Skip to main content
SpringerLink
Log in

What are the differentiating clinical and MRI-features of enchondromas from low-grade chondrosarcomas?

  • Musculoskeletal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To evaluate the role of clinical assessment, conventional and dynamic contrast-enhanced MRI in differentiating enchondromas from chondrosarcomas of long bone.

Methods

The following clinical and MRI findings were assessed: age, gender, pain, pain attributable to lesion, tumour location, tumour length, presence, depth of endosteal scalloping, bone marrow oedema, soft tissue oedema, cortical destruction, periosteal reaction, bone expansion, macroscopic fat, calcification, soft tissue mass, haemorrhage, dynamic contrast-enhanced MRI. Clinical and MRI findings were compared with histopathological grading.

Results

Sixty patients with central chondroid tumours were included (27 enchondromas, 10 cartilaginous lesions of unknown malignant potential, 15 grade 1 chondrosarcomas, 8 high-grade chondrosarcomas). Pain attributed to lesion, tumour length, endosteal scalloping > 2/3, cortical destruction, bone expansion and soft tissue mass were differentiating features between enchondromas and grade 1 chondrosarcomas. Dynamic contrast-enhanced MRI could not differentiate enchondromas from grade 1 chondrosarcomas.

Conclusions

Previously reported imaging signs of chondrosarcomas are useful in the diagnosis of grade 1 lesions but have lower sensitivity than in higher grade lesions. Deep endosteal scalloping is the most sensitive imaging sign of grade 1 chondrosarcomas. Pain due to the lesion is an important clinical sign of grade 1 chondrosarcomas. Dynamic contrast-enhanced MRI is not useful in differentiating enchondromas from grade 1 chondrosarcomas.

Key Points

• Differentiation of enchondroma from low-grade chondrosarcoma is challenging for radiologists and pathologists.

• The utility of clinical assessment, conventional and dynamic contrast-enhanced MRI was uncertain.

• Clinical assessment and conventional MRI aid in differentiating enchondromas from low-grade chondrosarcoma.

• Dynamic contrast-enhanced MRI cannot differentiate enchondromas from grade 1 chondrosarcoma.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Explore related subjects

Discover the latest articles, news and stories from top researchers in related subjects.

Abbreviations

CS:

Chondrosarcoma

CLUMP:

Cartilaginous lesion of unknown malignant potential

DCE MRI:

Dynamic contrast-enhanced MRI

References

  1. Hogendoorn PCW, Bovee J, Nielsen GP (2013) World health organization classification of tumours of soft tissue and bone. In: Fletcher CDM, Bridge JA, Hogendoorn PCW, Mertens F (ed). IARCPress, Lyon, pp 264–268

  2. Hong ED, Carrino JA, Weber KL, Fayad LM (2011) Prevalence of shoulder enchondromas on routine MR imaging. Clin Imaging 35:378–384

    Article  PubMed  Google Scholar 

  3. Stomp W, Reijnierse M, Kloppenburg M et al (2015) Prevalence of cartilaginous tumours as an incidental finding on MRI of the knee. Eur Radiol. doi:10.1007/s00330-015-3764-6

    PubMed Central  Google Scholar 

  4. Walden MJ, Murphey MD, Vidal JA (2008) Incidental enchondromas of the knee. AJR Am J Roentgenol 190:1611–1615

    Article  PubMed  Google Scholar 

  5. (2007) Reliability of histopathologic and radiologic grading of cartilaginous neoplasms in long bones. J Bone Joint Surg Am 89:2113–2123

  6. Eefting D, Schrage YM, Geirnaerdt MJ et al (2009) Assessment of interobserver variability and histologic parameters to improve reliability in classification and grading of central cartilaginous tumors. Am J Surg Pathol 33:50–57

    Article  PubMed  Google Scholar 

  7. Logie CI, Walker EA, Forsberg JA, Potter BK, Murphey MD (2013) Chondrosarcoma: a diagnostic imager's guide to decision making and patient management. Semin Musculoskelet Radiol 17:101–115

    Article  PubMed  Google Scholar 

  8. 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 1244-1215

    Article  CAS  PubMed  Google Scholar 

  9. De Coninck T, Jans L, Sys G et al (2013) Dynamic contrast-enhanced MR imaging for differentiation between enchondroma and chondrosarcoma. Eur Radiol. doi:10.1007/s00330-013-2913-z

    PubMed  Google Scholar 

  10. Choi BB, Jee WH, Sunwoo HJ et al (2013) MR differentiation of low-grade chondrosarcoma from enchondroma. Clin Imaging 37:542–547

    Article  PubMed  Google Scholar 

  11. Ferrer-Santacreu EM, Ortiz-Cruz EJ, Gonzalez-Lopez JM, Perez Fernandez E (2012) Enchondroma versus low-grade chondrosarcoma in appendicular skeleton: clinical and radiological criteria. J Oncol 2012:437958

