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The current study investigates the utility of surveillance nuclear magnetic resonance imaging (MRI) for detection of asymptomatic LRs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The study cohort consisted of 168 adult patients with extremity STS treated with limb\u2010sparing surgery and RT with curative intent between October 2001 and January 2011. Follow\u2010up surveillance MRIs and history and physical examinations were performed per the NCCN guidelines with additional MRIs as clinically indicated. The method of LR detection and MRI number and indication were determined.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>After a median follow\u2010up of 4.7 years (range: 0.6\u201310.5) 11 (6.5%; 11\/168) patients developed LRs. Five hundred two MRIs were obtained, 429 (85.5%; 429\/502) for surveillance and 73 (14.5%; 73\/502) as clinically indicated. One hundred fourteen patients underwent \u22651 surveillance MRI. The median surveillance MRI interval was 6.4 months (range 1.4\u201368.9). Surveillance MRI detected an asymptomatic LR in 1 (0.9%; 1\/114) patient with a complex reconstruction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Surveillance MRI infrequently detects asymptomatic LRs following limb\u2010sparing surgery and RT for extremity STS and should be limited to patients whose primary tumor sites are not easily assessed by history and physical examination. <jats:italic>J. Surg. 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