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Bones
terms: Magnetic resonance imaging of
magnetic resonance Imaging
Magnetic
staging
resonance imaging primary malignant bone tumors
Johan L. Bloem, M.D.* Allan 1. Van Oosterom, M.D4
Theo H.M. Falke, M.D.* Robert M. Steiner, M.D.* #{182}
Anthony H.M. Taminiau, M.D.t Everett E.H. Overbosch, M.D.*
Joost Doornbos, M.D.*
B. George Ziedses des Plantes, Jr., M.D.*II
THIS EXHIBIT. A SELECTION OF THE
RADIATION THERAPY PANEL, WAS DIS- The authors report a refrospective study that suggests that
PLAYED AT THE 70TH SCIENTIFIC AS-
SEMBLY AND ANNUAL MEETING OF MRI may be superior to CT for the preoperative evaluation
THE RADIOLOGICAL SOCIETY OF of bone tumors
NORTH AMERICA. NOVEMBER 25-30.
1984, WASHINGTON. D.C.
From the Departments of Introduction
Diagnostic Radiology Or-
(#{176}),
thopedic Surgery (Ii, and During the last decade, there has been a growing awareness of the
Oncology (fl, of the Universily value of wide, but local en bloc resection of malignant soft tissue and
Medical Center, Leiden, The skeletal tumors followed by reconstructive surgery to restore function (5,
Netherlands. 10, 16, 18, 20). Resection and reconstructive procedures in patients with
Presently atthe Depart- primary malignant bone tumors can, however, be performed only if accu-
ment of Radiology and Radio-
rate information can be obtained concerning the extent ofthe tumor with
logical Sciences, Vanderbilt Uni-
respect to anatomic planes and concerning the involvement of vessels
versily Medical Center,
and nerves flable I, Figure 1) (1 1).
Nashville (s);Department of
Diagnostic Radiology, St. Geer-
tuiden Gasthuis, Deventer, The
Netherlands (IB; Department of r_’r L1I .! TABLEI !,
Radiology, Thomas Jefferson Uni- I Important Criteria in
versify Hospital, Philadelphia (1) StagiflgofPrifflaryBon#{235}T......
Study supported by the Us Extension I Extraosseous I
Netherlands Cancer Founda-
tion Grant 1KW 8589.
Address reprint requests to
J.L. Bloem,
Diagnostic
Hospital,
M.D.,
Radiology,
Leiden,
Department
Universily
Rijnsburger-
of
I
weg 10,2333 M Leiden, The
Netherlands.
Volume 5, Number 6 November,
#{149} 1985 ‘ RadioGraphics 853
MRI of malignant tumors Bloem et al.
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Figure 1
Malignant bone tumors can be resected and function can be restored by
reconstructive procedures, as in this patient with Ewing’s sarcoma of the
tibia, ifaccurate information concerning the intra- and extraosseous exten-
sian oftumor can be obtained.
854 RadioGraphics November,
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Bioem et al MRI ofmalignant tumors
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This change in operative approach has been In this study, we shall compare the abilily of 0
facilitated by improved surgical technique, by CT, arteriography, and magnetic resonance rn- 0
computed tomography (CT) and other imaging aging (MRI) to provide precise and useful
technologies (1, 3, 4, 6, 9, 13, 15, 17)which provide anatomic information as part of the preoperative
abundant information about the extent of tumor examination of patients with primary malignant
involvement, and by an increase in the life expec- bone tumors. Magnetic resonance images of dif-
tancy of the patient owing to effective ferent stages of intra- and extracompartmental
chemotherapy (1, 7, 8, 14, 16, 19, 21, 22). tumor extension are displayed for two different
The combined modalily approach with pre- pulse sequences, and in addition, the effect of
operative chemotherapy requires that the re- chemotherapy ofthe lesions on their MR images is
sponse of the tumor to the chemotherapeutic illustrated.
agents be determined promptly in order to avoid
unproductive delay in surgical treatment (21).
Materials and Methods
Twenly-one patients with malignant bone and microscopic pathology were correlated with
tumors were studied in retrospect. The pathology the diagnostic images. The resected specimens
of the tumors and their locations are summarized were sliced in axial, sagittal, or coronal planes cor-
in Table II. responding to the planes used in the MRI studies.
