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Surgical Staging 1: Primary Tumour

  • Chapter
Imaging of Bone Tumors and Tumor-Like Lesions

Part of the book series: Medical Radiology ((Med Radiol Diagn Imaging))

Key Points

• The objectives of local staging of primary bone tumours are to detect: (a) the extent of bone marrow involvement, including epiphyseal involvement and the presence of skip lesions; and (b) the presence and extent of extraosseous soft tissue mass including involvement of the adjacent joint, neurovascular bundle and muscle compartments, thus establishing the feasibility of limb salvage, as opposed to amputation.

• MRI of the whole bone containing the primary tumour, including joints at both ends of long bones, should be obtained to show the full extent of bone marrow involvement and skip lesions.

• Longitudinal non-contrast T1-weighted SE sequences are the most accurate for determining intraosseous tumour extent.

• Assessment of neurovascular involvement is optimally demonstrated in the axial plane using fat-suppressed T2-weighted or PDW FSE sequences.

• Dynamic enhanced MRI can aid in the differentiation of extraosseous tumour from adjacent oedema due to the delayed enhancement of the latter, although its clinical utility has not been proven.

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References

  • Abdelwahab IF, Miller TT, Hermann G et al. (1991) Transarticular invasion of joints by bone tumours: hypothesis. Skeletal Radiol 20:279−283

    Article  PubMed  CAS  Google Scholar 

  • Aegerter E, Kirkpatrick JA (1975) Orthopedic diseases: physiology, pathology, radiology, 4th edn. Saunders, Philadelphia, pp 519−520

    Google Scholar 

  • Alkalay D, Kollender Y, Mozes M et al. (1998) Transarticular tumor invasion via ligamentum teres: a clinical pathologic study of 12 patients. Acta Orthop Scand (Suppl) 445:25−35

    Google Scholar 

  • Alyas F, James SL, Davies AM et al. (2007) The role of MR imaging in the diagnostic characterisation of appendicular bone tumours and tumour-like conditions. Eur Radiol 17:2675−2686

    Article  PubMed  CAS  Google Scholar 

  • American Joint Committee on Cancer (1997) Bone. In: Fleming ID, Cooper JS, Henson DE et al. (eds) AJCC cancer staging manual. Lippincott-Raven, Philadelphia, pp 143−147

    Google Scholar 

  • American Joint Committee on Cancer (2002) Bone. In: Greene FL, Page DL, Fleming ID et al. (eds) AJCC cancer staging manual. Springer, Berlin Heidelberg New York, pp 213−219

    Google Scholar 

  • Ardran GM (1951) Bone destruction not demonstrable by radiography. Br J Radiol 24:107−109

    Article  PubMed  CAS  Google Scholar 

  • Bhagia SM, Grimer RJ, Davies AM et al. (1997) Scintigraphically negative skip metastasis in osteosarcoma. Eur Radiol 7:1446−1448

    Article  PubMed  CAS  Google Scholar 

  • Bloem JL, Taminiau AH, Eulderink F et al. (1988) Radiologic staging of primary bone sarcoma: MR imaging, scintigraphy, angiography, and CT correlated with pathologic examination. Radiology 169:805−810

    PubMed  CAS  Google Scholar 

  • Bohndorf K, Reiser M, Lochner B et al. (1986) Magnetic resonance imaging of primary tumours and tumour-like lesions of bone. Skeletal Radiol 15(7):511−517

    Article  PubMed  CAS  Google Scholar 

  • Boyko OB, Cory DA, Cohen MD et al. (1987) MR imaging of osteogenic and Ewing’s sarcoma. Am J Roentgenol 148:317−322

    CAS  Google Scholar 

  • Brisse H, Ollivier L, Edeline V et al. (2004) Imaging of malignant tumours of the long bones in children: monitoring response to neoadjuvant chemotherapy and preoperative assessment. Pediatr Radiol 34:595–605

    Article  PubMed  Google Scholar 

  • Chew FS, Hudson TM (1982) Radionuclide bone scanning of osteosarcoma: falsely extended uptake patterns. Am J Roentgenol 139:49−54

    CAS  Google Scholar 

  • Chhaya S, White LM, Kandel R et al. (2005) Transarticular invasion of bone tumours across the sacroiliac joint. Skeletal Radiol 34:771−777

