Guidelines 2024 from the European Society of Musculoskeletal Radiology (ESSR)
    (Springer Science and Business Media Deutschland GmbH, 2025) Noebauer-Huhmann I.-M.; Vanhoenacker F.M.; Vilanova J.C.; Tagliafico A.S.; Weber M.-A.; Lalam R.K.; Grieser T.; Nikodinovska V.V.; de Rooy J.W.J.; Papakonstantinou O.; Mccarthy C.; Sconfienza L.M.; Verstraete K.; Martel-Villagrán J.; Szomolanyi P.; Lecouvet F.E.; Afonso D.; Albtoush O.M.; Aringhieri G.; Arkun R.; Aström G.; Bazzocchi A.; Botchu R.; Breitenseher M.; Chaudhary S.; Dalili D.; Davies M.; de Jonge M.C.; Mete B.D.; Fritz J.; Gielen J.L.M.A.; Hide G.; Isaac A.; Ivanoski S.; Mansour R.M.; Muntaner-Gimbernat L.; Navas A.; O´Donnell P.; Örgüç Ş.; Rennie W.J.; Resano S.; Robinson P.; Sanal H.T.; Ter Horst S.A.J.; van Langevelde K.; Wörtler K.; Koelz M.; Panotopoulos J.; Windhager R.; Bloem J.L.
    Objectives: The revised European Society of Musculoskeletal Radiology (ESSR) consensus guidelines on soft tissue tumor imaging represent an update of 2015 after technical advancements, further insights into specific entities, and revised World Health Organization (2020) and AJCC (2017) classifications. This second of three papers covers algorithms once histology is confirmed: (1) standardized whole-body staging, (2) special algorithms for non-malignant entities, and (3) multiplicity, genetic tumor syndromes, and pitfalls. Materials and methods: A validated Delphi method based on peer-reviewed literature was used to derive consensus among a panel of 46 specialized musculoskeletal radiologists from 12 European countries. Statements that had undergone interdisciplinary revision were scored online by the level of agreement (0 to 10) during two iterative rounds, that could result in ‘group consensus’, ‘group agreement’, or ‘lack of agreement’. Results: The three sections contain 24 statements with comments. Group consensus was reached in 95.8% and group agreement in 4.2%. For whole-body staging, pulmonary MDCT should be performed in all high-grade sarcomas. Whole-body MRI is preferred for staging bone metastasis, with [18F]FDG-PET/CT as an alternative modality in PET-avid tumors. Patients with alveolar soft part sarcoma, clear cell sarcoma, and angiosarcoma should be screened for brain metastases. Special algorithms are recommended for entities such as rhabdomyosarcoma, extraskeletal Ewing sarcoma, myxoid liposarcoma, and neurofibromatosis type 1 associated malignant peripheral nerve sheath tumors. Satisfaction of search should be avoided in potential multiplicity. Conclusion: Standardized whole-body staging includes pulmonary MDCT in all high-grade sarcomas; entity-dependent modifications and specific algorithms are recommended for sarcomas and non-malignant soft tissue tumors. Clinical relevance statement: These updated ESSR soft tissue tumor imaging guidelines aim to provide support in decision-making, helping to avoid common pitfalls, by providing general and entity-specific algorithms, techniques, and reporting recommendations for whole-body staging in sarcoma and non-malignant soft tissue tumors. Key Points: An early, accurate, diagnosis is crucial for the prognosis of patients with soft tissue tumors. These updated guidelines provide best practice expert consensus for standardized imaging algorithms, techniques, and reporting. Standardization can improve the comparability examinations and provide databases for large data analysis. © The Author(s) 2024.