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Kanthawang T, Wudhikulprapan W, Phinyo P, Settakorn J, Pruksakorn D, Link TM, Pattamapaspong N. Can conventional magnetic resonance imaging at presentation predict chemoresistance in osteosarcoma? Br J Radiol 2024; 97:451-461. [PMID: 38308035 DOI: 10.1093/bjr/tqad047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/03/2023] [Accepted: 11/25/2023] [Indexed: 02/04/2024] Open
Abstract
OBJECTIVES Histological tumour necrosis is the current indicator for the response of osteosarcoma after neoadjuvant chemotherapy. Chemoresistant tumours require close monitoring and adjustment of treatment. Characteristics of tumours on baseline MRI may be able to predict response to chemotherapy. The aim is to identify which baseline MRI findings can help predict chemoresistant osteosarcoma. METHODS Baseline MRI before giving neoadjuvant chemotherapy of 95 patients during 2008-2021 was reviewed by 2 musculoskeletal radiologists. Histological necrosis from surgical specimens was the reference standard. MRIs were reviewed for tumour characteristics (tumour volume, maximum axial diameter, central necrosis, haemorrhage, fluid-fluid level), peritumoural bone and soft tissue oedema, and other parameters including intra-articular extension, epiphyseal involvement, neurovascular involvement, pathologic fracture, and skip metastasis. The cut-off thresholds were generated by receiver operating characteristic curves which then tested for diagnostic accuracy. RESULTS Two-third of patients were chemoresistance (histological necrosis <90%). Tumour volume >150 mL, maximum axial diameter >7.0 cm, area of necrosis >50%, presence of intra-articular extension, and peritumoural soft tissue oedema >6.5 cm significantly predicted chemoresistance, particularly when found in combination. Tumour volume >150 mL and maximum axial diameter >7.0 cm could be used as an independent predictor (multivariable analysis, P-value = .025, .045). CONCLUSIONS Findings on baseline MRI could help predicting chemoresistant osteosarcoma with tumour size being the strongest predictor. ADVANCES IN KNOWLEDGE Osteosarcomas with large size, large cross-sectional diameter, large area of necrosis, presence of intra-articular extension, and extensive peritumoural soft tissue oedema were most likely to have a poor response to neoadjuvant chemotherapy.
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Affiliation(s)
- Thanat Kanthawang
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Wanat Wudhikulprapan
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Phichayut Phinyo
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Jongkolnee Settakorn
- Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Dumnoensun Pruksakorn
- Department of Orthopedics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Thomas M Link
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA 94158, United States
| | - Nuttaya Pattamapaspong
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
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Chen G, Wang L, He P, Su T, Lai Q, Kuo HC, Wu W, Chen SL, Tu CC. Biodistributions and Imaging of Poly(ethylene glycol)-Conjugated Silicon Quantum Dot Nanoparticles in Osteosarcoma Models via Intravenous and Intratumoral Injections. ACS APPLIED BIO MATERIALS 2023; 6:4856-4866. [PMID: 37843986 DOI: 10.1021/acsabm.3c00595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
Osteosarcoma is a malignant tumor with relatively high mortality rates in children and adolescents. While nanoparticles have been widely used in assisting the diagnosis and treatment of cancers, the biodistributions of nanoparticles in osteosarcoma models have not been well studied. Herein, we synthesize biocompatible and highly photoluminescent silicon quantum dot nanoparticles (SiQDNPs) and investigate their biodistributions in osteosarcoma mouse models after intravenous and intratumoral injections by fluorescence imaging. The bovine serum albumin (BSA)-coated and poly(ethylene glycol) (PEG)-conjugated SiQDNPs, when dispersed in phosphate-buffered saline (PBS), can emit red photoluminescence with the photoluminescence quantum yield more than 30% and have very low in vitro and in vivo toxicity. The biodistributions after intravenous injections reveal that the SiQDNPs are mainly metabolized through the livers in mice, while only slight accumulation in the osteosarcoma tumor is observed. Furthermore, the PEG conjugation can effectively extend the circulation time. Finally, a mixture of SiQDNPs and indocyanine green (ICG), which complement each other in the spectral range and diffusion length, is directly injected into the tumor for imaging. After the injection, the SiQDNPs with relatively large particle sizes stay around the injection site, while the ICG molecules diffuse over a broad range, especially in the muscular tissue. By taking advantage of this property, the difference between the osteosarcoma tumor and normal muscular tissue is demonstrated.
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Affiliation(s)
- Guo Chen
- University of Michigan-Shanghai Jiao Tong University Joint Institute, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Lei Wang
- Department of Orthopaedic Surgery, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Pengbo He
- University of Michigan-Shanghai Jiao Tong University Joint Institute, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Taiyu Su
- University of Michigan-Shanghai Jiao Tong University Joint Institute, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Qingxuan Lai
- Instrumental Analysis Center, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Hao-Chung Kuo
- Hon Hai Research Institute, Foxconn Technology Group, Shenzhen 518109, China
| | - Wen Wu
- Department of Orthopaedic Surgery, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
- Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai 200030, China
| | - Sung-Liang Chen
- University of Michigan-Shanghai Jiao Tong University Joint Institute, Shanghai Jiao Tong University, Shanghai 200240, China
- Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai 200030, China
| | - Chang-Ching Tu
- University of Michigan-Shanghai Jiao Tong University Joint Institute, Shanghai Jiao Tong University, Shanghai 200240, China
- Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai 200030, China
- Hon Hai Research Institute, Foxconn Technology Group, Shenzhen 518109, China
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Huang M, Ma Z, Yu J, