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The Changing World of Musculoskeletal Imaging Oncology

The Changing World of Musculoskeletal Imaging Oncology

When they are malignant, bone and soft tissue tumors are devastating. Unfortunately, the more common benign tumors are hard to distinguish from their deadly counterparts, leading to unnecessary biopsies of many tumors that are harmless. Laura Fayad, M.D., chief of musculoskeletal imaging at Johns Hopkins, uses MRI in new ways to change how doctors approach these tumors.

Fayad has developed functional and metabolic imaging techniques from which she can determine malignancy, potentially saving the patient from a biopsy. Furthermore, for conditions that are associated with tumors all over the body, such as neurofibromatosis (the most common congenital neurologic disorder), Fayad and her team have developed whole-body MRI techniques to see the tiny tumors growing on the peripheral nerves. They are able to spot a malignancy amid the vast array of benign tumors that are characteristic of this disease.

“If it’s benign, we don’t do a biopsy. We follow it or forget it,” Fayad says. “These advanced sequences probably save patients a biopsy about 20 percent of the time.” Furthermore, Fayad’s musculoskeletal imaging team has worked on using her advanced MRI techniques to improve the accuracy of medical interventions, like biopsies and tumor treatments.

Another burgeoning area in musculoskeletal work is in developing new MRI techniques for imaging prosthetic joints to reduce visual artifacts that have plagued traditional CT and MRI.

“More than 1 million people will get joint replacements in the United States each year. Better imaging will be important for them, and at Johns Hopkins, we have a technique called SMART imaging that uses metal artifact reduction sequences in patients who have had traumas, tumors and arthritis,” she says.

Central to any musculoskeletal imaging is the practice of sports medicine. Fayad says the team is capable of the fastest high-resolution scans in the country. Her team worked directly with MRI engineers to optimize image sequencing.

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