    Article  PubMed  CAS  Google Scholar 

  • Davies AM, Makwana NK, Grimer RJ et al. (1997) Skip metastases in Ewing’s sarcoma: a report of three cases. Skeletal Radiol 26:379−384

    Article  PubMed  CAS  Google Scholar 

  • Egmont-Petersen M, Hogendoorn PCW, van der Geest RJ et al. (2000) Detection of areas with viable remnant tumor in postchemotherapy patients with Ewing’s sarcoma by dynamic contrast-enhanced MRI using pharmacokinetic modeling. Magn Reson Imaging 18:525−535

    Article  PubMed  CAS  Google Scholar 

  • El Khadrawy AM, Hoffer FA, Reddick WA (1999) Ewing sarcoma recurrence vs radiation necrosis in dynamic contrast-enhanced MR imaging: a case report. Pediatr Radiol 29:272−274

    Article  PubMed  Google Scholar 

  • Enneking WF, Dunham WK (1978) Resection and reconstruction for primary neoplasms involving the innominate bone. J Bone Joint Surg Am 60:731−746

    PubMed  CAS  Google Scholar 

  • Enneking WF, Kagan A (1975) Skip metastases in osteosarcoma. Cancer 36:2192−2205

    PubMed  CAS  Google Scholar 

  • Enneking WF, Kagan A (1978) Transepiphyseal extension of osteosarcoma: incidence, mechanism, and implications. Cancer 41:1526−1537

    Article  PubMed  CAS  Google Scholar 

  • Enneking WF, Spanier SS, Goodman MA (1980) A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop 153:106−120

    PubMed  Google Scholar 

  • Feydy A, Anract P, Tomeno B et al. (2006) Assessment of vascular invasion by musculoskeletal tumors of the limbs: use of contrast enhanced MR angiography. Radiology 238:611−621

    Article  PubMed  Google Scholar 

  • Gillespy T III, Manfrini M, Ruggieri P et al. (1988) Staging of intraosseous extent of osteosarcoma: correlation of preoperative CT and MR imaging with pathologic macroslides. Radiology 167:765−767

    PubMed  Google Scholar 

  • Golfieri R, Baddeley H, Pringle JS et al. (1990) The role of the STIR sequence in magnetic resonance imaging examination of bone tumours. Br J Radiol 1990 63:251−256

    Article  PubMed  CAS  Google Scholar 

  • Golfieri R, Baddeley H, Pringle JS et al. (1991) MRI in primary bone tumors: therapeutic implications. Eur J Radiol 12:201−207

    Article  PubMed  CAS  Google Scholar 

  • Gronemeyer SA, Kauffman WM, Rocha MS et al. (1997) Fat-saturated contrast-enhanced T1-weighted MRI in the evaluation of osteosarcoma and Ewing sarcoma. J Magn Reson Imaging 7:585−589

    Article  PubMed  CAS  Google Scholar 

  • Hanna SL, Fletcher BD, Parham DM et al. (1991) Muscle edema in musculoskeletal tumours: MR imaging characteristics and clinical significance. J Magn Reson Imaging 1:441−449

    Article  PubMed  CAS  Google Scholar 

  • Hoffer FA, Nikanorov AY, Reddick WE et al. (2000) Accuracy of MR imaging for detecting epiphyseal extension of osteosarcoma. Pediatr Radiol 30:289−298

    Article  PubMed  CAS  Google Scholar 

  • Hudson TM, Schiebler M, Springfield DS et al. (1983) Radiologic imaging of osteosarcoma: role in planning surgical treatment. Skeletal radiol 10:137−146

    Article  PubMed  CAS  Google Scholar 

  • Huth JF, Eckardt JJ, Pignatti G et al. (1988) Resection of malignant bone tumors of the pelvic girdle without extremity amputation. Arch Surg 123:1121−1124

    PubMed  CAS  Google Scholar 

  • Kager l, Zoubek A, Kastner U et al. (2006) Skip metastases in osteosarcoma: experience of the cooperative osteosarcoma study group. J Clin Oncol 24(10):1535−1541

    Article  PubMed  Google Scholar 

  • Kuettner KE, Pauli BU, Soble L (1978) Morphological studies on the resistance of cartilage to invasion by osteosarcoma cells in vitro and in vivo. Cancer Res 38:277

