1
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Jamshidi K, Mirzaei A, Bagherifard A, Jahansouz A, Mohaghegh MR. Does the adherence of distal femur parosteal osteosarcoma to the neurovascular bundle increase the rate of local recurrences? Orthop Traumatol Surg Res 2022; 108:103220. [PMID: 35093566 DOI: 10.1016/j.otsr.2022.103220] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/16/2021] [Accepted: 07/09/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Proximity of tumor to the neurovascular bundle (NVB) makes achieving a wide margin difficult. In low-grade parosteal osteosarcoma (POS), it is not clear whether adherence of tumor to NVB increases the rate of local recurrence (LR). In this study, we evaluated whether tumor adherence to the NVB increases the risk of LR in low-grade POS of the distal femur? HYPOTHESIS We hypothesized that if the thin neurovascular barrier (the adventitia of the vessels and the epineurium of the nerve) prevents tumor penetration, the rate of LR should be comparable between the lesions with and without a continuous layer of healthy fatty tissue between the tumor and NVB. MATERIALS AND METHODS In a retrospective survey, 30 patients with low-grade POS of the posterior aspect of the distal femur were evaluated for the proximity of mass to NVB. Based on the proximal to distal T1 axial MRI sections, the tumors were divided into two groups including the tumors with an uninterrupted (group A) and interrupted (group B) rim of fatty tissue between the mass and NVB. The rate of LR was compared between the two study groups. The concordance of MRI in detecting NVB adherence was checked with pathology specimen. RESULTS Using MRI, we identified 16 cases in group A and 14 cases in group B. The MRI status of fatty rim was concordant with pathology specimen in 96.4% of cases. The mean follow-up period of the two groups was not statistically different (117±27.6 vs. 105.8±29.4 months, respectively, p=0.29). The other baseline characteristics of the two groups were statistically comparable, as well. The rate of LR was 12.5% (2 out of 16 patients) in group A and 14.3% (2 out of 14 patients) in group B (95% CI: 0.142-9.586, p=0.87). The 10-year recurrence-free survival was 87.5% for group A and 85.7% for group B (p=0.9). DISCUSSION The absence of a continuous rim of fatty tissue between the tumor and NVB in MRI does not increase the risk of LR in low-grade POS of the distal femur. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Khodamorad Jamshidi
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Mirzaei
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Abolfazl Bagherifard
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Jahansouz
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Reza Mohaghegh
- Anesthesiology and Critical Care Department, Hasheminejad Kidney Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
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2
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Menendez N, Epelman M, Shao L, Douglas D, Meyers AB. Pediatric Osteosarcoma: Pearls and Pitfalls. Semin Ultrasound CT MR 2022; 43:97-114. [PMID: 35164914 DOI: 10.1053/j.sult.2021.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Osteosarcoma is a malignant bone tumor most commonly presenting in children. It has a bimodal distribution with a peak incidence occurring during the ages of 10-14 years old and in adults greater than age 65. The first peak of osteosarcoma correlates with the increased proliferation of bone during the pubertal growth period. Osteosarcoma most frequently presents with localized bone pain, swelling, and an antalgic gait. The patient may attribute symptoms to trauma or strenuous exercise, causing the patient to be managed conservatively. In these cases, the pain persists and eventually leads to further evaluation. The most common type of osteosarcoma is the conventional high-grade osteosarcoma. For conventional osteosarcoma, the diagnosis is typically made or strongly suggested based upon the initial radiographic appearance. Other types of osteosarcomas include low grade central, telangiectatic, small-cell, surface and intracortical. Consequently, it is important for radiologists to be aware of these subtypes and the imaging features that differentiate them from other etiologies to prevent a delay in treatment.
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Affiliation(s)
- Nelson Menendez
- University of Central Florida College of Medicine, Orlando, FL; Department of Radiology, Nemours Children's Health System/Nemours Children's Hospital, Orlando, FL
| | - Monica Epelman
- University of Central Florida College of Medicine, Orlando, FL; Department of Radiology, Nemours Children's Health System/Nemours Children's Hospital, Orlando, FL
| | - Lei Shao
- University of Central Florida College of Medicine, Orlando, FL; Department of Pathology and Lab Medicine, Nemours Children's Health System/Nemours Children's Hospital, Orlando, FL
| | - Dorothea Douglas
- University of Central Florida College of Medicine, Orlando, FL; Department of Pediatrics, Nemours Children's Health System/Nemours Children's Hospital, Orlando, FL
| | - Arthur B Meyers
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Dept. of Radiology, Cincinnati, OH.
