A Better Way to Assess Neurovascular Bundle Involvement in Extremity Sarcoma

Background: Bone or soft tissue extremity sarcomas can threaten nearby neurovascular bundles. In these situations, accurate imaging assessment is crucial for surgical planning. The decision between limb salvage and amputation depends on delineating the tumor’s relationship with adjacent vessels and nerves. The authors review MRI’s important role in evaluating neurovascular bundle (NVB) involvement and implications for sarcoma management. Objective: To describe patterns of neurovascular involvement by extremity sarcoma on MRI. Discussion: The NVB, composed of artery, vein, and nerve within a connective sheath, is uninvolved if fat planes are preserved. Peritumoral edema can complicate the interpretation of MRI. T2-weighted fat-suppressed and T1-weighted axial sequences are necessary in helping differentiate true tumor margins from reactive edema, with reactive edema often responsive to neoadjuvant therapy. The article proposes a 4-tier categorization of tumor–NVB relationships: Catego more...