Soft Tissue-RADS: An ACR Work-in-Progress Framework for Standardized Reporting of Soft-Tissue Lesions on MRI

Soft-tissue tumors and tumorlike lesions are commonly identified on imaging and encompass a wide spectrum of entities. For lesions lacking classic features of a particular benign diagnosis, the radiologist must carefully assess its likelihood of representing an aggressive or malignant entity. However, in the absence of classic features, this determination is challenging. In 2023, the American College of Radiology (ACR) launched the development of Soft Tissue-RADS to serve as a unified framework for approaching these lesions. Soft Tissue-RADS, currently designated by the ACR as a work in progress, provides a standardized classification for soft-tissue tumors and tumorlike lesions encountered on MRI, incorporating seven categories (0 through 6), each with linked management recommendations, and diagnostic algorithms presented as flowcharts for guiding category selection. This Clinical Perspective provides an overview of Soft Tissue-RADS. We present the proposed risk categories and associated diagnostic algorithms, provide a structured report template, and show numerous case examples. The proposed system seeks to assist radiologists in differentiating benign soft-tissue tumors and tumorlike lesions from aggressive or malignant tumors, improve the clarity of radiology reports through succinct communication of malignancy risk, guide appropriate management recommendations, facilitate assessment of radiologic-pathologic concordance, refine posttreatment evaluation, and streamline data-informed approaches to sarcoma care.

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Publication Details

Journal
American Journal of Roentgenology
Published
2025-11-26
DOI
https://doi.org/10.2214/ajr.25.34013
Citations
6
Primary Topic
Sarcoma Diagnosis and Treatment
Type
article
Field-Weighted Citation Impact
9.11
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article

Soft Tissue-RADS: An ACR Work-in-Progress Framework for Standardized Reporting of Soft-Tissue Lesions on MRI

Carol D. Morris, Julie C. Fanburg–Smith, Majid Chalian, Hillary W. Garner et al.
6 citations
American Journal of Roentgenology
Sarcoma Diagnosis and Treatment
9.11
article

Soft Tissue-RADS: An ACR Work-in-Progress Framework for Standardized Reporting of Soft-Tissue Lesions on MRI

Carol D. Morris, Julie C. Fanburg–Smith, Majid Chalian, Hillary W. Garner, Ty K. Subhawong, M. Atiq U Rehman, Shyam Ramachandran, Shivani Ahlawat, Jeffrey H. Samet, Kambiz Motamedi, Jim S. Wu, Avneesh B. Chhabra, Behrang Amini, Yin Xi, Edwin Y Choi, Mark D. Murphey, Gitanjali Bajaj, M. Havránek
article en
6 citations

Abstract

Soft-tissue tumors and tumorlike lesions are commonly identified on imaging and encompass a wide spectrum of entities. For lesions lacking classic features of a particular benign diagnosis, the radiologist must carefully assess its likelihood of representing an aggressive or malignant entity. However, in the absence of classic features, this determination is challenging. In 2023, the American College of Radiology (ACR) launched the development of Soft Tissue-RADS to serve as a unified framework for approaching these lesions. Soft Tissue-RADS, currently designated by the ACR as a work in progress, provides a standardized classification for soft-tissue tumors and tumorlike lesions encountered on MRI, incorporating seven categories (0 through 6), each with linked management recommendations, and diagnostic algorithms presented as flowcharts for guiding category selection. This Clinical Perspective provides an overview of Soft Tissue-RADS. We present the proposed risk categories and associated diagnostic algorithms, provide a structured report template, and show numerous case examples. The proposed system seeks to assist radiologists in differentiating benign soft-tissue tumors and tumorlike lesions from aggressive or malignant tumors, improve the clarity of radiology reports through succinct communication of malignancy risk, guide appropriate management recommendations, facilitate assessment of radiologic-pathologic concordance, refine posttreatment evaluation, and streamline data-informed approaches to sarcoma care.

American Journal of Roentgenology
Northwestern University (US), Brigham and Women's Hospital (US), American Institute for Economic Research (US), Memorial Sloan Kettering Cancer Center (US), The University of Texas MD Anderson Cancer Center (US), Johns Hopkins University (US), University of Miami (US), University of Liverpool (GB), Uniformed Services University of the Health Sciences (US), University of California, Los Angeles (US), University of Washington (US), Johns Hopkins Medicine (US), Walter Reed National Military Medical Center (US), Texas College (US), Jacksonville College (US), Walton Centre (GB), Massachusetts General Hospital (US), Latino Health Institute (United States) (US), Walton Hospital (GB), Southwestern Medical Center (US), Center for Neuro-Oncology (US), Lurie Children's Hospital (US), College Station Medical Center (US), Mayo Clinic in Florida (US), Center for Cancer Research (US), Robert H. Lurie Comprehensive Cancer Center of Northwestern University, University of Virginia (US), University of Arkansas for Medical Sciences (US), The University of Texas Southwestern Medical Center (US), Texas A&M University (US)
Openalex Percentile: Top 2%
Sarcoma Diagnosis and Treatment
9.11
DOISourceOpenAlex
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