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3
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Zhao K, Zhang M, Xie Z, Yan X, Wu S, Liao P, Lu H, Shen W, Fu C, Cui H, Fang Q, Mei J. Deep Learning Assisted Diagnosis of Musculoskeletal Tumors Based on Contrast-Enhanced Magnetic Resonance Imaging. J Magn Reson Imaging 2021; 56:99-107. [PMID: 34882890 DOI: 10.1002/jmri.28025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Misdiagnosis of malignant musculoskeletal tumors may lead to the delay of intervention, resulting in amputation or death. PURPOSE To improve the diagnostic efficacy of musculoskeletal tumors by developing deep learning (DL) models based on contrast-enhanced magnetic resonance imaging and to quantify the improvement in diagnostic performance obtained by using these models. STUDY TYPE Retrospective. POPULATION Three hundreds and four musculoskeletal tumors, including 212 malignant and 92 benign lesions, were randomized into the training (n = 180), validation (n = 62) and testing cohort (n = 62). FIELD STRENGTH/SEQUENCE A 3 T/T1 -weighted (T1 -w), T2 -weighted (T2 -w), diffusion-weighted imaging (DWI), and contrast-enhanced T1-weighted (CET1 -w) images. ASSESSMENT Three DL models based, respectively, on the sagittal, coronal, and axial MR images were constructed to predict the malignancy of tumors. Blinded to the prediction results, a group of specialists made independent initial diagnoses for each patient by reading all image sequences. One month after the initial diagnoses, the same group of doctors made another round of diagnoses knowing the malignancy of each tumor predicted by the three models. The reference standard was the pathological diagnosis of malignancy. STATISTICAL TESTS Sensitivity, specificity, and accuracy (all with 95% confidential intervals [CI]) corresponding to each diagnostic test were computed. Chi-square tests were used to assess the differences in those parameters with and without DL models. A P value < 0.05 was considered statistically significant. RESULTS The developed models significantly improved the diagnostic sensitivities of two oncologists by 0.15 (95% CI: 0.06-0.24) and 0.36 (95% CI: 0.24-0.28), one radiologist by 0.12 (95% CI: 0.04-0.20), and three of the four orthopedists, respectively, by 0.12 (95% CI: 0.04-0.20), 0.29 (95% CI: 0.18-0.40), and 0.23 (95% CI: 0.13-0.33), without impairing any of their diagnostic specificities (all P > 0.128). DATA CONCLUSION The DL models developed can significantly improve the performance of doctors with different training and experience in diagnosing musculoskeletal tumors. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Keyang Zhao
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, 200233, China
| | - Mingzi Zhang
- Shanghai Aitrox Technology Corporation Limited, Shanghai, China
| | - Zhaozhi Xie
- Department of Computer Science and Engineering, Shanghai Jiao Tong University, Shanghai, 200233, China
| | - Xu Yan
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, 200233, China
| | - Shenghui Wu
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, 200233, China
| | - Peng Liao
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, 200233, China
| | - Hongtao Lu
- Department of Computer Science and Engineering, Shanghai Jiao Tong University, Shanghai, 200233, China
| | - Wei Shen
- MoE Key Lab of Artificial Intelligence, AI Institute, Shanghai Jiao Tong University, Shanghai, 200233, China
| | - Chicheng Fu
- Shanghai Aitrox Technology Corporation Limited, Shanghai, China
| | - Haoyang Cui
- Shanghai Aitrox Technology Corporation Limited, Shanghai, China
| | - Qu Fang
- Shanghai Aitrox Technology Corporation Limited, Shanghai, China
| | - Jiong Mei
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, 200233, China
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4
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Qu Y, Li X, Yan Z, Zhao L, Zhang L, Liu C, Xie S, Li K, Metaxas D, Wu W, Hao Y, Dai K, Zhang S, Tao X, Ai S. Surgical planning of pelvic tumor using multi-view CNN with relation-context representation learning. Med Image Anal 2021; 69:101954. [PMID: 33550006 DOI: 10.1016/j.media.2020.101954] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 11/21/2020] [Accepted: 12/28/2020] [Indexed: 12/20/2022]
Abstract
Limb salvage surgery of malignant pelvic tumors is the most challenging procedure in musculoskeletal oncology due to the complex anatomy of the pelvic bones and soft tissues. It is crucial to accurately resect the pelvic tumors with appropriate margins in this procedure. However, there is still a lack of efficient and repetitive image planning methods for tumor identification and segmentation in many hospitals. In this paper, we present a novel deep learning-based method to accurately segment pelvic bone tumors in MRI. Our method uses a multi-view fusion network to extract pseudo-3D information from two scans in different directions and improves the feature representation by learning a relational context. In this way, it can fully utilize spatial information in thick MRI scans and reduce over-fitting when learning from a small dataset. Our proposed method was evaluated on two independent datasets collected from 90 and 15 patients, respectively. The segmentation accuracy of our method was superior to several comparing methods and comparable to the expert annotation, while the average time consumed decreased about 100 times from 1820.3 seconds to 19.2 seconds. In addition, we incorporate our method into an efficient workflow to improve the surgical planning process. Our workflow took only 15 minutes to complete surgical planning in a phantom study, which is a dramatic acceleration compared with the 2-day time span in a traditional workflow.
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Affiliation(s)
- Yang Qu
- Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Xiaomin Li
- Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Zhennan Yan
- SenseBrain Technology, Princeton, NJ 08540, USA
| | - Liang Zhao
- SenseTime Research, Shanghai 200233, China
| | - Lichi Zhang
- Institute for Medical Imaging Technology, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030 China
| | - Chang Liu
- SenseTime Research, Shanghai 200233, China
| | | | - Kang Li
- Department of Orthopaedics, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
| | - Dimitris Metaxas
- Department of Computer Science, Rutgers University, Piscataway, NJ 08854, USA
| | - Wen Wu
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Yongqiang Hao
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Kerong Dai
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China; Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai 200240, China
| | - Shaoting Zhang
- SenseTime Research, Shanghai 200233, China; Qing Yuan Research Institute, Shanghai Jiao Tong University, Shanghai 200240, China.
| | - Xiaofeng Tao
- Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China.
| | - Songtao Ai
- Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China.
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5
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Aoki T, Fujisaki A, Terasawa T, Hayashida Y, Todoroki Y, Hirano N, Hisaoka M, Sakai A, Korogi Y. Primary Site Identification of Soft-Tissue Mass: Things to Know in MRI Assessment. J Magn Reson Imaging 2020; 55:37-47. [PMID: 32949073 DOI: 10.1002/jmri.27368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/02/2020] [Accepted: 09/03/2020] [Indexed: 11/09/2022] Open
Abstract
The spectrum of soft-tissue mass is varied, including neoplastic and nonneoplastic/inflammatory lesions. However, soft-tissue tumors have similar imaging findings and, therefore, the diagnosis of soft-tissue mass is challenging. Although careful assessment of the internal characteristics on imaging can often narrow the differential diagnoses, the differential diagnosis may be out of the question if identification of the soft-tissue mass origin is missed. The purpose of this article is to review the imaging findings and the essential anatomy to identify the primary site of the soft-tissue mass, and discuss the associated potential pitfalls. In order not to fall into a pitfall, recognition of characteristic imaging findings indicating the origin of the soft-tissue mass and anatomical knowledge of the normal tissue distribution are necessary. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY STAGE: 3.
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Affiliation(s)
- Takatoshi Aoki
- Department of Radiology, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan
| | - Akitaka Fujisaki
- Department of Radiology, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan
| | - Takashi Terasawa
- Department of Radiology, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan
| | - Yoshiko Hayashida
- Department of Radiology, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan
| | - Yo Todoroki
- Department of Radiology, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan
| | - Natsumi Hirano
- Department of Radiology, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan
| | - Masanori Hisaoka
- Department of Pathology and Oncology, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan
| | - Akinori Sakai
- Department of Orthopaedic Surgery, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan
| | - Yukunori Korogi
- Department of Radiology, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan
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6
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Abstract
Despite the evolution in imaging, especially the introduction of advanced imaging technologies, radiographs still are the key for the initial assessment of a bone tumor. Important aspects to be considered in radiographs are the location, shape and size or volume, margins, periosteal reaction, and internal mineralization of the tumor's matrix; careful evaluation of these may provide for accurate diagnosis in >80% of cases. Computed tomography and magnetic resonance imaging are often diagnostic for lesions with typical findings such as the nidus of osteoid osteoma and bone destruction such as in Ewing sarcoma and lymphoma that may be difficult to detect with radiographs; they may also be used for surgical planning. Magnetic resonance imaging accurately determines the intraosseous extent and articular and vascular involvement by the tumor. This article summarizes the diagnostic accuracy of imaging analyses in bone tumors and emphasizes the specific radiographic findings for optimal radiographic diagnosis of the patients with these tumors.
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Affiliation(s)
- Costantino Errani
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Shinji Tsukamoto
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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7
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Dionísio FCF, Oliveira LS, Hernandes MA, Engel EE, Rangayyan RM, Azevedo-Marques PM, Nogueira-Barbosa MH. Manual and semiautomatic segmentation of bone sarcomas on MRI have high similarity. ACTA ACUST UNITED AC 2020; 53:e8962. [PMID: 32022102 PMCID: PMC6993358 DOI: 10.1590/1414-431x20198962] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 10/14/2019] [Indexed: 02/07/2023]
Abstract
The aims of this study were to evaluate the intra- and interobserver reproducibility of manual segmentation of bone sarcomas in magnetic resonance imaging (MRI) studies and to compare manual and semiautomatic segmentation methods. This retrospective study included twelve osteosarcoma and eight Ewing sarcoma MRI studies performed prior to any therapeutic intervention. All cases were histopathologically confirmed. Three radiologists used 3D-Slicer software to perform manual segmentation of bone sarcomas in a blinded and independent manner. One radiologist segmented manually and also performed semiautomatic segmentation with the GrowCut tool. Segmentation exercises were timed for comparison. The dice similarity coefficient (DSC) and Hausdorff distance (HD) were used to evaluate similarity between the segmentation results and further statistical analyses were performed to compare DSC, HD, and volumetric results. Manual segmentation was reproducible with intraobserver DSC varying from 0.83 to 0.97 and HD from 3.37 to 28.73 mm. Interobserver DSC of manual segmentation showed variation from 0.73 to 0.97 and HD from 3.93 to 33.40 mm. Semiautomatic segmentation compared to manual segmentation resulted in DSCs of 0.71−0.96 and HDs of 5.38−31.54 mm. Semiautomatic segmentation required significantly less time compared to manual segmentation (P value ≤0.05). Among all situations compared, tumor volumetry did not show significant statistical differences (P value >0.05). We found excellent intra- and interobserver agreement for manual segmentation of osteosarcoma and Ewing sarcoma. There was high similarity between manual and semiautomatic segmentation, with a significant reduction of segmentation time using the semiautomatic method.
