The role of imaging in the staging of bone tumors

Comparison of Different Fusion Radiomics for Predicting Benign and Malignant Sacral Tumors: A Pilot Study

Differentiating between benign and malignant sacral tumors is crucial for determining appropriate treatment options. This study aims to develop two benchmark fusion models and a deep learning radiomic nomogram (DLRN) capable of distinguishing between benign and malignant sacral tumors using multiple imaging modalities. We reviewed axial T2-weighted imaging (T2WI) and non-contrast computed tomography (NCCT) of 134 patients pathologically confirmed as sacral tumors. The two benchmark fusion models were developed using fusion deep learning (DL) features and fusion classical machine learning (CML) features from multiple imaging modalities, employing logistic regression, K-nearest neighbor classification, and extremely randomized trees. The two benchmark models exhibiting the most robust predictive performance were merged with clinical data to formulate the DLRN. Performance assessment involved computing the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, accuracy, negative predictive value (NPV), and positive predictive value (PPV). The DL benchmark fusion model demonstrated superior performance compared to the CML fusion model. The DLRN, identified as the optimal model, exhibited the highest predictive performance, achieving an accuracy of 0.889 and an AUC of 0.961 in the test sets. Calibration curves were utilized to evaluate the predictive capability of the models, and decision curve analysis (DCA) was conducted to assess the clinical net benefit of the DLR model. The DLRN could serve as a practical predictive tool, capable of distinguishing between benign and malignant sacral tumors, offering valuable information for risk counseling, and aiding in clinical treatment decisions.

Giant Cell Tumor of the Distal Fibula Managed by an Autologous Proximal Fibula Graft

A giant cell tumor of the bone is among the most common bone tumors encountered by orthopedic surgeons. These benign and aggressive tumors are most commonly present around the knee joint; however, rare cases may involve the distal fibula. An 18-year-old man presented with a painless swelling of the lateral aspect of the left ankle. Clinical examination, radiologic evaluation, and biopsy confirmed the diagnosis of a giant cell tumor of the distal fibula. The patient was treated with resection of the distal fibula followed by reconstruction using an ipsilateral proximal fibula graft. The post-operative recovery was uneventful, and the patient was doing well on the last visit, one month after the intervention.

The appropriate and sequential value of standard radiograph, computed tomography and magnetic resonance imaging to characterize a bone tumor

Radiographs (XR), computed tomography (CT) or magnetic resonance imaging (MRI) are regularly analyzed to determine whether a bone lesion is benign or malignant. An online quiz was created providing 15 cases with a clinical summary, MRI, CT, and XR. After each image, participants were asked to rate the probability (0–100%) the bone tumor was malignant. Order and difficulty of the images were randomly determined. Probability statements regarding the diagnosis were actualized along the sequence of exam, to quantify how the degree of belief changed to account for evidence from those exams. 64 physicians participated and provided 154 assessments from 1 (n = 18) to 3 (n = 44) different cases. After the first image, participants favored the correct malignancy status at 70%; 80% after the second and 80% after the third one. Participants were more likely to favor the correct malignancy status when the lesion was malignant and when first confronted with XR or CT, rather than MRI, though the most predictive factor of correct diagnosis was the difficulty of the case. In conclusion, the additional information provided by successive imaging studies was moderate. XR or CT seemed more appropriate than MRI as first imaging study. Bypassing XR should be discouraged.

Image-guided musculoskeletal biopsy

Image guidance allows safe passage of needles, often into small and otherwise inaccessible lesions, and into the portions of the lesion most likely to yield useful samples, while avoiding damage to important structures. This article hopes to provide a useful guide to image-guided musculoskeletal biopsy for radiologists in practice and in training.

Role of MRI in paediatric musculoskeletal conditions

The aim of this review is to discuss the indications and use of MR imaging (MRI) in the paediatric musculoskeletal system. After briefly reviewing basic technical considerations the MRI appearance of the most relevant congenital, inflammatory, infectious, ischemic, and posttraumatic skeletal conditions, as well as benign and malignant bone and soft tissue tumours that are typical for the paediatric age group will be presented.

Imaging, diagnosis, and staging of bone tumors: A primer

By considering the radiographic appearance in combination with the lesion location and the patient's history, an informed differential diagnosis can be generated for a bone lesion. Primary musculoskeletal malignancies often display aggressive characteristics such as cortical breakthrough, bone destruction, periosteal reaction, and associated soft-tissue masses. On the other hand, benign lesions usually do not have these aggressive features. The matrix mineralization reflects the lesion's underlying pathology and can help to narrow the differential diagnosis.

Primary bone tumors of adulthood

Imaging plays a crucial role in the evaluation of primary bone tumors in adults. Initial radiographic evaluation is indicated in all cases with suspected primary bone tumors. Radiographs are useful for providing the diagnosis, a short list of differential diagnosis or at least indicating the degree of aggressiveness of the lesion. More detailed information about the lesion, such as cortical destruction or local spread, can be obtained using cross-sectional imaging techniques such as computed tomography and magnetic resonance imaging. This article discusses the characteristic features of the more common primary bone tumors of adulthood, and also the pre-treatment evaluation and staging of these lesions using imaging techniques.

The role of imaging in the staging and treatment planning of primary malignant bone tumors in children

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.

Malignant and benign bone tumors

The authors have intentionally included some confusing examples to demonstrate that the imaging findings of benign and malignant pediatric bone lesions are not always pathognomonic. The radiologist's role is to recognize malignant bone lesions and encourage the prompt referral of these patients to an appropriate institution for biopsy and treatment. The radiologist must also be able to identify benign lesions and help determine whether these lesions require biopsy and intervention or simply observation.