    PubMed  CAS  Google Scholar 

  • Lang P, Honda G, Roberts TW et al. (1995) Musculoskeletal neoplasms: perineoplastic edema versus tumor on dynamic postcontrast images with spatial mapping of instantaneous enhancement rates. Radiology 197:831−839

    PubMed  CAS  Google Scholar 

  • Langer R, Brem H, Falterman K et al. (1976) Isolation of a cartilage factor that inhibits tumour neovascularization. Science 193:70

    Article  PubMed  CAS  Google Scholar 

  • Mahboubi S (1989) Radiologic approach to primary bone lesions. In: Mahboubi S (ed) Pediatric bone imaging: a practical approach. Little, Brown, Boston, pp 175

    Google Scholar 

  • Malawer MM, Dunham WK (1983) Skip metastases in osteosarcoma: recent experience. J Surg Oncol 22:236−245

    Article  PubMed  CAS  Google Scholar 

  • May DA, Good RB, Smith DK et al. (1997) MR imaging of musculoskeletal tumors and tumor mimickers with intravenous gadolinium: experience with 242 patients. Skeletal Radiol 26:2−15

    Article  PubMed  CAS  Google Scholar 

  • Mayilvahanan N, Bose JC (2005) Reconstructive options in pelvic tumours. Indian J Orthop 39:151−157

    Article  Google Scholar 

  • Norton KI, Hermann G, Abdelwahab IF et al. (1991) Epiphyseal involvement in osteosarcoma. Radiology 180:813−816

    PubMed  CAS  Google Scholar 

  • O’Flanagan SJ, Stack JP, McGee HM et al. (1991) Imaging of intramedullary tumour spread in osteosarcoma: a comparison of techniques. J Bone Joint Surg Br 73:998−1001

    PubMed  Google Scholar 

  • Ongolo-Zogo P, Thiesse P, Sau J et al. (1999) Assessment of osteosarcoma response to neoadjuvant chemotherapy: comparative usefulness of dynamic gadolinium-enhanced spin-echo magnetic resonance imaging and technetium-99m skeletal angioscintigraphy. Eur Radiol 9:907−914

    Article  PubMed  CAS  Google Scholar 

  • Onikul E, Fletcher BD, Parham DM et al. (1996) Accuracy of MR imaging for estimating intraosseous extent of osteosarcoma. Am J Roentgenol 167:1211−1215

    CAS  Google Scholar 

  • Panuel M, Gentet JC, Scheiner C et al. (1993) Physeal and epiphyseal extent of primary malignant bone tumours in childhood. Pediatr Radiol 23:421−424

    Article  PubMed  CAS  Google Scholar 

  • Peabody TD, Gibbs CP Jr, Simon MA (1998) Evaluation and staging of musculoskeletal neoplasms. J Bone Joint Surg Am 80:1204−1218

    PubMed  CAS  Google Scholar 

  • Quan GMY, Slavin JL, Schlicht SM et al. (2005) Osteosarcoma near joints: assessment and implications. J Surg Oncol 91:159−166

    Article  PubMed  Google Scholar 

  • Reddick WE, Wang S, Xiong X et al. (2001) Dynamic magnetic resonance imaging of regional contrast access as an additional prognostic factor in pediatric osteosarcoma. Cancer 91:2230−2237

    Article  PubMed  CAS  Google Scholar 

  • Saifuddin A (2002) The accuracy of imaging in the local staging of appendicular osteosarcoma. Skeletal Radiol 31:191−201

    Article  PubMed  Google Scholar 

  • Saifuddin A, Mitchell, Burnett SJD et al. (2000a) Ultrasound-guided needle biopsy of primary bone tumours. J Bone Joint Surg Br 82-B:50−54

    Article  Google Scholar 

  • Saifuddin A, Twinn P, Emanuel R et al. (2000b) An audit of MRI for bone and soft-tissue tumours performed at referral centres. Clin Radiol 55:537−541

    Article  CAS  Google Scholar 

  • Sajadi KR, Heck RK, Neel MD et al. (2004) The incidence and prognosis of osteosarcoma skip metastases. Clin Orthop Relat Res 426:92−96

    Article  PubMed  Google Scholar 

  • Schima W, Amann G, Stiglbauer R et al. (1994) Preoperative staging of osteosarcoma: efficacy of MR imaging in detecting joint involvement. Am J Roentgenol 163:1171−1175

