European Radiology

, Volume 19, Issue 12, pp 3008–3014 | Cite as

Differentiating high-grade from low-grade chondrosarcoma with MR imaging

  • Hye Jin Yoo
  • Sung Hwan Hong
  • Ja-Young Choi
  • Kyung Chul Moon
  • Han-Soo Kim
  • Jung-Ah Choi
  • Heung Sik Kang
Musculoskeletal

Abstract

The purpose of the study was to evaluate the MR imaging features that differentiate between low-grade chondrosarcoma (LGCS) and high-grade chondrosarcoma (HGCS) and to determine the most reliable predictors for differentiation. MR images of 42 pathologically proven chondrosarcomas (28 LGCS and 14 HGCS) were retrospectively reviewed. There were 13 male and 29 female patients with an age range of 23–72 years (average age 51 years). On MR images, signal intensity, specific morphological characteristics including entrapped fat, internal lobular architecture, and outer lobular margin, soft tissue mass formation and contrast enhancement pattern were analysed. MR imaging features used to identify LGCS and HGCS were compared using univariate analysis and multivariate stepwise logistic regression analysis. On T1-weighted images, a central area of high signal intensity, which was not seen in LGCS, was frequently observed in HGCS (n = 5, 36%) (p < 0.01). Entrapped fat within the tumour was commonly seen in LGCS (n = 26, 93%), but not in HGCS (n = 1, 4%) (p < 0.01). LGCS more commonly (n = 24, 86%) preserved the characteristic internal lobular structures within the tumour than HGCSs (n = 4, 29%) (p < 0.01). Soft tissue formation was more frequently observed in HGCS (n = 11, 79%) than in LGCS (n = 1, 4%) (p < 0.01). On gadolinium-enhanced images, large central nonenhancing areas were exhibited in only two (7.1%) of LGCS, while HGCS frequently (n = 9, 64%) had a central nonenhancing portion (p < 0.01). Results of multivariate stepwise logistic regression analysis showed that soft tissue formation and entrapped fat within the tumour were the variables that could be used to independently differentiate LGCS from HGCS. There were several MR imaging features of chondrosarcoma that could be helpful in distinguishing HGCS from LGCS. Among them, soft tissue mass formation favoured the diagnosis of HGCS, and entrapped fat within the tumour was highly indicative of LGCS.

