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Olson JT, Wenger DE, Rose PS, Petersen IA, Broski SM. Chordoma: (18)F-FDG PET/CT and MRI imaging features. Skeletal Radiol 2021; 50:1657-66. [PMID: 33521875 DOI: 10.1007/s00256-021-03723-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 01/21/2021] [Accepted: 01/21/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Examine the 18F-FDG PET/CT and MRI imaging characteristics of chordoma. MATERIALS AND METHODS Biopsy-proven chordoma with a pre-therapy 18F-FDG PET/CT from 2001 through 2019 in patients > 18 years old were retrospectively reviewed. Multiple PET/CT and MRI imaging parameters were assessed. RESULTS A total of 23 chordoma patients were included (16 M, 7 F; average age of 60.1 ± 13.0 years) with comparative MRI available in 22 cases. This included 13 sacrococcygeal, 9 mobile spine, and one clival lesions. On 18F-FDG PET/CT, chordomas demonstrated an average SUVmax of 5.8 ± 3.7, average metabolic tumor volume (MTV) of 160.2 ± 263.8 cm3, and average total lesion glycolysis (TLG) of 542.6 ± 1210 g. All demonstrated heterogeneous FDG activity. On MRI, chordomas were predominantly T2 hyperintense (22/22) and T1 isointense (18/22), contained small foci of T1 hyperintensity (17/22), and demonstrated heterogeneous enhancement (14/20). There were no statistically significant associations found between 18F-FDG PET/CT and MRI imaging features. There was no relationship of SUVmax (p = 0.53), MTV (p = 0.47), TLG (p = 0.48), maximal dimension (p = 0.92), or volume (p = 0.45) to the development of recurrent or metastatic disease which occurred in 6/22 patients over a mean follow-up duration of 4.1 ± 2.0 years. CONCLUSION On 18F-FDG PET/CT imaging, chordomas demonstrate moderate, heterogeneous FDG uptake. Predominant T2 hyperintensity and small foci of internal increased T1 signal are common on MRI. The inherent FDG avidity of chordomas suggests that 18F-FDG PET/CT may be a useful modality for staging, evaluating treatment response, and assessing for recurrent or metastatic disease.
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Chetan MR, Lyon PC, Wu F, Phillips R, Cranston D, Gillies MJ, Bojanic S. Role of diffusion-weighted imaging in monitoring treatment response following high-intensity focused ultrasound ablation of recurrent sacral chordoma. Radiol Case Rep 2019; 14:1197-1201. [PMID: 31428215 PMCID: PMC6698304 DOI: 10.1016/j.radcr.2019.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 07/12/2019] [Indexed: 11/25/2022] Open
Abstract
Chordoma is the most common malignant tumor of the sacrum and is associated with significant neurologic morbidity. Local recurrence is very common, and the long-term prognosis is poor. High-intensity focused ultrasound (HIFU) is a noninvasive and nonionising ablative therapy that has been successful in treating other tumor types and is being evaluated as a new therapy for sacral chordoma. Contrast-enhanced magnetic resonance imaging is typically used to evaluate tumor perfusion following HIFU; however, its utility is limited in poorly perfused tumors. Diffusion-weighted imaging (DWI) provides tissue contrast based on differences in the diffusion of extracellular water without using gadolinium-based contrast agents. We present novel DWI findings following a planned partial HIFU ablation of a large sacral chordoma which had recurred after radiotherapy. Following HIFU, the treated tumor volume demonstrated loss of restriction on DWI correlating with photopenia on positron emission tomography. This suggests successful ablation and tumor necrosis. This novel finding may provide guidance for sequence selection when evaluating HIFU therapy for sacral chordoma and other tumor types for which contrast-enhanced magnetic resonance imaging may have limited utility.
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Affiliation(s)
- Madhurima R Chetan
- Nuffield Department of Surgical Sciences, University of Oxford, Room 6607, Level 6, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.,Department of Radiology, Churchill Hospital, Old Road, Oxford, OX3 7LE, UK
| | - Paul C Lyon
- HIFU Unit, Churchill Hospital, Old Road, Oxford, OX3 7LE, UK.,Department of Radiology, Churchill Hospital, Old Road, Oxford, OX3 7LE, UK
| | - Feng Wu
- Nuffield Department of Surgical Sciences, University of Oxford, Room 6607, Level 6, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.,HIFU Unit, Churchill Hospital, Old Road, Oxford, OX3 7LE, UK
| | - Rachel Phillips
- Department of Radiology, Churchill Hospital, Old Road, Oxford, OX3 7LE, UK
| | - David Cranston
- Nuffield Department of Surgical Sciences, University of Oxford, Room 6607, Level 6, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
| | - Martin J Gillies
- Nuffield Department of Surgical Sciences, University of Oxford, Room 6607, Level 6, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.,Department of Neurosurgery, John Radcliffe Hospital, Headley Way, Oxford, UK
| | - Stana Bojanic
- Department of Neurosurgery, John Radcliffe Hospital, Headley Way, Oxford, UK
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Gallicchio R, Nardelli A, Pedicini P, Guglielmi G, Storto G. PET/CT and Bone Scintigraphy: Metabolic Results in Musculoskeletal Lesions. Curr Radiol Rep 2018. [DOI: 10.1007/s40134-018-0290-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
Purpose of Review Chordoma are rare tumours of the axial skeleton which occur most often at the base of the skull and in the sacrum. Although chordoma are generally slow-growing lesions, the recurrence rate is high and the location makes it often difficult to treat. Both computed tomography (CT) and magnetic resonance imaging (MRI) are crucial in the initial diagnosis, treatment planning and post-treatment follow-up. Recent Findings Basic MRI and CT characteristics of chordoma were described in the late 1980s and early 1990s. Since then, imaging techniques have evolved with increased resolution and new molecular imaging tools are rapidly evolving. New imaging tools have been developed not only to study anatomy, but also physiologic changes and characterization of tissue and assessment of tumour biology. Recent studies show the uptake of multiple PET tracers in chordoma, which may become an important aspect in the diagnosis, follow-up and personalized therapy. Summary This review gives an overview of skull base chordoma histopathology, classic imaging characteristics, radiomics and state-of-the-art imaging techniques that are now emerging in diagnosis, treatment planning and disease monitoring of skull base chordoma.
