Assessment of neurovascular bundle involvement by an extremity sarcoma on MRI: a critical decision for sarcoma surgeon.

Abstract

Bone or soft tissue sarcoma of the extremity represents a varied group of mesenchymal tumors, with an extensive range of histopathology, epidemiology, and anatomical involvement. Many of these tumors grow to involve the adjacent major neurovascular bundles, leading to a paradigm shift of management between limb salvage and limb amputation. MRI is the gold standard imaging modality for assessing neurovascular involvement, primarily on T2-weighted fat suppressed (T2 W FS) axial and T1-weighted (T1 W) axial sequences. The differential imaging pattern or appearance of peritumoral edema and tumor has led to further insights in managing extremity sarcoma. This article aims to unfurl the various intricacies of neurovascular involvement by extremity sarcoma on MRI for a multidisciplinary management approach.