The abilily of MRI to define the anatomy of the In addition, three patients with osteosarcomas
tumors was compared with that of plain films, CT, and one with a Ewing’s sarcoma were examined
and arteriography. All of the patients, with the ex- by MRI before and after chemotherapy to estab-
ception ofthe one with non-Hodgkin’s lymphoma, lish whether chemotherapy altered the MR im-
were operated upon, and in each case the gross ages.
TABLEIi
Material
Case # Sex Age Histology Localization Field strength
I F 36 osteosarcoma femur 0.15 T
2 M 18 osteosarcoma femur 0.15 T
3 M 16 osteosarcoma femur 0.15 T
4 F 16 teleangiectatic femur 0.15T
osteosarcoma
5 F 14 osteosarcoma femur 0.15 T
6 F 11 osteosarcoma femur 0.15 T
7 F 15 osfeosarcoma femur 0.5 T
8 F 17 osteosarcoma fibula 0.151
9 F 13 osteosarcoma fibula 0.151
10 M 47 clearcell tibia 0.151
chondrosarcoma
II M 23 chondrosarcoma pelvis 0.151
12 F 22 chondrosarcoma lumbarspine 0.151
13 F 22 chondrosarcoma lumbarspine 0.151
14 M 30 chondrosarcoma scapula 0.5 T
15 F 16 Ewing’ssarcoma tibia 0.151
16 M 25 Ewingssarcoma femur 0.5 T
17 M 10 Ewing’ssarcoma toe 0.5 1
18 M 57 fibrosarcoma tibia 0.151
19 M 16 fibrosarcoma femur 0.15 T
20 M 44 fibrosarcoma pelvis 0.5 1
21 F 24 non-Hodgkin’s scapula 0.5 1
lymphoma
Volume 5, Number 6 November, 1985 ‘ RadioGraphics 855
MRI of malignant tumors Bioem et ai.
All of the patients were examined on either a was limited to inversion recovery (IR) with inversion
0.15 T or 0.5 T Philips MRI system1 in transverse, time (TI) of400, echo time (TE) of 30, and repetition
sagiffal, or coronal planes. Patient access and time (TR) of 1400 msec; and spin echo (SE) with TE
image qualily were improved for the 0.1 5 T resis- of 50, and TR of I 000 msec. Computed tomog-
tive system by the use of a thick tube saddle coil raphic studies were performed on a Pfizer 450 AS
with geometry tailored to the examination of the & E scanner with a scan time of 4.9 sec, slice thick-
lower extremities (Figures 2 and 3). The slice thick- ness of 9 or S mm, and a matrix of 256 x 256.
ness was I cm, and data acquisition was per- When necessary, studies were performed both
formed by single slice technique, using a two di- before and after the intravenous administration of
mensional Fourier transformation and a matrix of contrast material for the identification of major
256 x 256. To keep the examination time within blood vessels.
reasonable limits, the CT findings were used as a
guide to select representative slices for MRI. For
I Philips Medical Systems. Eindhoven, The Netherlands.
the same reason, the number of pulse sequences
Figure 2
Asaddle coil especially designed for imaging extremities at 0.1 5 1. The use of a
thick copper tube as the conducting material made possible an open design
which afforded excellent patient access.
856 RadioGraphics November,
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Bloem et ai. MRI ofmalignant tumors
Figure 3
In addition to excellent patient access, the especially designed coil provided
for significant improvement in signal to noise ratio. (A & B) are comparative im-
ages made with the manufacturer’s coil (A) and the thick tube coil (B) at the
same level and with identical pulse sequences. Note the improved signal to
noise ratio in (B).
Pulse Sequence and Signal intensities
As has been stated, image contrast in MRI suggesting an increased T2 (2, 12) (Figure 4D). As
varies with the pulse sequence used (24). The influ- described below, the presence of extensive tumor
ence of the pulse sequence on the signal inten- calcification was an important factor in the abilily
sities of the primary bone tumors in this study is of MRI to determine soft tissue extent.
demonstrated in ten patients who were examined
with both IR and SE techniques at 0. 1 S T. The results
are summarized in Table III. In the absence of TABLEIII 1
hemorrhage, all tumors had a relatively low signal Observation of Tumor Signal Intensity Relative
intensily on IR, suggesting increased TI (Figure to Bone Marrow Signal intensity (0.15 T)
4C). The signal intensify on SE strongly depended SElechnique IRlechnique
on the presence of calcifications. In the presence Type of Lesion Intensity Intensity
of diffuse calcifications, the tumor had a relatively Higher Lower Higher Lower
low overall signal intensity, suggesting low spin
Osteolytic 13 2 0 8
density or a shortT2 or both (Figure 5). In the ab- Osteosclerotic 0 9 0 5
sence of calcifications, the tumor had a high sig-
nal intensily on the SE image in 90% of cases,
Volume 5, Number 6 ‘ November, 1985 ‘ RadioGraphics 857
MRI of malignant tumors Bloem et ai.