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Cui F, Su M, Zhang H, Tian R. Humeral metastasis of sacrococcygeal chordoma detected by fluorine-18 fluorodeoxyglucose positron emission tomography-computed tomography: A case report. Radiol Case Rep 2018; 13:449-452. [PMID: 29904494 PMCID: PMC6000026 DOI: 10.1016/j.radcr.2018.01.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 01/27/2018] [Indexed: 02/05/2023] Open
Abstract
Chordomas are rare, slow-growing, locally aggressive bone tumors arising from embryonic remnants of the notochord. Distant metastases most commonly involve the lung, liver, axial skeleton, skin, and lymph nodes. Humeral metastases are extremely rare. We report the case of a recurrent chordoma with humeral metastasis, complicated with pathologic fracture. Fluorine-18 fluorodeoxyglucose positron emission tomography-computed tomography revealed multiple hypermetabolic skeletal lesions, corresponding to the symptoms. Our report suggests that positron emission tomography-computed tomography is useful for evaluation of recurrence and distant metastases of chordomas.
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Affiliation(s)
- Futao Cui
- Department of Nuclear Medicine, West China Hospital, Sichuan University, 37 Guoxue Lane, Wuhou District, Chengdu, Sichuan 610000, P.R. China
| | - Minggang Su
- Department of Nuclear Medicine, West China Hospital, Sichuan University, 37 Guoxue Lane, Wuhou District, Chengdu, Sichuan 610000, P.R. China
| | - Han Zhang
- Department of nuclear medicine and molecular imaging, Singapore General Hospital, Outram Road, Singapore 169608, Singapore
| | - Rong Tian
- Department of Nuclear Medicine, West China Hospital, Sichuan University, 37 Guoxue Lane, Wuhou District, Chengdu, Sichuan 610000, P.R. China
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Chang C, Chebib I, Torriani M, Bredella M. Osseous metastases of chordoma: imaging and clinical findings. Skeletal Radiol 2017; 46:351-358. [PMID: 28064345 DOI: 10.1007/s00256-016-2566-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 12/13/2016] [Accepted: 12/29/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To describe the imaging and clinical characteristics of chordoma osseous metastases (COM). MATERIALS AND METHODS Our study was IRB approved and HIPAA compliant. A retrospective search of our pathology database for pathology-proven COM yielded 15 patients who had undergone MRI, CT, bone scan, and/or FDG-PET/CT. The imaging and clinical features of the COMs were recorded. A control group of age and gender matched chordoma patients without osseous metastasis was evaluated. RESULTS The COM mean maximal dimension was 6.4 ± 4.0 cm. The majority (60%) of patients had one lesion. Extra-osseous soft tissue component was present in 85% and was larger than intra-osseous component in 76%. On MRI the lesions were heterogeneous but predominantly T2 hyperintense with hypointense septae, and with variable enhancement. On CT the lesions were typically destructive or permeative; calcifications were rare. The extent of the soft tissue component was isodense to muscle on CT and therefore better evaluated on MRI. COM was in a body part contiguous to the site of the primary tumor. Compared to the controls, COM patients were more likely to have local recurrence (P = 0.0009) and positive resection margins (P = 0.002). At 1 year, 33% of COM patients were deceased and 13% had progressive metastases. CONCLUSION COM are associated with large extra-osseous soft tissue components, which are better visualized by MRI. They are often located in a body part contiguous to the site of the primary tumor, portend poor prognosis, and are associated with positive resection margins and local recurrence.
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Affiliation(s)
- Connie Chang
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street Yawkey 6E, Boston, MA, 02114, USA.
| | - Ivan Chebib
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Martin Torriani
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street Yawkey 6E, Boston, MA, 02114, USA
| | - Miriam Bredella
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street Yawkey 6E, Boston, MA, 02114, USA
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