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Simple Summary: Sarcomas are a heterogeneous group of tumors that arise from mesenchymal tissue, including adipose, bone, cartilage, skeletal muscle, and smooth muscle. Because of their rarity, optimal treatment planning requires discussion among sarcoma-experienced subspecialists. Studies have shown that treatment guided by multidisciplinary tumor boards (MTBs) is associated with better compliance with clinical practice guidelines and, in some cases, increased survival. The role of radiologists in the MTB setting is valuable in assessing disease in patients with sarcoma; however, radiologists' recommendations may differ from the MTB's consensus. This study highlights the discordance between the disease assessment and the clinical recommendations provided by radiologists and MTBs and encourages all radiologists caring for patients with sarcoma to participate in MTBs to best align their interpretations with optimal clinical management and make multidisciplinary aligned recommendations whenever feasible. Multidisciplinary tumor boards (MTBs) facilitate decision-making among subspecialists in the care of oncology patients, but the mechanisms by which they enhance outcomes remain incompletely understood. Our aim was to measure the agreement between sarcoma MTBs and radiology reports' disease assessment and management recommendations. This single-center IRB-approved retrospective study evaluated cases presented at a weekly sarcoma MTB from 1 August 2020 to 31 July 2021. Cases without clinical notes, imaging studies, or radiology reports were excluded. The data collected included the patient's clinical status at the time of the MTB, the treatment response assessment by the MTB and radiologists (stable disease; partial response; complete response; progressive disease/recurrence), and the recommendations of the radiology reports and of the MTB. The agreement between the initial radiologist review and MTB on disease assessment and recommendations was analyzed using kappa statistics. In total, 283 cases met the inclusion criteria. Radiology reports provided recommendations in 34.3% of cases, which were adhered to by the ordering providers in 73.2% of cases. The agreement between MTBs and radiology reports was moderate in disease assessment (86.2% agreement; κ = 0.78; p < 0.0001) and negligible in recommendations (36% agreement; κ = 0.18; p < 0.0001). Radiologists were more likely to assign progressive disease/recurrence than MTBs (54.4% vs. 44.4%; p < 0.001) and to recommend short-term imaging follow-up more commonly than MTBs (46.4% vs. 21.7%; p < 0.001). At a tertiary care center, radiologists' isolated interpretations of imaging findings and management recommendations frequently differ from the MTB's consensus, reflecting the value of multidisciplinary discussions incorporating the patient's clinical status and the available treatment options into the final radiographic assessment. [ABSTRACT FROM AUTHOR]

31Phosphorus magnetic resonance spectroscopy (31P‐MRS) has been shown to detect altered energetic status (e.g. the ratio of inorganic phosphate to phosphocreatine: Pi/PCr), intracellular acid–base status, and free intracellular magnesium ([Mg2+]) in dystrophic muscle compared with unaffected muscle; however, the causes of these differences are not well understood. The purposes of this study were to examine 31P‐MRS indices of energetic status and sarcolemma integrity in young mdx mice compared with wild‐type and to evaluate the effects of downhill running to induce muscle damage on 31P‐MRS indices in dystrophic muscle. In vivo 31P‐MRS spectra were acquired from the posterior hindlimb muscles in young (4–10 weeks of age) mdx (C57BL/10ScSn‐DMDmdx) and wild‐type (C57BL/10ScSnJ) mice using an 11.1‐T MR system. The flux of phosphate from PCr to ATP was estimated by 31P‐MRS saturation transfer experiments. Relative concentrations of high‐energy phosphates were measured, and intracellular pH and [Mg2+] were calculated. 1H2O‐T2 was measured using single‐voxel 1H‐MRS from the gastrocnemius and soleus using a 4.7‐T MR system. Downhill treadmill running was performed in a subset of mice. Young mdx mice were characterized by elevated 1H2O‐T2 (p < 0.01), Pi/PCr (p = 0.02), PCr to ATP flux (p = 0.04) and histological inflammatory markers (p < 0.05) and reduced (p < 0.01) [Mg2+] compared with wild‐type. Furthermore, 24 h after downhill running, an increase (p = 0.02) in Pi/PCr was observed in mdx and wild‐type mice compared with baseline, and a decrease (p < 0.001) in [Mg2+] and a lower (p = 0.048) intracellular [H+] in damaged muscle regions of mdx mice were observed, consistent with impaired sarcolemma integrity. Overall, our findings demonstrate that 31P‐MRS markers of energetic status and sarcolemma integrity are altered in young mdx compared with wild‐type mice, and these indices are exacerbated following downhill running. [ABSTRACT FROM AUTHOR]

31 Phosphorus magnetic resonance spectroscopy ( 31 P-MRS) has been shown to detect altered energetic status (e.g. the ratio of inorganic phosphate to phosphocreatine: Pi/PCr), intracellular acid-base status, and free intracellular magnesium ([Mg 2+ ]) in dystrophic muscle compared with unaffected muscle; however, the causes of these differences are not well understood. The purposes of this study were to examine 31 P-MRS indices of energetic status and sarcolemma integrity in young mdx mice compared with wild-type and to evaluate the effects of downhill running to induce muscle damage on 31 P-MRS indices in dystrophic muscle. In vivo 31 P-MRS spectra were acquired from the posterior hindlimb muscles in young (4-10 weeks of age) mdx (C57BL/10ScSn-DMDmdx) and wild-type (C57BL/10ScSnJ) mice using an 11.1-T MR system. The flux of phosphate from PCr to ATP was estimated by 31 P-MRS saturation transfer experiments. Relative concentrations of high-energy phosphates were measured, and intracellular pH and [Mg 2+ ] were calculated. 1 H 2 O-T 2 was measured using single-voxel 1 H-MRS from the gastrocnemius and soleus using a 4.7-T MR system. Downhill treadmill running was performed in a subset of mice. Young mdx mice were characterized by elevated 1 H 2 O-T 2 (p < 0.01) , Pi/PCr (p = 0.02), PCr to ATP flux (p = 0.04) and histological inflammatory markers (p < 0.05) and reduced (p < 0.01) [Mg 2+ ] compared with wild-type. Furthermore, 24 h after downhill running, an increase (p = 0.02) in Pi/PCr was observed in mdx and wild-type mice compared with baseline, and a decrease (p < 0.001) in [Mg 2+ ] and a lower (p = 0.048) intracellular [H + ] in damaged muscle regions of mdx mice were observed, consistent with impaired sarcolemma integrity. Overall, our findings demonstrate that 31 P-MRS markers of energetic status and sarcolemma integrity are altered in young mdx compared with wild-type mice, and these indices are exacerbated following downhill running., (© 2021 John Wiley & Sons, Ltd.)