[Postoperative and posttherapeutic changes after primary bone tumors : What's important for radiologists?]

[Bone tumors and metastases: tips for initial diagnosis and follow-up : Update 2019]

Benign bone tumors are frequently discovered as incidental findings, whereas malignant tumors and metastases often become clinically noticeable due to pain or swelling. The initial radiological diagnostics by conventional X‑ray imaging, magnetic resonance imaging (MRI) and computed tomography (CT) play an important role in the assessment of dignity and further treatment planning. The aftercare of bone tumors is necessary for the recognition of recurrences and distant metastases as well as the detection of complications, e.g. after implantation of a prosthesis. Implanted metal and posttherapeutic alterations can impede the aftercare due to artifacts and treatment-associated tissue alterations. In addition to the recommendations of the Association of the Scientific Medical Societies in Germany (AWMF), the European Organisation for Research and Treatment of Cancer (EORTC) and the European Society of Musculoskeletal Radiology (ESSR), study protocols can be used as orientation for the aftercare of individual primary malignant bone tumors.

[The importance of radiology in bone sarcoma diagnostics : Initial and advanced diagnostics]

BACKGROUND

Reliable diagnostic assessment of malignant bone lesions remains a challenge in all the medical disciplines involved. The high incidence of benign (mainly pediatric) bone lesions needs to be distinguished from the rare malignant counterparts. If clinical presentation and patient history are unable to exclude a malignant tumour, adequate imaging of the affected region is necessary.

OBJECTIVES

This article focuses on giving implementable advice in dealing with problems and questions arising in the diagnostic process of treating patients with suspected or confirmed bone sarcoma. Also, follow-up recommendations from a radiological point of view are presented.

METHODS

Review and discussion of relevant literature against personal experiences in the medical imaging of patients with bone sarcomas.

RESULTS

Interpretation of projection radiographic images usually succeeds in assessing a bone tumour's dignity by evaluating periosteal reaction, the formation of a tumour matrix and consideration of the Lodwick classification. A current adaptation of the classic Lodwick classification incorporates diagnostic possibilities of more recent imaging techniques (magnetic resonance imaging (MRI), positron emission tomography (PET)) and is presented in this article. Plain radiographs are superseded by MRI as the primary imaging performed when depicting bone lesions with increasing frequency. The role of MRI in terms of primary diagnostics, staging, planning of biopsy tracts and tumour resections, evaluation of treatment response and follow-up are discussed. All diagnostic imaging techniques, including whole-body imaging methods, relevant in the diagnosis and therapy of bone sarcomas are presented in the sequence in which they appear during treatment.

CONCLUSIONS

Radiological imaging and expertise are important pillars in diagnosis and treatment of bone sarcomas. A variety of complementing imaging techniques provide a treatment-relevant basis significant for all medical disciplines involved.