Open Access

Iris-Melanie Noebauer-Huhmann, Filip M. Vanhoenacker, Joan C. Vilanova, Alberto S. Tagliafico, Marc-André Weber, Radhesh K. Lalam, Thomas Grieser, Violeta Vasilevska Nikodinovska, Jacky W. J. de Rooy, Olympia Papakonstantinou, Catherine Mccarthy, Luca Maria Sconfienza, Koenraad Verstraete, José Martel-Villagrán, Pavol Szomolanyi, Frédéric E. Lecouvet, Diana Afonso, Omar M. Albtoush, Giacomo Aringhieri, Remide Arkun, Gunnar Aström, Alberto Bazzocchi, Rajesh Botchu, Martin Breitenseher, Snehansh Chaudhary, Danoob Dalili, Mark Davies, Milko C. de Jonge, Berna D. Mete, Jan Fritz, Jan L. M. A. Gielen, Geoff Hide, Amanda Isaac, Slavcho Ivanoski, Ramy M. Mansour, Lorenzo Muntaner-Gimbernat, Ana Navas, Paul O´Donnell, Şebnem Örgüç, Winston Rennie, Santiago Resano, Philip Robinson, Hatice T. Sanal, Simone A. J. Ter Horst, Kirsten van Langevelde, Klaus Wörtler, Marita Koelz, Joannis Panotopoulos, Reinhard Windhager, Johannes L. Bloem

• Objectives Early, accurate diagnosis is crucial for the prognosis of patients with soft tissue sarcomas. To this end, standardization of imaging algorithms, technical requirements, and reporting is therefore a prerequisite. Since the first European Society of Musculoskeletal Radiology (ESSR) consensus in 2015, technical achievements, further insights into specific entities, and the revised WHO-classification (2020) and AJCC staging system (2017) made an update necessary. The guidelines are intended to support radiologists in their decision-making and contribute to interdisciplinary tumor board discussions. Materials and methods A validated Delphi method based on peer-reviewed literature was used to derive consensus among a panel of 46 specialized musculoskeletal radiologists from 12 European countries. Statements were scored online by level of agreement (0 to 10) during two iterative rounds. Either “group consensus,” “group agreement,” or “lack of agreement” wasObjectives Early, accurate diagnosis is crucial for the prognosis of patients with soft tissue sarcomas. To this end, standardization of imaging algorithms, technical requirements, and reporting is therefore a prerequisite. Since the first European Society of Musculoskeletal Radiology (ESSR) consensus in 2015, technical achievements, further insights into specific entities, and the revised WHO-classification (2020) and AJCC staging system (2017) made an update necessary. The guidelines are intended to support radiologists in their decision-making and contribute to interdisciplinary tumor board discussions. Materials and methods A validated Delphi method based on peer-reviewed literature was used to derive consensus among a panel of 46 specialized musculoskeletal radiologists from 12 European countries. Statements were scored online by level of agreement (0 to 10) during two iterative rounds. Either “group consensus,” “group agreement,” or “lack of agreement” was achieved. Results Eight sections were defined that finally contained 145 statements with comments. Overall, group consensus was reached in 95.9%, and group agreement in 4.1%. This communication contains the first part consisting of the imaging algorithm for suspected soft tissue tumors, methods for local imaging, and the role of tumor centers. Conclusion Ultrasound represents the initial triage imaging modality for accessible and small tumors. MRI is the modality of choice for the characterization and local staging of most soft tissue tumors. CT is indicated in special situations. In suspicious or likely malignant tumors, a specialist tumor center should be contacted for referral or teleradiologic second opinion. This should be done before performing a biopsy, without exception. Clinical relevance The updated ESSR soft tissue tumor imaging guidelines aim to provide best practice expert consensus for standardized imaging, to support radiologists in their decision-making, and to improve examination comparability both in individual patients and in future studies on individualized strategies.…