    CAS  Google Scholar 

  • Seeger LL, Widoff BE, Bassett LW et al. (1991) Preoperative evaluation of osteosarcoma: value of gadopentetate dimeglumine-enhanced MR imaging. Am J Roentgenol 157:347−351

    CAS  Google Scholar 

  • Simon MA, Bos GD (1980) Epiphyseal extension of metaphyseal osteosarcoma in skeletally immature individuals. J Bone Joint Surg Am 62:195−204

    PubMed  CAS  Google Scholar 

  • Simon MA, Hecht JD (1982) Invasion of joints by primary bone sarcomas in adults. Cancer 50:1649−1655

    Article  PubMed  CAS  Google Scholar 

  • Stacy GS, Mahal RS, Peabody TD (2006) Staging of bone tumours: a review with illustrative examples. Am J Roentgenol 186:967−976

    Article  Google Scholar 

  • Sundaram M (1997) The use of gadolinium in the MR imaging of bone tumors. Semin Ultrasound CT MR 18:307−311

    Article  PubMed  CAS  Google Scholar 

  • Sundaram M, McGuire MH, Herbold DR et al. (1986) Magnetic resonance imaging in planning limb-salvage surgery for primary malignant tumours of bone. J Bone Joint Surg Am 68:809−819

    PubMed  CAS  Google Scholar 

  • Sundaram M, Merenda G, McGuire MM (1989) A skip lesion in association with Ewing’s sarcoma: report of a case. J Bone Joint Surg Am 71:764−768

    PubMed  CAS  Google Scholar 

  • Tsuboyama T, Windhager R, Dock W et al. (1993) Knee function after operation for malignancy of the distal femur. Quadriceps muscle mass and knee extension strength in 21 patients with hinged endoprostheses. Acta Orthop Scand 64(6):673−677

    Article  PubMed  CAS  Google Scholar 

  • Van Trommel MF, Kroon HM, Bloem JL et al. (1997) MR imaging based strategies in limb salvage surgery for osteosarcoma of the distal femur. Skeletal Radiol 26:636−641

    Article  PubMed  Google Scholar 

  • Verstraete KL, Lang P (2000) Bone and soft tissue tumors: the role of contrast agents for MR imaging. Eur J Radiol 34:229−246

    Article  PubMed  CAS  Google Scholar 

  • Wetzel LH, Schweiger GD, Levine E (1990) MR imaging of transarticular skip metastases from distal osteosarcoma. J Comput Assist Tomogr 14:315−317

    Article  PubMed  CAS  Google Scholar 

  • Wuisman P, Enneking WF (1990) Prognosis for patients who have osteosarcoma with skip metastasis. J Bone Joint Surg Am 72:60−68

    PubMed  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Radiology, Royal National Orthopaedic Hospital Trust, Brockley Hill, Stanmore, HA7 4LP, London, Middlesex, UK

    Alun Davies & Asif Saifuddin

  2. Department of Bone and Soft Tissue Sarcoma Surgery, Royal National Orthopaedic Hospital Trust, Brockley Hill, Stanmore, HA7 4LP, London, Middlesex, UK

    John A. Skinner

Authors
  1. Alun Davies
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  2. John A. Skinner
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  3. Asif Saifuddin
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Editor information

Editors and Affiliations

  1. MRI Department, Royal Orthopaedic Hospital, NHS Foundation Trust, Bristol Road South, Northfield, B31 2AP, Birmingham, UK

    A. Mark Davies

  2. Section of Musculoskeletal Radiology, Imaging Institute, Diagnostic Radiology/A21, School of Medicine of Case Western Reserve University, Cleveland Clinic Foundation, 9500 Euclid Ave., 44195, Cleveland, OH, USA

    Murali Sundaram

  3. Imaging Department, Royal Orthopaedic Hospital, NHS Foundation Trust, Bristol Road South, Northfield, B31 2AP, Birmingham, UK

    Steven L. J. James

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© 2009 Springer-Verlag Berlin Heidelberg

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Davies, A., Skinner, J., Saifuddin, A. (2009). Surgical Staging 1: Primary Tumour. In: Davies, A., Sundaram, M., James, S. (eds) Imaging of Bone Tumors and Tumor-Like Lesions. Medical Radiology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-77984-1_9

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  • DOI: https://doi.org/10.1007/978-3-540-77984-1_9

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  • Print ISBN: 978-3-540-77982-7

  • Online ISBN: 978-3-540-77984-1

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