Bone Marrow Involvement
Bone marrow has a high signal intensily on the SE image because oftumor calcifications. Def-
both TI and T2 weighted images. Therefore, con- inition of affected bone marrow was more accu-
trast between tumor and normal marrow was rate with MRI than with CT in all cases because of
higher on our IR images than on our SE images in superb contrast and the absence of beam hard-
seven out of the ten cases that were studied by ening artifacts in the MR images (Figure 6). Unlike
both pulse sequences (Figure 4). In one case, no CT and technetium isotope studies, MRI may be
difference could be observed. In two cases, af- helpful in differentiating marrow replacement by
fected bone marrow was beffer delineated on tumor from hyperemic osteoporosis (Figure 7).
Cortical Invoivement
Although cortical destruction is best demon- identified as a thin line of low signal intensify. In
strated on plain radiographs and CT scans, it cases of destruction, interruption of this line could
could be depicted on MR images. Cortical de- be appreciated owing to an increase in signal in-
struction was correctly diagnosed in I 8 cases on tensily on the SE images (Figure 8).
both CT and MRI. Normal cortical bone on MRI was
Soft Tissue Extension
On the IR image, contrast between the low Soft tissue extension ofthe neoplasm was bet-
signal intensily of tumor and the low signal inten- ter delineated on MRI than on CT, especially when
sily of normal or slightly edematous muscle was no calcifications were present (Figure 9). Focal
poor in all patients (Figures 4C and aD). On the SE edema had an even higher signal intensify than
images, however, contrast between the high sig- tumor on the SE image, as is illustrated in one pa-
nal intensity of tumor and the low signal intensify tient with an osteosarcoma accompanied by a
of normal muscle was high in all patients (Figures compartment syndrome (Figure 10).
4D, 6C and 7C). In six of ten patients examined
with both pulse sequences, tumor delineation was
more accurate on the SE image.
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Joint Involvement
The free choice of imaging planes with MRI onstrated joint involvement correctly in nine cases
permiffed accurate visualization of the spatial re- (Figure I 1), but CT wrongly suggested joint involve-
lationship of the tumor to the adjacent joint in all ment in two normal knee joints (Figure 4). All nor-
18 cases. Computed tomography and MRI dem- mal joints were correctly identified.
Vascuiar invoivement
With MRI it was possible to visualize large yes- hanced CT (Figure 12). In the absence ofa clear
sels and to determine their proximily to the tumor interface, MRI and CT did not permit one to dif-
in all cases without the use of a contrast medium ferentiate tumor invasion of the vessel wall from
(Figure 1 1). Normal tissue situated between the vessel compression without direct invasive growth
tumor and nearby large vessels correctly (Figure 13).
excluded vascular involvement by MRI and en-
Chemotherapy
Three of four patients treated with chemo- of in vitro experiments. The experiments consisted
therapy (cis-platinum, vincristin, and adriamycin) of measuring TI and T2 relaxation times of liver
improved clinically. In these three patients, CT and and muscle in WAG/RY rats treated with I mg
MRI demonstrated a reduction in tumor volume. In platinum and comparing them with the values ob-
addition, a decrease in signal intensify on the spin tamed in a normal control group. No differences
echo MR image was observed in Iwo patients (Fig- in the relaxation times ofthe specified tissues were
ures 14 and 15). In one patient, the decrease in observed. These findings were supported by de-
signal intensify could be explained by the de- terminations ofthe relaxation times of I millimolar
velopment oftumor calcifications (Figure 14). In cis-platinum solutions. Between water and the cis-
the other patient, the change was thought to be platinum solutions, the difference in TI was 1000
due to a Change in the spin densily or relaxation msec and the difference in T2 was 997 msec. Al-
time ofthe tissue following chemotherapy, or both though the cis-platinum in the solution decreased
(Figure I5).The possibiliiythatthedecrease in sig- relaxation times, the paramagnetic effectfor such
nal intensify was caused by accumulated cis- concentrations is low. Therefore, it is not likely that
platinum in the tumor acting as a paramagnetic the much lower concentrations in tumors could
substance was considered less likely on the basis produce a measurable effect.
