Skeletal Radiology

, Volume 34, Issue 2, pp 87–94 | Cite as

Sacrococcygeal chordoma: MR imaging in 30 patients

  • Mi Sook Sung
  • Gyung Kyu Lee
  • Heung Sik Kang
  • Soon Tae Kwon
  • Jin Gyoon Park
  • Jin Suk Suh
  • Gil Ho Cho
  • Sung Moon Lee
  • Myung Hee Chung
  • Donald Resnick
Scientific Article
First Online:
Received:
Revised:
Accepted:

Abstract

Objective

To evaluate MR imaging of sacrococcygeal chordoma.

Design and patients

Thirty patients (age range 22–80 years) underwent MR imaging for the diagnosis and preoperative evaluation of sacrococcygeal chordomas. Eight patients had follow-up MR examination after treatment. The MR images were performed with T1- and T2-weighted imaging, and gadolinium (Gd)-enhanced imaging. The MR images were analyzed for the signal intensity, enhancing pattern, tumor size, growth pattern of the soft tissue component, and tumor extension.

Results and conclusions

T1-weighted images showed low signal masses with foci of high signal intensity in 73% of cases. Tumors enhanced in a variety of patterns after the administration of Gd. Soft tissue masses extending anteriorly were seen in all cases with posterior extension in 77% of cases. The posterior masses involved the surrounding muscles and extended toward the greater sciatic notch, appearing with pseudopodia (87%). Sacroiliac joints were involved in 23% of cases. Four lesions showed intraspinal extension and involvement of the posterior spinal muscles above the level of bony involvement. In 6 patients recurrent tumors were found at or around the surgical margin of the tumor 6 months to 5 years after resection of the sacral tumor. In two of the patients, nodular metastases to the pelvic bones and femur were found 1–4 years after initial examination. In conclusion, MR imaging is useful in the diagnosis and preoperative assessment of sacrococcygeal chordoma. Characteristic findings included sacral mass with heterogeneously high signal intensity with crisscrossing septa on long-repetition-time imaging, well-encapsulated pseudopodia-like or lobulated appearance, and gluteal muscle infiltration. Follow-up MR imaging is helpful to assess for recurrent or metastatic lesions of chordomas.

Keywords

Chordoma Sacrococcygeal MR imaging Recurrent tumor Metastasis 
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References

