Quality of Initial MRI Reports for Soft-Tissue Sarcomas and Their Association with Radiologic Recognition of Sarcoma

Objectives: Although MRI is the preferred modality for evaluating suspected soft-tissue sarcomas (STSs), initial MRI reports are frequently incomplete and often fail to document key features that support diagnosis, staging, and timely referral. This study assessed the quality of initial MRI reports for STSs and identified the specific reporting characteristics most strongly associated with diagnostic correlation. Methods: A retrospective review was performed of 100 patients with histologically confirmed STSs presenting to a specialized sarcoma center between 2021 and 2024. Initial MRI reports performed externally were analyzed for 19 characteristics based on the European Society of Musculoskeletal Radiology guidelines. Reports were stratified by radiologist fellowship training. Findings were compared across groups, and individual MRI features were assessed for correlation with final histopathologic diagnosis. Results: Overall, initial MRI reporting was incomplete, with most features documented in fewer than 70% of cases. Reports by MSK radiologists were higher in quality, more often included bone involvement, peritumoral edema, and suspicion of malignancy. Diagnostic correlation was significantly greater for MSK radiologists compared to general radiologists (p = 0.027). Documentation of heterogeneity, depth, gadolinium use, necrosis, and suspicion of malignancy were all strongly associated with diagnostic correlation. Conclusions: Initial MRI reports for STSs frequently lack key diagnostic features, but MSK fellowship-trained radiologists produce higher-quality reports and demonstrate stronger diagnostic concordance. Standardized reporting frameworks may ultimately improve patient care and would benefit from direct evaluation in future studies.