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Imaging of Sacral Tumors: Experience of the Rizzoli Institute

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Tumors of the Sacrum

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Abstract

Sacral bone tumors usually present nonspecific features so they are often large at diagnosis.

When the mass enlarges, it can induce compression on nerves and pelvic organs causing pelvic pain or heaviness, radiculopathy, and gastrointestinal or urinary tract disorders.

Conventional radiography has a low sensitivity because of the sacrum curved shape and overlapping bowel gas. It can only show bone destruction, calcifications, or a pelvic mass when the tumor stage is advanced.

Computed tomography is the most accurate examination for the diagnosis of sacral masses, and it is necessary to guide biopsy. A correct CT scan requires thin-slice sections and multiplanar 2D and 3D reconstructions on sacrum axis.

It can help detect bone pattern osteolysis, calcifications, tumor matrix mineralization, bone and soft tissues involvement. Bone marrow invasion is often underestimated at CT.

Magnetic resonance imaging (MRI) is fundamental for tumor staging because of its multiplanarity and high contrast resolution. Oblique coronal images, parallel to the long axis of the sacrum, should always be acquired. For a correct depiction of the tumor, anatomical extension, foramina, roots, and spinal involvement T1-w images are recommended. T2-weighted and T1-weighted Fat-Suppression images after Gadolinium injection can help in the differential diagnosis and show bone and soft tissues involvement. T2-w images also give information about tumor matrix; sagittal plane is particularly useful to assess sacral bone involvement.

Bone scintigraphy can help detect distant sites of disease and is usually performed in patients with a diagnosis of cancer.

[18F]-fluorodeoxyglucose (FDG) positron emission tomography (PET) shows the metabolic activity of the disease, and it is useful especially in hematogeneous malignancies and in primary bone sarcomas to evaluate the response after neoadjuvant therapy. Few data are available on its role in chordoma.

In the following chapter, imaging features of sacral tumors are reviewed according to the different pathological entities.

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Conflict-of-Interest Statement

No benefits have been or will be received from a commercial party related directly or indirectly to the subject matter of this chapter.

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Authors and Affiliations

  1. Diagnostic and Interventional Radiology, Istituto Ortopedico Rizzoli, Bologna, Italy

    Alessandra Bartoloni M.D. & Alberto Bazzocchi M.D.

  2. Department of Pathology, Istituto Ortopedico Rizzoli, Bologna, Italy

    Daniel Vanel M.D.

Authors
  1. Alessandra Bartoloni M.D.
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  2. Alberto Bazzocchi M.D.
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  3. Daniel Vanel M.D.
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Corresponding author

Correspondence to Daniel Vanel M.D. .

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Editors and Affiliations

  1. Department of Orthopedics and Orthopedic Oncology, University of Padova, Padova, Padova, Italy

    Pietro Ruggieri

  2. Department of Orthopedics and Orthopedic Oncology, University of Padova, Padova, Padova, Italy

    Andrea Angelini

  3. Department of Pathology, Istituto Ortopedico Rizzoli, Bologna, Italy

    Daniel Vanel

  4. Laboratory of Experimental Oncology, Musculoskeletal Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy

    Piero Picci

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Bartoloni, A., Bazzocchi, A., Vanel, D. (2017). Imaging of Sacral Tumors: Experience of the Rizzoli Institute. In: Ruggieri, P., Angelini, A., Vanel, D., Picci, P. (eds) Tumors of the Sacrum. Springer, Cham. https://doi.org/10.1007/978-3-319-51202-0_5

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  • DOI: https://doi.org/10.1007/978-3-319-51202-0_5

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