The role of MR imaging in the diagnostic characterisation of appendicular bone tumours and tumour-like conditions

Abstract

MRI has an established role in the local staging of primary bone tumours. However, as the majority of tumours have non-specific appearances on MRI, the diagnosis is usually established on the basis of clinical history, plain film findings and biopsy. This article reviews the value of MRI in the further characterisation of appendicular bone tumours and tumour-like lesions, with particular reference to peri-lesional oedema, fluid-fluid levels, flow voids, fat signal, cartilage signal and dedifferentiation. These features are a useful adjunct for distinguishing between benign and malignant disease, pointing towards a more specific diagnosis, and guiding biopsy.

Insights into Enchondroma, Enchondromatosis and the risk of secondary Chondrosarcoma. Review of the literature with an emphasis on the clinical behaviour, radiology, malignant transformation and the follow up

“…Conventional radiographs in two planes should always be the first imaging method used. MRI and CT should be used when diagnosis is difficult because they offer ability to visualize more clearly calcification, periosteal bone formation, cortical destruction or soft tissue involvement [23,[42][43][44][45][46][47].…”

“…On computed tomography, characteristic features of malignancy were lytic areas, especially when pronounced in comparison with previously made radiographs, cortical lesions with a scalloping greater than 2/3 of the cortex or extension to soft tissue [29,[42][43][44][45][46][47][48].…”

“…-Rearrangements of chromosome 6 and chromosome 12 -PTPN11 mutations -Alterations at some level in the pRb pathway -Other highly variable genetic alterations tion, edema surrounding the tumor on MR images, and soft tissue mass [2,29,[42][43][44][45][46][47]49]. Note that the use of scalloping in the diagnosis is limited when examining the metaphyseal region because the cortex is thin, especially in the proximal fibula [29].…”

“…If malignancy is diagnosed, general staging should be carried out to assess the extent to which the disease has spread including bone scintigraphy and chest radiographs and CT [42][43][44][45][46][47][48]; small nodules are not specific for malignancy Whole body MRI and PET are under evaluation for both staging and treatment response evaluation.…”

The Spine: Acquired Disorders

“…Septations typically enhance after gadolinium administration [ 29 ]. Fluid-fl uid levels are common and result from serum and blood separating in the cavernous spaces [ 32 ]. There may be a large soft tissue mass extending along more than one vertebral segment.…”