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Affiliation(s)
- F C F Dionísio
- Departamento de Imagens Médicas, Hematologia e Oncologia Clínica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil.,Laboratório de Pesquisa em Imagens Musculoesqueléticas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - L S Oliveira
- Departamento de Imagens Médicas, Hematologia e Oncologia Clínica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil.,Laboratório de Pesquisa em Imagens Musculoesqueléticas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - M A Hernandes
- Departamento de Imagens Médicas, Hematologia e Oncologia Clínica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - E E Engel
- Departamento de Imagens Médicas, Hematologia e Oncologia Clínica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - R M Rangayyan
- Department of Electrical and Computer Engineering, University of Calgary, Calgary, Alberta, Canada
| | - P M Azevedo-Marques
- Departamento de Imagens Médicas, Hematologia e Oncologia Clínica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - M H Nogueira-Barbosa
- Departamento de Imagens Médicas, Hematologia e Oncologia Clínica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil.,Laboratório de Pesquisa em Imagens Musculoesqueléticas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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8
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He F, Qin L, Bao Q, Zang S, He Q, Qiu S, Shen Y, Zhang W. Pre-Operative chemotherapy response assessed by contrast-enhanced MRI can predict the prognosis of Enneking surgical margins in patients with osteosarcoma. J Orthop Res 2019; 37:258-264. [PMID: 30255519 DOI: 10.1002/jor.24143] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 09/04/2018] [Indexed: 02/04/2023]
Abstract
The method used to evaluate the response of osteosarcoma to preoperative chemotherapy before specimen resection is still unclear. The purpose of this study was to identify factors that contribute to overall survival (OS) and to discuss their roles in making a decision regarding Enneking surgical margins. Patients (109) with pathologically confirmed Enneking stage IIB osteosarcoma were retrospectively analyzed. Univariate and multivariate survival analyses were performed. Patient characteristics and chemotherapy-induced contrast-enhanced MRI changes were considered as potential factors. Changes in the tumor volume and the relative necrosis ratio measured by MRI were independent risk factors predicting the OS of patients who underwent limb-salvage surgery. For those in whom the tumor volume had decreased (VolRatio <1) or the relative necrosis ratio had increased by at least 10% (NecRatioInc ≥0.1), there was no significant difference in OS between Enneking wide and marginal margins. Variables measured by contrast-enhanced MRI could be used to evaluate chemotherapy response and increase the limb-salvage rate. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
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Affiliation(s)
- Fangzhou He
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Le Qin
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiyuan Bao
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shizhao Zang
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qin He
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shijing Qiu
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Bone and Mineral Research Laboratory, Henry Ford Hospital, Detroit, Michigan
| | - Yuhui Shen
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Weibin Zhang
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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9
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Putta T, Gibikote S, Madhuri V, Walter N. Accuracy of Various MRI Sequences in Determining the Tumour Margin in Musculoskeletal Tumours. Pol J Radiol 2016; 81:540-548. [PMID: 28058070 PMCID: PMC5181551 DOI: 10.12659/pjr.898108] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 04/16/2016] [Indexed: 12/02/2022] Open
Abstract
Background It is imperative that bone tumour margin and extent of tumour involvement are accurately assessed pre-operatively in order for the surgeon to attain a safe surgical margin. In this study, we comprehensively assessed each of the findings that influence surgical planning, on various MRI sequences and compared them with the gold standard – pathology. Material/Methods In this prospective study including 21 patients with extremity bone tumours, margins as seen on various MRI sequences (T1, T2, STIR, DWI, post-gadolinium T1 FS) were measured and biopsies were obtained from each of these sites during the surgical resection. The resected tumour specimen and individual biopsy samples were studied to assess the true tumour margin. Margins on each of the MRI sequences were then compared with the gold standard – pathology. In addition to the intramedullary tumour margin, we also assessed the extent of soft tissue component, neurovascular bundle involvement, epiphyseal and joint involvement, and the presence or absence of skip lesions. Results T1-weighted imaging was the best sequence to measure tumour margin without resulting in clinically significant underestimation or overestimation of the tumour extent (mean difference of 0.8 mm; 95% confidence interval between −0.9 mm to 2.5 mm; inter-class correlation coefficient of 0.998). STIR and T1 FS post-gadolinium imaging grossly overestimated tumour extent by an average of 16.7 mm and 16.8 mm, respectively (P values <0.05). Post-gadolinium imaging was better to assess joint involvement while T1 and STIR were the best to assess epiphyseal involvement. Conclusions T1-weighted imaging was the best sequence to assess longitudinal intramedullary tumour extent. We suggest that osteotomy plane 1.5 cm beyond the T1 tumour margin is safe and also limits unwarranted surgical bone loss. However, this needs to be prospectively proven with a larger sample size.
