Soft tissue sarcoma: preoperative and postoperative imaging for staging

Soft tissue sarcoma (STS) management requires accurate tumor imaging for staging, treatment planning, and clinical follow-up. Careful preoperative planning may prevent poor primary resections that place the patient at risk for more operations, local recurrence, and worse survival. Although MRI may be preferred for extremity STS, contrast-enhanced CT is an excellent alternative, with no decrease in ability to plan the operative strategy for limb-sparing resection. In retroperitoneal and other intra-abdominal STS, double (oral/intravenous) contrast-enhanced CT evaluates for liver metastases, defines surrounding vital structures that might be resected en bloc, identifies margins at risk for local recurrence, and shows surrounding organs at risk for toxicity during radiation therapy. Postoperative clinical follow-up and imaging must continue even beyond 5 years because of the continued risk of long-term relapse.