Volume 5, Number 6 ‘ November, 1985 RadioGraphics
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MRI of malignant tumors Bioem et ai.
Case 19
Figure 4A
Radiographs ofa 16 year old boy show an osteolytic fibrosarcoma in the distal
femur.
Figure 4B
A CT scan atthe level ofthe patella demonstrates possible joint involvement
(arrows).
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FIgure4C Figure 4D
Sagiffal view, IRtechnique, 0.15 1. Viable tumor emits a low Sagiffal view, SEtechnique, 0.15 1. Tumor, necrosis, and
intensity signal (open arrows) relative to that of normal hemorrhage (arrows) have a high signal intensity almost
bone marrow. The area of necrosis (solid arrows) has an identical to the signal intensity of normal bone marrow.
even lower signal intensity. The central area of high signal Note the normal retropatellar space (arrowhead) which
intensity (curved arrow) represents hemorrhage. excludes the joint involvement suggested on CT.
Figure 4E
The gross specimen sliced in the sagittal plane.
The extent of viable tumor and the area of nec-
rosis correspond well with the MR images. The
bony ridge (arrows) atthe proximal border of the
tumor can be identified on the MR images as an
area of decreased signal intensity on IRand SE.
The joint was not involved.
Volume 5, Number 6 ‘ November, 1985 ‘ RadioGraphics 861
MRI of malignant tumors Bloem et ai.
Case 2
Figure 5A
These are the radiographs of an 18 year old man with a mixed osteosclerotic
and osteocytic osteosarcoma of the distal femur.
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B
Figures 5B & C
Sagittal and transverse views, SEtechnique, 0.15 T.The os-
teosclerotic part ofthe tumor is seen as an area of low signal
intensity (arrows) extending into the medial condyle.
Figure 5D
Comparison with the gross specimen.
The area of calcifications in the tumor
corresponds to the darker zone on the
spin echo image.
Volume 5, Number 6 ‘ November, 1985 ‘ RadioGraphics 863
MRI of malignant tumors Bloem et al.
Case 7
Figure 6A
Radiographs of a 15 year old girl
show an osteosarcoma of the
distal femur.
Figure 6B
On CT, the extent of marrow in-
volvement (arrows) is difficult to
ascertain.
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Figure 6C
Transverseview, SE,O.5T.The osteolytic part of the
tumor has a high signal intensity (small arrows)
and is, therefore, difficult to separate from the
normal bone marrow which has a similarly high
signal intensity.
Figure 6D
Transverse view, IR, 0.5 1. There is a clear delinea-
tion of intramedullary tumor which, with this pulse
sequence, appears as a zone of low signal inten-
sity (small arrows). Normal marrow is clearly den-
tified as a residual rim producing a signal of high
intensity (long arrows).
Figure 6E
Transverse section ofthe gross specimen. There is
a striking similarity in the spatial distribution of
normal bone marrow, cortical bone, and tumor
between the MR image and the gross specimen.
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MRI of malignant tumors Bloem et al.
Case 9
Figure7A
Radiographs of this 13 year old girl
show an osteosarcoma of the fibula.
Figure lB Figure 7C
CT at the level of the proximal diaphysis demonstrates fibular This transverse SEimage, 0. 15 T, at the level of the proximal
destruction and an ill defined mass containing flecks of cal- diaphysis outlines the tumor more clearly (arrows).
cium (arrows).
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Figure 7D Figure 7E
The low attenuation of the proximal fibular metaphysis (arrow) This technetium scintigram shows high uptake in
shown on this CT scan suggests tumor involvement. thetumorarea extendingtothelevelofthe proxi-
mal metaphysis. This supports the suggestion of
metaphyseal involvementfrom the CT scan.
Flgure7F
MR images, SE and IR, atthe site ofthe metaphysis show normal bone marrow
(arrows) without replacement by tumor. The surgical specimen confirmed the
existence of osteoporosis but absence oftumor involvement atthis level.
Volume 5, Number 6 ‘ November, 1985 ‘ RadioGraphics 867
MRI of malignant tumors Bioem et ai.
Case 8
Figure8A
Radiographs of a I 7 year old girl show an osteosarcoma in the fibula.