  1. 1.
    Meyer JE, Lepke RA, Lindfors KK et al. Chordomas: their CT appearance in the cervical, thoracic, and lumbar spine. Radiology 1984; 153:693–696.PubMedGoogle Scholar
  2. 2.
    Bjornsson J, Wold LE, Ebersold MJ, Laws ER. Chordoma of the mobile spine: a clinicopathologic analysis of 40 patients. Cancer 1993; 71:735–740.PubMedGoogle Scholar
  3. 3.
    Jenkins CNJ, Colquhoun IR. Case report: symptomatic metastasis from a sacrococcygeal chordoma. Clin Radiol 1995; 50:416–417.PubMedGoogle Scholar
  4. 4.
    Tan WS, Spigos D, Khine N. Chordoma of the sellar region. J Comput Assist Tomogr 1982; 6:154–158.PubMedGoogle Scholar
  5. 5.
    Yonemoto T, Tatazaki S, Takenouchi T, Ishii T, Satoh T, Moriya H. The surgical management of sacrococcygeal chordoma. Cancer 1999; 85:878–883.CrossRefPubMedGoogle Scholar
  6. 6.
    Firooznia H, Golimbu C, Rafii M, Reede DL, Kricheff II, Bjorkengren A. Computed tomography of spinal chordomas. J Comput Assist Tomogr 1986;10:45.CrossRefGoogle Scholar
  7. 7.
    Hertzanu Y, Glass RBJ, Mendelsohn DB. Sacrococcygeal chordoma in young adults. Clin Radiol 1983; 34:327–329.PubMedGoogle Scholar
  8. 8.
    Hudson TM, Galceran M. Radiology of sacrococcygeal chordoma: difficulties in detecting soft tissue extension. Clin Orthop 1983; 175:237–242.PubMedGoogle Scholar
  9. 9.
    Smith J, Ludwig RL, Marcove RC. Sacrococcygeal chordoma: a clinicoradiologic study of 60 patients. Skeletal Radiol 1987; 16:37–44.PubMedGoogle Scholar
  10. 10.
    Meyers SP, Hirsch WL, Curtin HD, Barmes L, Sekhar LN, Sen C. Chordomas of the skull base: MR features. AJNR 1992; 13:1627–1636.Google Scholar
  11. 11.
    Doucet V, Peretti-Viton P, Figarella-Branger D, Manera L, Salamon G. MRI of intracranial chordomas. Extent of tumor and contrast enhancement: criteria for differential diagnosis. Neuroradiology 1997; 39:571–576.CrossRefPubMedGoogle Scholar
  12. 12.
    Soo MY. Chordoma: review of clinicoradiological features and factors affecting survival. Australas Radiol 2001; 45:427–434.CrossRefPubMedGoogle Scholar
  13. 13.
    Diel J, Ortiz O, Losada RA, Price DB, Hayt MW, Katz DS. The sacrum: pathologic spectrum, multimodality imaging, and subspecialty approach. Radiographics 2001; 21:83–104.PubMedGoogle Scholar
  14. 14.
    Rosenthal DI, Scott JA, Mankin HJ, Wismer GL, Brady TJ. Sacrococcygeal chordoma: magnetic resonance imaging and computed tomography. AJR 1985; 145:143–147.PubMedGoogle Scholar
  15. 15.
    Murphey MD, Andrews CL, Flemming DJ, Temple HT, Smith WS, Smirniotopoulos JG. Primary tumors of the spine: radiologic–pathologic correlation. Radiographics 1996; 16:1131–1158.PubMedGoogle Scholar
  16. 16.
    Smolders D, Wang X, Drevelengas A, Vanhoenacker F, De Schepper AM. Value of MRI in the diagnosis of non-clival, non-sacral chordoma. Skeletal Radiol 2003; 32:343–350.PubMedGoogle Scholar
  17. 17.
    Schajowicz F. Tumors and tumor like lesions of bones and joints, 2nd ed. New York: Springer, 1981:459–468.Google Scholar
  18. 18.
    Cheng EY, Ozerdemoglu RA, Transfeldt EE, Thompson RC. Lumbosacral chordoma: prognostic factors and treatment. Spine 1999; 24:1639–1645.CrossRefPubMedGoogle Scholar
  19. 19.
    Suarez R, Morrison D, Suarez V. A pain in the rear. Br J Radiol 1990; 63:77–78.PubMedGoogle Scholar
  20. 20.
    Coombs RJ, Coiner L. Sacral chordoma with unusual posterior radiographic presentation. Skeletal Radiol 1996; 25:679–681.CrossRefPubMedGoogle Scholar
  21. 21.
    Prabhakaran PS, Misra S, Kannan V, Chandrashekar M, Vijayakumar M, Veerendrakumar KV, Anantha N. Sacral chordomas: a 10-year study. Australas Radiol 1998; 42:42–46.PubMedGoogle Scholar
  22. 22.
    York JE, Kaczaraj A, Abi-Said D et al. Sacral chordoma: 40-year experience at a major cancer center. Neurosurgery 1999; 44:74–80.CrossRefPubMedGoogle Scholar
  23. 23.
    Abdelwahab IF, Miller TT, Hermann G, Klein MJ, Kenan S, Lewis MM. Transarticular invasion of joints by bone tumors: hypothesis. Skeletal Radiol 1991; 20:279–283PubMedGoogle Scholar
  24. 24.
    Sung MS, Kang HS, Suh JS, Lee JH, Park JM, Kim JY, Lee HG. Myxoid liposarcoma: appearance at MR imaging with histologic correlation. Radiographics 2000; 20:1007–1019PubMedGoogle Scholar
  25. 25.
    Davies AM, Hall AD, Strouhal PD, Evans N, Grimer RJ. The MR imaging appearances and natural history of seromas following excision of soft tissue tumours. Eur Radiol 2004; 14:1196–1202PubMedGoogle Scholar
  26. 26.
    Resnick D. Tumors and tumor-like diseases. In: Diagnosis of bone and joint disorders, 3rd ed. Philadelphia: Saunders, 1995:3785–3854.Google Scholar
  27. 27.
    Murphey MD, Smith WS, Al-Assir I, Shekitka KM. MR imaging of giant cell tumor of bone: signal intensity characteristics with radiologic–pathologic correlation (abstr). Radiology 1995; 197(P):195.Google Scholar
  28. 28.
    Llauger J, Palmer J, Amores S, Bague S, Camins A. Primary tumors of the sacrum: diagnostic imaging. AJR 2000; 174:417–424.PubMedGoogle Scholar
  29. 29.
    Aoki J, Sone S, Fujioka F et al. MR of enchondroma and chondrosarcoma: rings and arcs of Gd-DTPA enhancement. J Comput Assist Tomogr 1991; 15:1011.PubMedGoogle Scholar
  30. 30.
    Robert FO, Gordon EM, Paul FJN et al. The role of MR and CT in evaluating clival chordomas and chondrosarcomas. AJR 1988; 151:567–575.PubMedGoogle Scholar

Copyright information

© ISS 2004

Authors and Affiliations

  • Mi Sook Sung
    • 1
  • Gyung Kyu Lee
    • 2
  • Heung Sik Kang
    • 2
  • Soon Tae Kwon
    • 3
  • Jin Gyoon Park
    • 4
  • Jin Suk Suh
    • 5
  • Gil Ho Cho
    • 6
  • Sung Moon Lee
    • 7
  • Myung Hee Chung
    • 1
  • Donald Resnick
    • 8
  1. 1.Department of RadiologyThe Catholic University of Korea, Holy Family HospitalPucheon, Kyunggi-do 420-717Korea
  2. 2.Department of RadiologySeoul National University HospitalSeoulKorea
  3. 3.Department of RadiologyChungnam University HospitalTaejunKorea
  4. 4.Department of RadiologyChunnam University HospitalKwangjuKorea
  5. 5.Department of RadiologyYonsei University, Severans HospitalSeoulKorea
  6. 6.Department of RadiologyYeungnam University HospitalTaeguKorea
  7. 7.Department of RadiologyKaemyung University HospitalTaekuKorea
  8. 8.Department of RadiologyVA Medical CenterSan DiegoUSA

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