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Affiliation(s)
- Tharani Putta
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sridhar Gibikote
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Vrisha Madhuri
- Department of Paediatric Orthopaedics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Noel Walter
- Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, India
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10
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Holzapfel K, Regler J, Baum T, Rechl H, Specht K, Haller B, von Eisenhart-Rothe R, Gradinger R, Rummeny EJ, Woertler K. Local Staging of Soft-Tissue Sarcoma: Emphasis on Assessment of Neurovascular Encasement—Value of MR Imaging in 174 Confirmed Cases. Radiology 2015; 275:501-9. [DOI: 10.1148/radiol.14140510] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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11
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Ewing sarcoma causing back and leg pain in 2 patients. PM R 2012; 4:317-21. [PMID: 22541379 DOI: 10.1016/j.pmrj.2011.12.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Revised: 12/19/2011] [Accepted: 12/30/2011] [Indexed: 11/23/2022]
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12
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Girish G, Finlay K, Fessell D, Pai D, Dong Q, Jamadar D. Imaging review of skeletal tumors of the pelvis malignant tumors and tumor mimics. ScientificWorldJournal 2012; 2012:240281. [PMID: 22593667 PMCID: PMC3349129 DOI: 10.1100/2012/240281] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 11/30/2011] [Indexed: 11/18/2022] Open
Abstract
Malignant lesions of the pelvis are not uncommon and need to be differentiated from benign lesions and tumor mimics. Appearances are sometimes nonspecific leading to consideration of a broad differential diagnosis. Clinical history, anatomic location, and imaging characterization can help narrow the differential diagnosis. The focus of this paper is to demonstrate the imaging features and the role of plain films, computed tomography, and magnetic resonance imaging for detecting and characterizing malignant osseous pelvic lesions and their common mimics.
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Affiliation(s)
- Gandikota Girish
- Department of Radiology, University of MI, 1500 E. Medical Center Drive, TC-2910, Ann Arbor, MI 48109-0326, USA.
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Errani C, Kreshak J, Ruggieri P, Alberghini M, Picci P, Vanel D. Imaging of bone tumors for the musculoskeletal oncologic surgeon. Eur J Radiol 2011; 82:2083-91. [PMID: 22209430 DOI: 10.1016/j.ejrad.2011.11.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The appropriate diagnosis and treatment of bone tumors requires close collaboration between different medical specialists. Imaging plays a key role throughout the process. Radiographic detection of a bone tumor is usually not challenging. Accurate diagnosis is often possible from physical examination, history, and standard radiographs. The location of the lesion in the bone and the skeleton, its size and margins, the presence and type of periosteal reaction, and any mineralization all help determine diagnosis. Other imaging modalities contribute to the formation of a diagnosis but are more critical for staging, evaluation of response to treatment, surgical planning, and follow-up.When necessary, biopsy is often radioguided, and should be performed in consultation with the surgeon performing the definitive operative procedure. CT is optimal for characterization of the bone involvement and for evaluation of pulmonary metastases. MRI is highly accurate in determining the intraosseous extent of tumor and for assessing soft tissue, joint, and vascular involvement. FDG-PET imaging is becoming increasingly useful for the staging of tumors, assessing response to neoadjuvant treatment, and detecting relapses.Refinement of these and other imaging modalities and the development of new technologies such as image fusion for computer-navigated bone tumor surgery will help surgeons produce a detailed and reliable preoperative plan, especially in challenging sites such as the pelvis and spine.
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Affiliation(s)
- C Errani
- Department of Orthopaedic Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy.
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14
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Métastase intradurale extramédullaire lombosacrée d’un sarcome d’Ewing cervical: présentation d’un cas clinique et revue de la littérature. ONCOLOGIE 2010. [DOI: 10.1007/s10269-009-1120-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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15
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MRI of soft-tissue tumors: fast STIR sequence as substitute for T1-weighted fat-suppressed contrast-enhanced spin-echo sequence. AJR Am J Roentgenol 2010; 193:1607-14. [PMID: 19933655 DOI: 10.2214/ajr.09.2675] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the value of the fast STIR sequence in comparison with the T1-weighted fat-suppressed contrast-enhanced sequence in the evaluation of soft-tissue tumors. MATERIALS AND METHODS Sixty-seven soft-tissue tumors imaged with both STIR and T1-weighted fat-suppressed contrast-enhanced sequences were evaluated. The signal-to-noise and contrast-to-noise ratios of the tumors in comparison with normal muscle, bone marrow, and fat were measured. Subjective image contrast between soft-tissue tumors and the nearest normal tissue was evaluated by two observers. The observers classified the soft-tissue tumors as benign or malignant using a 5-point scale, and sensitivity, specificity, and accuracy were calculated. The results of the two readings were assessed with receiver operating characteristic analysis. RESULTS The contrast-to-noise ratios of all tumors in comparison with muscle (p < 0.01), bone marrow (p < 0.05), and fat (p < 0.05) were significantly higher on the fast STIR images than on the T1-weighted fat-suppressed contrast-enhanced images. Both observers' mean ratings of benign, malignant, and all tumors in comparison with muscle on fast STIR images were significantly higher than those on T1-weighted fat-suppressed contrast-enhanced images. For both observers, the mean sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve in evaluation of the fast STIR images did not differ significantly from those in evaluation of the T1-weighted fat-suppressed contrast-enhanced images. CONCLUSION The fast STIR sequence is excellent for evaluation of soft-tissue tumors, and contrast-enhancement is not always needed.