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Figure 8B
SEimage, sagittal view, 0.15 1. Normal low intensity lines
(white arrows) representing cortical bone can be identified
atthe level ofthe diaphysis and epiphysis. Atthe level of the
metaphysis, tumor (open arrows) can be identified and in-
terruption of cortical bone is present.
Figure 8C
Sagittally sectioned gross specimen.
Tumor at the level of the metaphysis de-
stroys cortical bone. At the level of the
normal epiphysis and diaphysis, normal
cortical bone can be seen.
Volume 5, Number 6 ‘ November, 1985 ‘ RadioGraphics 869
MRI of malignant tumors Bioem et al.
Case 10
Figure 9A
This isthe radiograph ofa 44 year old woman who had a fibrosarcoma (arrows)
of the right iliac bone.
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Figure 9B
The x-ray attenuation ofthe tumor equals the affenuation of normal muscle.
Therefore, on CT, only destruction ofcortical bone (arrows) and distortion (open
arrow) of normal contours can be seen.
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MRI ofmalignant tumors Bioem et ai.
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Coronal view, SE,0.5 1. Contrast be-
tween the high signal intensity of the
lobulated tumor (arrows) and surround-
ing structures allows accurate defini-
tion of softtissue extension. Tumor
infiltrates the spinous muscle comport-
ment. The high intensity artefact is
caused by a metallic suture.
Figure 9D
Transverse view, SE,0.5 T.Tumor invades
the iliac bone, gluteus, and spinous
muscle compartments (arrows).
Figure 9E
The transversely sliced gross specimen
correlates well with the transverse SE
image. Gluteus and spinous muscle
compartments are involved.
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Case I
Figure lOC
Transverse view, SE,0.15 T.The softtissue extension
(high intensity signal) containing calcifications
(low intensity signals) is well defined. In addition
to the clearly demarcated tumor outline, the
edematous compartment iswell shown as a zone
of high signal intensity.
Figure IOA
This radiograph of a 36 year old woman shows an os-
teosarcoma in the femoral diaphysis. A large soft tissue
mass is present.
Figure lOB
Abundant calcifications make it
possible to delineate the tumor
(white arrows) on CT. The zone of low
affenuation (curved black arrows)
within the tumor is due to an
edematous compartment.
Volume 5, Number 6 ‘ November, 1985 ‘ RadioGraphics 873
MRI ofmalignant tumors Bloem et al.
Case 4
Figure hA
These radiographs of a 16 year old girl show an extensive lesion that proved to
be a teleangiectatic osteosarcoma ofthe femur. Displacement ofthe patella
is demonstrated.
Figure IIB
Transverse view, SE,0.15 T.A large softtissue mass of high
signal intensity is seen to be invading the suprapatellar
pouch (arrows). Note, also, thatthe femoral artery (curved
arrow) is dorsally displaced.
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Figure hlC Figure I ID
Sagiffal view, SE,0. 15 T.A large mass is seen (white arrows) that Sagittal view, IR, 0.15 T. The large hemorrhagic compartment
is displacing the patella anteriorly and is infiltrating the re- of the tumor (arrows) is responsible for the relatively high signal
tropatellar space (long arrow). The femoral vessels, rep- intensity seen in this IR image. Extension of the lesion into the
resented by a line ot decreased signal intensity (small arrows), knee joint is confirmed.
is contiguous with the tumor mass.
Figure lIE
This sagitfal section ofthe gross specimen demonstrates a
large hemorrhagictumor involving thejoint. Notethe sclero-
tic part ofthe tumor which is visible as an area of decreased
signal intensity on SEand IR.
Volume 5, Number 6 ‘ November, 1985 ‘ RadioGraphics 875
MRI ofmalignant tumors Bioem et al.
Case 21
Figures 12A& B
This 20 year old woman had a non-Hodgkin’s lymphoma of
the scapula. Axillary DSA (A) and arteriography (B) show the
arterial walls to be smooth and regular.
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Figurel2C
On CT, afatplane can be identified between the
major vessels (v) and the tumor surface (t). Note
the destruction ofthe scapula (arrowheads).
Figure -__ Figure I__
Coronal view, SE,0.5 1. MRI demonstrates a large tumor (ar- Sagiffal view, SE,0.5 T.Tumor (arrows) is destroying
rows) encasing the joint. the scapula (arrowheads) and extending into the
subscapular muscle (curved arrows). The artery
and vein (open arrows) are separated from the
tumor margin by interposed axillary fat.