    Article  PubMed  PubMed Central  Google Scholar 

  12. Crim J, Schmidt R, Layfield L, Hanrahan C, Manaster BJ (2015) Can imaging criteria distinguish enchondroma from grade 1 chondrosarcoma? Eur J Radiol 84:2222–2230

    Article  PubMed  Google Scholar 

  13. Grimer RJ, Carter SR, Tillman RM, Mangham DC, Abudu A, Fiorenza F (2000) Chondrosarcoma of bone. J Bone Joint Surg Am 82-A:1203–1204

    Article  CAS  PubMed  Google Scholar 

  14. Lee FY, Mankin HJ, Fondren G et al (1999) Chondrosarcoma of bone: an assessment of outcome. J Bone Joint Surg Am 81:326–338

    Article  CAS  PubMed  Google Scholar 

  15. Campanacci DA, Scoccianti G, Franchi A et al (2013) Surgical treatment of central grade 1 chondrosarcoma of the appendicular skeleton. J Orthop Traumatol 14:101–107

    Article  PubMed  PubMed Central  Google Scholar 

  16. Hanna SA, Whittingham-Jones P, Sewell MD et al (2009) Outcome of intralesional curettage for low-grade chondrosarcoma of long bones. Eur J Surg Oncol 35:1343–1347

    Article  CAS  PubMed  Google Scholar 

  17. Souna BS, Belot N, Duval H, Langlais F, Thomazeau H (2010) No recurrences in selected patients after curettage with cryotherapy for grade I chondrosarcomas. Clin Orthop Relat Res 468:1956–1962

    Article  PubMed  PubMed Central  Google Scholar 

  18. Verdegaal SH, Brouwers HF, van Zwet EW, Hogendoorn PC, Taminiau AH (2012) Low-grade chondrosarcoma of long bones treated with intralesional curettage followed by application of phenol, ethanol, and bone-grafting. J Bone Joint Surg Am 94:1201–1207

    Article  PubMed  Google Scholar 

  19. Geirnaerdt MJ, Hogendoorn PC, Bloem JL, Taminiau AH, van der Woude HJ (2000) Cartilaginous tumors: fast contrast-enhanced MR imaging. Radiology 214:539–546

    Article  CAS  PubMed  Google Scholar 

  20. Bui KL, Ilaslan H, Bauer TW, Lietman SA, Joyce MJ, Sundaram M (2009) Cortical scalloping and cortical penetration by small eccentric chondroid lesions in the long tubular bones: not a sign of malignancy? Skelet Radiol 38:791–796

    Article  Google Scholar 

  21. Douis H, Singh L, Saifuddin A (2014) MRI differentiation of low-grade from high-grade appendicular chondrosarcoma. Eur Radiol 24:232–240

    Article  PubMed  Google Scholar 

  22. Yoo HJ, Hong SH, Choi JY et al (2009) Differentiating high-grade from low-grade chondrosarcoma with MR imaging. Eur Radiol 19:3008–3014

    Article  PubMed  Google Scholar 

  23. Douis H, Jeys L, Grimer R, Vaiyapuri S, Davies AM (2015) Is there a role for diffusion-weighted MRI (DWI) in the diagnosis of central cartilage tumors? Skelet Radiol. doi:10.1007/s00256-015-2123-7

    Google Scholar 

Download references

Acknowledgements

We acknowledge the help of Dr Peter Nightingale (statistician at the University Hospital Birmingham) with the statistical analysis.

Author information

Authors and Affiliations

  1. Department of Radiology, Royal Orthopaedic Hospital, Birmingham, UK

    Hassan Douis & A. M. Davies

  2. Department of Radiology, University Hospital Birmingham, Birmingham, B15 2TH, UK

    Hassan Douis

  3. Department of Orthopaedic Oncology, Royal Orthopaedic Hospital, Birmingham, UK

    M. Parry

  4. Department of Musculoskeletal Pathology, Royal Orthopaedic Hospital, Birmingham, UK

    S. Vaiyapuri

Authors
  1. Hassan Douis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Parry
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Vaiyapuri
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. M. Davies
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hassan Douis.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Mark A. Davies.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Funding

The authors state that this work has not received any funding.

Statistics and biometry

Peter Nightingale kindly provided statistical advice for this manuscript.

Ethical approval

Institutional Review Board approval was obtained.

Informed consent

Written informed consent was not required for this study because of the retrospective nature of the study.

Methodology

• retrospective

• observational

• performed at one institution

Electronic supplementary material

Below is the link to the electronic supplementary material.

ESM 1

(DOCX 24 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Douis, H., Parry, M., Vaiyapuri, S. et al. What are the differentiating clinical and MRI-features of enchondromas from low-grade chondrosarcomas?. Eur Radiol 28, 398–409 (2018). https://doi.org/10.1007/s00330-017-4947-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-017-4947-0

Keywords

Search

Navigation