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Mahnken AH, Wildberger JE, Adam G, Stanzel S, Schmitz-Rode T, Günther RW, Buecker A. Is there a need for contrast-enhanced T1-weighted MRI of the spine after inconspicuous short τ inversion recovery imaging? Eur Radiol 2005; 15:1387-92. [PMID: 15776239 DOI: 10.1007/s00330-005-2719-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2004] [Revised: 02/07/2005] [Accepted: 02/15/2005] [Indexed: 10/25/2022]
Abstract
To assess the use of contrast-enhanced T1-weighted images in comparison with short tau inversion recovery (STIR) images for the detection of vertebral bone marrow abnormalities. A total of 201 vertebral magnetic resonance (MR) examinations were included in a prospective trial. Examinations were performed on a 0.5-T MR scanner. The examination protocol included STIR, T2-weighted turbo spin-echo and T1-weighted spin-echo images before and after administration of gadopentetate dimeglumine. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of STIR images were calculated. In the case of abnormal STIR images the additional information from contrast-enhanced images was evaluated using Fisher's exact test. The value of the combined evaluation of STIR and contrast-enhanced T1-weighted images was compared with that of the combined assessment of T2-weighted and contrast-enhanced T1-weighted images. The PPV and the NPV of STIR images for detection of vertebral bone marrow abnormalities were 99.3 and 95.9%. In the case of normal STIR images no relevant additional information was found with contrast-enhanced T1-weighted images, while in the case of abnormal STIR images significant supplementary information was obtained. There was no difference in the diagnostic value when comparing combined assessment of STIR and contrast-enhanced T1-weighted images with combined evaluation of T2-weighted and contrast-enhanced T1-weighted images. Normal STIR images allow contrast-enhanced T1-weighted images for detection of bone marrow abnormalities to be omitted, whereas further imaging is needed in case of abnormal STIR images.
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Affiliation(s)
- Andreas H Mahnken
- Department of Diagnostic Radiology, University Hospital, Aachen University of Technology, Germany.
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Brisse H, Ollivier L, Edeline V, Pacquement H, Michon J, Glorion C, Neuenschwander S. Imaging of malignant tumours of the long bones in children: monitoring response to neoadjuvant chemotherapy and preoperative assessment. Pediatr Radiol 2004; 34:595-605. [PMID: 15103428 DOI: 10.1007/s00247-004-1192-x] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2004] [Accepted: 03/13/2004] [Indexed: 10/26/2022]
Abstract
This review focuses on imaging of osteosarcoma and Ewing's sarcoma of the long bones in children during preoperative neoadjuvant chemotherapy. Morphological criteria on plain films and conventional static MRI are insufficiently correlated with histological response. We review the contribution of dynamic MRI, diffusion-weighted MR and nuclear medicine (18FDG-PET) to monitor tumoural necrosis. MRI is currently the best method to evaluate local extension prior to tumour resection, especially to assess the feasibility of conservative surgery. Quantitative models in dynamic MRI and 18FDG-PET are currently being developed in order to find new early prognostic criteria, but for the time being, treatment protocols are still based on the gold standard of histological response.
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Affiliation(s)
- Hervé Brisse
- Imaging Department, Institut Curie, 26 rue d'Ulm, 75005 Paris, France.
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Teo HEL, Peh WCG. The role of imaging in the staging and treatment planning of primary malignant bone tumors in children. Eur Radiol 2004; 14:465-75. [PMID: 14749946 DOI: 10.1007/s00330-003-2211-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2003] [Revised: 09/16/2003] [Accepted: 12/01/2003] [Indexed: 10/26/2022]
Abstract
The accurate staging of primary bone tumors in children is critical for treatment planning. Limb salvage operations can now be performed with excellent outcomes in suitable patients. The purpose of this article is to review the current state of imaging techniques and their roles in enabling accurate staging and treatment planning to be performed in pediatric patients with primary bone tumors.
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Affiliation(s)
- Harvey E L Teo
- Department of Diagnostic Imaging, KK Women's and Children's Hospital, 100 Bukit Timah Road, 229899 Singapore.
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Tokuda O, Hayashi N, Matsunaga N. MRI of bone tumors: Fast STIR imaging as a substitute for T1-weighted contrast-enhanced fat-suppressed spin-echo imaging. J Magn Reson Imaging 2004; 19:475-81. [PMID: 15065172 DOI: 10.1002/jmri.20031] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To compare the usefulness of short inversion recovery (STIR) and T1-weighted, contrast-enhanced, fat-suppressed (T1W-CEFS) sequences for the evaluation of bone tumors. MATERIALS AND METHODS Eighteen patients with 19 bone tumors who underwent both STIR and T1W-CEFS imaging were evaluated. The tumors were categorized in pairs as follows: bone marrow and soft-tissue components, benign and malignant tumors, and tumors with and without mineralization. The signal difference-to-noise ratio (SDNR), signal-to-noise ratio (SNR), and tumor volume were calculated in each group. An additional qualitative analysis was performed by means of the ratings of imaging contrast. RESULTS The mean SDNRs of all bone marrow components and bone marrow components without mineralization were significantly higher on fast STIR images than on T1W-CEFS images (P < 0.05). There was no significant difference in the mean SDNR and SNR of the other group (surrounding soft tissue components, bone marrow components with mineralization, benign and malignant lesions) between fast STIR images and T1W-CEFS images. The mean volume of the tumors was significantly higher with STIR than with the T1W-CEFS sequence (P < 0.05). CONCLUSION The STIR sequence should be used instead of T1W-CEFS imaging for the evaluation of bone tumors.