Keywords

High grade Low grade Chondrosarcoma MR findings 

References

  1. 1.
    Welkerling H, Kratz S, Ewerbeck V, Delling G (2003) A reproducible and simple grading system for classical chondrosarcomas. Analysis of 35 chondrosarcomas and 16 enchondromas with emphasis on recurrence rate and radiological and clinical data. Virchows Arch 443:725–733CrossRefPubMedGoogle Scholar
  2. 2.
    Rozeman LB, Cleton-Jansen AM, Hogendoorn PC (2006) Pathology of primary malignant bone and cartilage tumours. Int Orthop 30:437–444CrossRefPubMedGoogle Scholar
  3. 3.
    Marco RA, Gitelis S, Brebach GT, Healey JH (2000) Cartilage tumours: evaluation and treatment. J Am Acad Orthop Surg 8:292–304PubMedGoogle Scholar
  4. 4.
    Geirnaerdt MJ, Bloem JL, Eulderink F, Hogendoorn PC, Taminiau AH (1993) Cartilaginous tumours: correlation of gadolinium-enhanced MR imaging and histopathologic findings. Radiology 186:813–817PubMedGoogle Scholar
  5. 5.
    Cohen EK, Kressel HY, Frank TS et al (1988) Hyaline cartilage-origin bone and soft-tissue neoplasms: MR appearance and histologic correlation. Radiology 167:477–481PubMedGoogle Scholar
  6. 6.
    Welkerling H, Werner M, Delling G (1996) Histologic grading of chondrosarcoma. A qualitative and quantitative analysis of 74 cases of the Hamburg bone tumour register. Pathologe 17:18–25CrossRefPubMedGoogle Scholar
  7. 7.
    Inwards CY, Unni KK (1995) Classification and grading of bone sarcomas. Hematol Oncol Clin North Am 9:545–569PubMedGoogle Scholar
  8. 8.
    Sanerkin NG (1980) The diagnosis and grading of chondrosarcoma of bone: a combined cytologic and histologic approach. Cancer 45:582–594CrossRefPubMedGoogle Scholar
  9. 9.
    Welkerling H, Dreyer T, Delling G (1991) Morphological typing of chondrosarcoma: a study of 94 cases. Virchows Arch A Pathol Anat Histopathol 418:419–425CrossRefPubMedGoogle Scholar
  10. 10.
    Fiorenza F, Abudu A, Grimer RJ et al (2002) Risk factors for survival and local control in chondrosarcoma of bone. J Bone Joint Surg Br 84:93–99CrossRefPubMedGoogle Scholar
  11. 11.
    Soderstrom M, Ekfors TO, Bohling TO, Teppo LH, Vuorio EI, Aro HT (2003) No improvement in the overall survival of 194 patients with chondrosarcoma in Finland in 1971–1990. Acta Orthop Scand 74:344–350CrossRefPubMedGoogle Scholar
  12. 12.
    Papagelopoulos PJ, Mavrogenis AF, Galanis EC, Savvidou OD, Inwards CY, Sim FH (2007) Clinicopathological features, diagnosis, and treatment of adamantinoma of the long bones. Orthopedics 30:211–215 quiz 216–217PubMedGoogle Scholar
  13. 13.
    Pritchard DJ, Lunke RJ, Taylor WF, Dahlin DC, Medley BE (1980) Chondrosarcoma: a clinicopathologic and statistical analysis. Cancer 45:149–157CrossRefPubMedGoogle Scholar
  14. 14.
    Mankin HJ, Cantley KP, Lippiello L, Schiller AL, Campbell CJ (1980) The biology of human chondrosarcoma. I. Description of the cases, grading, and biochemical analyses. J Bone Joint Surg Am 62:160–176PubMedGoogle Scholar
  15. 15.
    De Beuckeleer LH, De Schepper AM, Ramon F (1996) Magnetic resonance imaging of cartilaginous tumours: is it useful or necessary? Skeletal Radiol 25:137–141CrossRefPubMedGoogle Scholar
  16. 16.
    De Beuckeleer LH, De Schepper AM, Ramon F, Somville J (1995) Magnetic resonance imaging of cartilaginous tumours: a retrospective study of 79 patients. Eur J Radiol 21:34–40CrossRefPubMedGoogle Scholar
  17. 17.
    Geirnaerdt MJ, Hogendoorn PC, Bloem JL, Taminiau AH, van der Woude HJ (2000) Cartilaginous tumours: fast contrast-enhanced MR imaging. Radiology 214:539–546PubMedGoogle Scholar
  18. 18.
    Murphey MD, Walker EA, Wilson AJ, Kransdorf MJ, Temple HT, Gannon FH (2003) From the archives of the AFIP: imaging of primary chondrosarcoma: radiologic-pathologic correlation. Radiographics 23:1245–1278CrossRefPubMedGoogle Scholar
  19. 19.
    Aoki J, Sone S, Fujioka F et al (1991) MR of enchondroma and chondrosarcoma: rings and arcs of Gd-DTPA enhancement. J Comput Assist Tomogr 15:1011–1016PubMedCrossRefGoogle Scholar
  20. 20.
    Hauck WW, Miike R (1991) A proposal for examining and reporting stepwise regressions. Stat Med 10:711–715CrossRefPubMedGoogle Scholar
  21. 21.
    Wang XL, De Beuckeleer LH, De Schepper AM, Van Marck E (2001) Low-grade chondrosarcoma vs enchondroma: challenges in diagnosis and management. Eur Radiol 11:1054–1057CrossRefPubMedGoogle Scholar
  22. 22.
    Varma DG, Ayala AG, Carrasco CH, Guo SQ, Kumar R, Edeiken J (1992) Chondrosarcoma: MR imaging with pathologic correlation. Radiographics 12:687–704PubMedGoogle Scholar
  23. 23.
    Murphey MD, Flemming DJ, Boyea SR, Bojescul JA, Sweet DE, Temple HT (1998) Enchondroma versus chondrosarcoma in the appendicular skeleton: differentiating features. Radiographics 18:1213–1237 quiz 1244–1215PubMedGoogle Scholar

Copyright information

© European Society of Radiology 2009

Authors and Affiliations

  • Hye Jin Yoo
    • 1
  • Sung Hwan Hong
    • 1
  • Ja-Young Choi
    • 1
  • Kyung Chul Moon
    • 2
  • Han-Soo Kim
    • 3
  • Jung-Ah Choi
    • 1
  • Heung Sik Kang
    • 1
  1. 1.Department of Radiology and Institute of Radiation MedicineSeoul National University College of MedicineSeoulKorea
  2. 2.Department of PathologySeoul National University College of MedicineSeoulKorea
  3. 3.Department of Orthopedic SurgerySeoul National University College of MedicineSeoulKorea

Personalised recommendations