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The incidence of skip metastases on whole bone MRI in high-grade bone sarcomas

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Abstract

Introduction

Skip metastases have been described with osteosarcoma, Ewing sarcoma and rarely chondrosarcoma. The aim of this study was to determine the incidence of skip metastases on whole bone MRI in all primary high-grade sarcomas of the major long bones.

Materials and method

Retrospective review of patients from April 2007 to April 2019 with high-grade primary bone sarcomas of the humerus, radius, ulna, femur, tibia or fibula who had whole bone MRI at initial staging. Data collected included age, sex, tumour type, presence and location of skip metastases based on whole bone MRI and presence of distant metastases (the skeleton and lung).

Results

The study included 216 males and 171 females with mean age 30.6 years (range 4–92 years). Tumour types were as follows: High-grade osteosarcoma n = 202, Ewing sarcoma n = 68, high-grade chondrosarcoma n = 44, dedifferentiated chondrosarcoma n = 37, high-grade spindle cell sarcoma n = 29 and angiosarcoma n = 7. Skip lesions were identified in 63 (16.3%). However, after taking into account the presence of distant skeletal (n = 11) and pulmonary (n = 33) metastases, the overall incidence of skip metastases was 6.5%, occurring in 15 (7.5%) high-grade osteosarcomas, 3 (4.5%) Ewing sarcoma, 1 (2.8%) high-grade chondrosarcoma, 4 (10.8%) dedifferentiated chondrosarcomas, and 2 (6.9%) high-grade spindle cell sarcomas. A false positive MRI diagnosis of skip metastasis was made in 4 cases, 3 enchondromata and one focal nodular marrow hyperplasia.

Conclusion

The current study has documented the incidence of skip metastases in common types of high-grade primary bone sarcoma. The possibility of false positive skip metastases has also been highlighted.

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Authors and Affiliations

  1. Department of Imaging, Royal National Orthopaedic Hospital, Stanmore, UK

    Asif Saifuddin, Ines Oliveira, Sarah Kalus & Ian Pressney

  2. Department of Imaging, Northwick Park Hospital, Harrow, UK

    Ban Sharif

  3. Department of Orthopaedics, Royal National Orthopaedic Hospital, Stanmore, UK

    James Barnett

Authors
  1. Asif Saifuddin
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  2. Ban Sharif
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  3. Ines Oliveira
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  4. Sarah Kalus
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  5. James Barnett
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  6. Ian Pressney
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Correspondence to Ban Sharif.

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Saifuddin, A., Sharif, B., Oliveira, I. et al. The incidence of skip metastases on whole bone MRI in high-grade bone sarcomas. Skeletal Radiol 49, 945–954 (2020). https://doi.org/10.1007/s00256-019-03369-9

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  • DOI: https://doi.org/10.1007/s00256-019-03369-9

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