Clinical and Radiologic Features Together Better Predict Lung Nodule Malignancy in Patients with Soft-Tissue Sarcoma.

We test the hypothesis that a model including clinical and computed tomography (CT) features may allow discrimination between benign and malignant lung nodules in patients with soft-tissue sarcoma (STS). Seventy-one patients with STS undergoing their first lung metastasectomy were examined. The performance of multiple logistic regression models including CT features alone, clinical features alone, and combined features, was tested to evaluate the best model in discriminating malignant from benign nodules. The likelihood of malignancy increased by more than 11, 2, 6 and 7 fold, respectively, when histological synovial sarcoma sub-type was associated with the following CT nodule features: size ≥ 5.6 mm, well defined margins, increased size from baseline CT, and new onset at preoperative CT. Likewise, in the case of grade III primary tumor, the odds ratio (OR) increased by more than 17 times when the diameter of pulmonary nodules (PNs) was >5.6 mm, more than 13 times with well-defined margins, more than 7 times with PNs increased from baseline CT, and more than 20 times when there were new-onset nodules. Finally, when CT nodule was ≥5.6 in size, it had well-defined margins, it increased in size from baseline CT, and when new onset nodules at preoperative CT were concomitant to residual primary tumor R2, the risk of malignancy increased by more than 10, 6, 25 and 28 times, respectively. The combination of clinical and CT features has the highest predictive value for detecting the malignancy of pulmonary nodules in patients with soft tissue sarcoma, allowing early detection of nodule malignancy and treatment options.

Quadratus Femoris muscle causing deep gluteal syndrome: A rare cause of refractory sciatica of extraspinal origin in the presence of an anatomic variation.

BACKGROUND: Sciatica of extraspinal origin represents both a diagnostic and a therapeutic challenge for spine specialists. Among these, quadratus femoris muscle (QF) is often overlooked as a pain-generator. REPORTED CASE: A 62-year old man was referred from general practitioner for isolated sciatica in the left leg, refractory to conservative treatments. Plain x-rays of the spine did not show any pathological finding nor did magnetic resonance imaging (MRI). MRI and CT showed QF with unusual morphologic features and agenesis of the contralateral QF. Ultrasonography-guided injection in the muscle was performed with mepivacaine and methylprednisolone obtaining relief of the symptoms. DISCUSSION: Leg pain can be very disabling and, when combined with a normal MRI of the spine, diagnosis can be tricky. Several causes of sciatica of extraspinal origin have been described, some of them originating from the so-called "deep gluteal space". Anecdotal communications on anatomical variations of the quadratus femoris muscle are reported in literature. CONCLUSIONS: Differential diagnosis of sciatica of extraspinal origin must rule out sacroiliac and hip joint so as deep gluteal space structures. Among these, quadratus femoris muscle is often overlooked as a pain-generator. Ultrasonography-guided intramuscular injections and a program of stretching and strengthening exercises can achieve durable control on the symptoms.

Does sarcopenia affect outcome in patients with non-small-cell lung cancer harboring EGFR mutations?

AIM: To evaluate gefitinib outcomes in EGFR-mutated non-small-cell lung cancer (NSCLC) patients harboring EGFR mutations, according to their sarcopenia status. PATIENTS & METHODS: We retrospectively evaluated 33 patients with advanced NSCLC and EGFR mutations (exon 19 or 21), dividing them into sarcopenic patients, with low skeletal muscle index ≤39 cm2/m2 for women and ≤55 cm2/m2 for men, and nonsarcopenic patients. RESULTS: Sarcopenia does not affect response to gefitinib treatment in EGFR mutated NSCLC patients, even if it is a bad prognostic indicator for overall survival (p = 0.035). CONCLUSION: Early recognition of sarcopenia is beneficial for prevention of cancer cachexia and detection of patients at potential risk of serious adverse events. Gefitinib dosage should be reduced and modulated in sarcopenic patients.

Neuropathic osteoarthropathy with and without superimposed osteomyelitis in patients with a diabetic foot.

Soft tissue and bone infection involving the foot is one of the most common long-term complications of diabetes mellitus, implying a serious impairment in quality of life for patients in the advanced stages of the disease. Neuropathic osteoarthropathy often coexists and differentiating between these two entities is commonly challenging, but crucial, as the management may differ substantially. The importance of correct diagnosis cannot be understated and effective management requires a multidisciplinary approach owing to the complicated nature of therapy in such patients. A missed diagnosis has a high likelihood of major morbidity for the patient, including limb amputation, and over-diagnosis results in a great socioeconomic challenge for healthcare systems, the over-utilization of healthcare resources, and the unwise use of antibiotics. Diagnosis is largely based on clinical signs supplemented by various imaging modalities such as radiography, MR imaging, and hybrid imaging techniques such as F-18 fluorodeoxyglucose-positron emission tomography. In the interests of the management of diabetic foot complications, this review article is aimed on the one hand at providing radiologists with important clinical knowledge, and on the other hand to equip clinicians with relevant radiological semiotics.