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Affiliation(s)
- Osamu Tokuda
- Department of Radiology, Yamaguchi University School of Medicine, Yamaguchi, Japan
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Wallack ST, Wisner ER, Werner JA, Walsh PJ, Kent MS, Fairley RA, Hornof WJ. Accuracy of magnetic resonance imaging for estimating intramedullary osteosarcoma extent in pre-operative planning of canine limb-salvage procedures. Vet Radiol Ultrasound 2002; 43:432-41. [PMID: 12375777 DOI: 10.1111/j.1740-8261.2002.tb01030.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The objective of this work was to compare the accuracy of radiographs and magnetic resonance imaging (MRI) for estimating appendicular osteosarcoma margins. The accuracy of computed tomography (CT) and bone scintigraphy was also assessed when these studies were available. Eight dogs with appendicular osteosarcoma underwent radiographic and MRI of affected limbs. In addition, bone scintigraphy was performed in six dogs and CT examination was performed in five dogs. Two observers jointly measured tumor length on all imaging studies. Correlative gross and histologic evaluation of all affected limbs was performed to determine tumor extent as measured from the nearest articular surface. Results from imaging studies were compared to gross and microscopic morphometry findings to determine the accuracy of each modality for determining tumor boundaries. MRI images were accurate with a mean overestimation of actual tumor length of 3 +/- 13%. T1-weighted non-contrast images were superior in identifying intramedullary tumor margins in most instances whereas contrast-enhanced images provided supplemental information in two dogs. Lateromedial and craniocaudal radiographs overestimated tumor length by 17 +/- 28% and 4 +/- 26%, respectively. Scintigraphy and CT overestimated tumor margins by 14 +/- 28% and 27 +/- 36%, respectively. MRI appears to be an accurate diagnostic imaging modality in determining intramedullary osteosarcoma boundaries. MRI should be considered as part of a pre-operative assessment of appendicular osteosarcoma, particularly when a limb-sparing procedure is contemplated.
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Affiliation(s)
- Seth T Wallack
- Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis 95616, USA
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Schmid MR, Hodler J, Vienne P, Binkert CA, Zanetti M. Bone marrow abnormalities of foot and ankle: STIR versus T1-weighted contrast-enhanced fat-suppressed spin-echo MR imaging. Radiology 2002; 224:463-9. [PMID: 12147843 DOI: 10.1148/radiol.2242011252] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To compare short inversion time inversion-recovery (STIR) and T1-weighted contrast material-enhanced fat-suppressed spin-echo magnetic resonance (MR) sequences for depiction of bone marrow abnormalities of the foot and ankle. MATERIALS AND METHODS Fifty-one consecutive patients with bone marrow abnormalities depicted on turbo STIR images were examined with additional T1-weighted contrast-enhanced (0.1 mmol/kg gadopentetate dimeglumine) MR imaging with fat suppression. Volume and signal difference-to-noise ratio (SDNR) were measured. An additional qualitative analysis was performed by two experienced musculoskeletal radiologists to correlate the presence or absence of ill-defined edema-like zones, well-defined zones, and cystlike zones. Diagnoses determined with MR findings with each sequence were compared with the results of a review panel. Correlation coefficients (r(2)) and paired t tests were calculated for all measurements. Agreement percentages and kappa values were calculated for inter- and intraobserver reproducibility. RESULTS Regarding volume of bone marrow abnormalities, a high correlation (r(2) = 0.98) of both sequences was found. SDNR was substantially higher on T1-weighted contrast-enhanced images than on STIR images (mean, 125.9 vs 95.4; P <.001). The qualitative analysis demonstrated identical imaging patterns with both sequences in 96% (79 of 82, kappa = 0.38) of ill-defined zones, in 88% (72 of 82, kappa = 0.76) of well-defined zones, and in 98% (80 of 82, kappa = 0.84) of cystlike zones. Interobserver reproducibility of the three imaging patterns was similar for both sequences. The kappa values for these three zones with STIR sequence were 0.55, 0.68, and 0.69, and those for the T1-weighted contrast-enhanced MR sequence were 0.49, 0.73, and 0.58, respectively. Diagnoses determined with MR findings were equal with both sequences in 94% (80 of 85) of involved bones. CONCLUSION STIR images and T1-weighted contrast-enhanced fat-suppressed MR images demonstrate almost identical imaging patterns, and diagnoses determined with these findings show little difference.
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Affiliation(s)
- Marius R Schmid
- Department of Radiology, Orthopedic University Hospital Balgrist, Forchstrasse 340, 8008 Zurich, Switzerland.
