Sacrococcygeal chordoma: MR imaging in 30 patients



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.

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  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.

    CAS  PubMed  Google 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.

    CAS  PubMed  Google Scholar 

  3. 3.

    Jenkins CNJ, Colquhoun IR. Case report: symptomatic metastasis from a sacrococcygeal chordoma. Clin Radiol 1995; 50:416–417.

    CAS  PubMed  Google Scholar 

  4. 4.

    Tan WS, Spigos D, Khine N. Chordoma of the sellar region. J Comput Assist Tomogr 1982; 6:154–158.

    CAS  PubMed  Google 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.

    Article  CAS  PubMed  Google 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.

    Article  CAS  Google Scholar 

  7. 7.

    Hertzanu Y, Glass RBJ, Mendelsohn DB. Sacrococcygeal chordoma in young adults. Clin Radiol 1983; 34:327–329.

    CAS  PubMed  Google Scholar 

  8. 8.

    Hudson TM, Galceran M. Radiology of sacrococcygeal chordoma: difficulties in detecting soft tissue extension. Clin Orthop 1983; 175:237–242.

    PubMed  Google Scholar 

  9. 9.

    Smith J, Ludwig RL, Marcove RC. Sacrococcygeal chordoma: a clinicoradiologic study of 60 patients. Skeletal Radiol 1987; 16:37–44.

    CAS  PubMed  Google 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.

    CAS  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.

    Article  CAS  PubMed  Google Scholar 

  12. 12.

    Soo MY. Chordoma: review of clinicoradiological features and factors affecting survival. Australas Radiol 2001; 45:427–434.

    Article  CAS  PubMed  Google 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.

    CAS  PubMed  Google 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.

    CAS  PubMed  Google 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.

    CAS  PubMed  Google 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.

    CAS  PubMed  Google Scholar 

  17. 17.

    Schajowicz F. Tumors and tumor like lesions of bones and joints, 2nd ed. New York: Springer, 1981:459–468.

  18. 18.

    Cheng EY, Ozerdemoglu RA, Transfeldt EE, Thompson RC. Lumbosacral chordoma: prognostic factors and treatment. Spine 1999; 24:1639–1645.

    Article  CAS  PubMed  Google Scholar 

  19. 19.

    Suarez R, Morrison D, Suarez V. A pain in the rear. Br J Radiol 1990; 63:77–78.

    CAS  PubMed  Google Scholar 

  20. 20.

    Coombs RJ, Coiner L. Sacral chordoma with unusual posterior radiographic presentation. Skeletal Radiol 1996; 25:679–681.

    Article  CAS  PubMed  Google 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.

    CAS  PubMed  Google 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.

    Article  CAS  PubMed  Google 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; 20:279–283

    CAS  PubMed  Google 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; 20:1007–1019

    CAS  PubMed  Google 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; 14:1196–1202

    CAS  PubMed  Google Scholar 

  26. 26.

    Resnick D. Tumors and tumor-like diseases. In: Diagnosis of bone and joint disorders, 3rd ed. Philadelphia: Saunders, 1995:3785–3854.

  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.

  28. 28.

    Llauger J, Palmer J, Amores S, Bague S, Camins A. Primary tumors of the sacrum: diagnostic imaging. AJR 2000; 174:417–424.

    CAS  PubMed  Google 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.

    CAS  PubMed  Google 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.

    PubMed  Google Scholar 

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Corresponding author

Correspondence to Mi Sook Sung.

Additional information

This paper was presented at the International Skeletal Society 27th Annual meeting, Barcelona, Spain, August 2000.

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Sung, M.S., Lee, G.K., Kang, H.S. et al. Sacrococcygeal chordoma: MR imaging in 30 patients. Skeletal Radiol 34, 87–94 (2005).

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  • Chordoma
  • Sacrococcygeal
  • MR imaging
  • Recurrent tumor
  • Metastasis