Imaging Evaluation of the Response of High-Grade Osteosarcoma and EwingSarcoma to Chemotherapy with Emphasis on Dynamic Contrast-Enhanced MagneticResonance Imaging

Abstract

Response of high-grade osteosarcoma and Ewing sarcoma to preoperative chemotherapy can significantly affect the surgical approach to patients with these tumors and their disease-free survival. This article presents the findings and limitations of different imaging modalities (radiography, angiography, sonography, scintigraphy, and magnetic resonance [MR] imaging and spectroscopy) for evaluating this chemotherapeutic response. Particular emphasis is given to the currently most effective modality--dynamic contrast-enhanced MR imaging.

Multiplanar Osteotomy with Limited Wide Margins: A Tissue Preserving Surgical Technique for High-grade Bone Sarcomas

“…It is a challenge to the musculoskeletal oncologist to know how to balance the amount of tissue resection needed to adequately resect a tumor with the quantity of tissue needed for maximizing the reconstructive and functional outcomes. The use of MRI helps with this challenge when planning a bone tumor resection [28,30,31] as it allows the surgeon to determine the extent of the tumor and its relationship to surrounding structures, which can be correlated to intraoperative landmarks [23] to estimate the location of the tumor and the osteotomies required to resect it. MR images also can be used to estimate the degree of tumor necrosis by comparing the size of the tumor from images obtained at the time of diagnosis with those obtained after neoadjuvant chemotherapy [28,33].…”

Three-dimensional Radiologic Assessment of Chemotherapy Response in Ewing Sarcoma Can Be Used to Predict Clinical Outcome

“…Changes in tumor volume in response to chemotherapy have been linked to the degree of tumor necrosis (47). Dynamic contrast-enhanced MR imaging has been used to quantitate the degree of necrosis that corresponds to a positive response histologically (48,49). Also, tumor necrosis is a histologic indicator of prognosis in various cancers, including sarcomas (50,51).…”

Musculoskeletal Tumors: How to Use Anatomic, Functional, and Metabolic MR Techniques

“…Perfusion imaging sequences are used for providing insight into the vascularity of a tumor and can be accomplished with a variety of pulse sequences, including DW sequences (31), unenhanced perfusion sequences (60,61), and the most commonly implemented dynamic contrastenhanced sequence (62)(63)(64)(65)(66)(67)(68)(69)(70)(71)(72)(73)(74)(75)(76)(77)(78)(79)(80). Perfusion imaging with dynamic contrast-enhanced MR imaging is the most popular technique at this time, since other techniques have not been well explored for musculoskeletal tumors.…”