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MRI of malignant tumors Bloem et al.
Case 14
Figure 13A
This 30 year old man with multiple exostoses had a recurrence of chondrosar-
coma after the resection of a tumor located in the scapula. The axillary artery
does not show involvement.
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Figure 13B
Sagiffal view, SE,0.5 T.The tumor (arrows) is clearly defined.
No clear fat interface is seen between the tumor and the
axillary artery (arrowhead), and,therefore, a definite state-
ment aboutvascular involvement cannot be made.
A = anterior; P = posterior
Figure 13C
Sagittal sections ofthe gross specimen. At surgery, a
close relationship between the axillary vessels and the
tumor was found. The tumor could be easily separated
from the vascular bundle, however.
M = tumor mass; S = scapula; ss = subscapularis;
is = infraspinatus.
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MRI of malignant tumors Bloem et al.
Case 16
p.. oronaI view, , u. I I , ewing’s sarcoma ol ..e femur s. .is a
. ..
zone of slightly increased signal intensity (open arrow) along the thickened
cortex following chemotherapy. Diminished signal intensity is seen in the mar-
row (arrows). This finding is consistent with calcification.
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Figure I4B
The recalcification in the area of the diaphysis after chemotherapy is con-
firmed by these plain radiographs.
VolumeS, Number#{243} November,
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MRI of malignant tumors Bioemetai.
Case 3
Figure h5A Figure I5B
Sagiffal view, SE,0. 15 T. Osteosarcoma prior to Sagittal view, SE0.15 T. Following chemotherapy, a reduc-
chemotherapy. The softtissue extension ofthe tumor (ar- tion oftumor volume as well as a decrease in signal intensity
rows) shows high signal intensity, while the intramedullary can be observed.
sclerotictumor (arrowheads) shows low signal intensity. Also
note the joint involvement.
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Figures 15C & D
Lateral conventional radiographs before (C) and after (D) chemotherapy con-
firm the absence of extensive soft tissue calcifications.
Volume 5, Number 6 ‘ November, 1985 ‘ RadioGraphics 883
MRI of malignant tumors Bloem et al.
Case 15
Figure 16A
year
This is the radiograph of a l#{243} old girl with
Ewing’s sarcoma in the tibial diaphysis.
(See opposite page for Figures 16B and C.)
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t._ 1 ‘ . .
. . . -.- ..i. . -.,
Figure 16D
Transverse section of gross specimen. In the softtissue, fibrosis
and some viable tumor was present. In bone marrow, only fib-
rosis without viable tumor was found.
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Figure 16B
Transverse view, SE,0.15 T and CT. Prior to chemotherapy, the softtissue exten-
sian (open arrows) and the marrow involvement (arrow) are better appreciated
on the MR image (left) than on CT (right).
Figure 16C
After chemotherapy, MRI shows essentially normal signal intensity in the soft tis-
sue as well as in the marrow (arrow) compared to the examination before
chemotherapy. This indicates a satisfactory response.
Volume 5, Number 6 November,
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MRI ofmalignant tumors Bioem et al.
Conclusions
I Although
. a prospective study is not yet 4. Osteopenia owing to tumor invasion of the
available, MRI seems to be superior to CT for the bone marrow can be differentiated from osteo-
preoperative staging of primary bone tumors be- porosis caused by tumor related hyperemia with
cause of its superior delineation of intra- and ex- MRI.
traosseous tumor extension. 5. The decrease in signal intensify of a bone
2. Involvement of coritcal bone and soft tis- tumor seen on SE images after chemotherapy
sues including vascular structures and joint spaces may be due to calcifications or may be related to
is best shown with the SE (spin echo) technique (TR a change in the MR characteristics of the tissue.
I 000, TE 50 msec). The change seems to be a function of tumor re-
3. The extent of marrow involvement is best gression. Therefore, MRI may be useful in monitor-
shown with the IR (inversion recovery) technique ing the effect of chemotherapy.
(TI 400, TR I 400, TE 50 msec).
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The authors gratefully acknowledge the assistance of D. Ruiter, M.D., C. Ruygrok, M.
Popkes, F. Noorderljk, M. Henry, and J. Fields in the preparation ofthis manuscript.
886 RadioGraphics #{149} November, 1985 Volume
#{149} 5, Number 6