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Burdach S, Jürgens H. High-dose chemoradiotherapy (HDC) in the Ewing family of tumors (EFT). Crit Rev Oncol Hematol 2002; 41:169-89. [PMID: 11856593 DOI: 10.1016/s1040-8428(01)00154-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
EFT is defined by the expression of ews/ets fusion genes. The type of the fusion transcript impacts on the clinical biology. EFT requires risk adapted treatment. A risk-adapted treatment is determined by tumor localisation, tumor stage and volume. For metastatic and relapsed disease the pattern of spread and the time of relapse are the determinants of risk stratification. Staging of Ewing tumors has been considerably improved by magnetic resonance imaging and modern isotope scanning techniques. However, the determination of the extent of the metastatic spread in particular number of involved bones remains an unresolved issue. The prognosis for high-risk Ewing tumors has been improved by multimodal and high-dose radio/chemotherapy (HDC). The concepts for high-dose therapy in Ewing tumors are based on dose response and dose intensity relationships. In single agent HDC most experience exists with Melphalan. Several chemotherapeutic agents have been used in combination HDC with or without TBI such as Adriamycin, BCNU, Busulphan, Carboplatin, Cyclophosphamide, Etoposide, Melphalan, Thiotepa Procarbazin and Vincristine. To date, superiority of any high-dose chemotherapy regimen has not been established. However, the clinical biology, the pattern of spread and the time of relapse determine the prognosis of patient who are eligible for HDC. In particular, patients with multifocal bone or bone marrow metastases have a poorer prognosis than patients with lung metastases. In addition, patients with a relapse within 24 months have a poorer prognosis than patients with a relapse later than 24 months after diagnosis. This review will analyze the results of single- and multi-agent chemotherapy with respect to agent combination, dose and risk stratum of patient population. Future therapeutic modalities for the treatment of EFT might encompass immunotherapeutic and genetic strategies including allogeneic stem cell transplantation.
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Affiliation(s)
- S Burdach
- Division of Pediatric Hematology/Oncology and Children's Cancer Research Center, Martin-Luther-University Halle Wittenberg, 06097, Halle, Germany.
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Gorospe L, Fernández-Gil MA, García-Raya P, Royo A, López-Barea F, García-Miguel P. Ewing's sarcoma of the mandible: radiologic features with emphasis on magnetic resonance appearance. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2001; 91:728-34. [PMID: 11402290 DOI: 10.1067/moe.2001.113546] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Ewing's sarcoma is an uncommon malignancy that usually occurs in children. A case of Ewing's sarcoma of the mandible is presented, and the radiologic appearance is described, with special consideration given to the magnetic resonance imaging features.
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Affiliation(s)
- L Gorospe
- Department of Radiology, La Paz University Hospital, Autonomous University of Madrid, Madrid, Spain.
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Abstract
Magnetic resonance imaging is an important modality for the imaging evaluation of musculoskeletal tumors. Although there is general agreement on the value of unenhanced MR in detection, diagnosis and staging, intravenous use of gadolinium-contrast media (gd-CM) is indicated in selected cases. The purpose of this article is to review the basic pharmacokinetic principles and imaging techniques for static and dynamic contrast-enhanced MR imaging and to highlight the most important indications for administration of gd-CM in patients with musculsokeletal tumors and tumor-like lesions: adding specificity in tissue characterization, staging of local extent and biopsy planning, monitoring preoperative chemotherapy and detection of recurrence.
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Affiliation(s)
- K L Verstraete
- Department of Magnetic Resonance/MR/-1K 12 I.B., University Hospital Gent, De Pintelaan 185, B-9000, Gent, Belgium.
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Dosdá R, Martí-Bonmatí L, Menor F, Aparisi F, Rodrigo C, Ricart V. Comparison of plain radiographs and magnetic resonance images in the evaluation of periosteal reaction and osteoid matrix in osteosarcomas. MAGMA (NEW YORK, N.Y.) 1999; 9:72-80. [PMID: 10555176 DOI: 10.1007/bf02634595] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
To determine the relationship and the degree of agreement between radiographs and MR images for the existence of osteoid matrix and periosteal reactions in the initial diagnosis of osteosarcomas, the plain radiographs and MR studies of 54 patients with proven osteosarcoma were retrospectively evaluated. In each tumor the visualization and type of osseous matrix, periosteal reaction and Codman angle were recorded independently for both techniques and by consensus between two radiologists. In 37 tumors agreement existed regarding osteoid matrix and in 31 cases regarding periosteal reactions. The Kappa statistic showed a significant relationship between both tests (0.49 and 0.44, respectively). Both techniques were also not statistically different in the proportion of findings with the McNemar test. Therefore, the ability of MR images seems important in reporting the MR features of bone tumors. Identification of osteoid mineralization and periosteal reaction can also be used with MR in the diagnosis of osteosarcoma.
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Affiliation(s)
- R Dosdá
- Department of Magnetic Resonance, ATQ-Quirón Valencia, Spain
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TECHNIQUES, COILS, PULSE SEQUENCES, AND CONTRAST ENHANCEMENT IN PEDIATRIC MUSCULOSKELETAL MR IMAGING. Magn Reson Imaging Clin N Am 1998. [DOI: 10.1016/s1064-9689(21)00231-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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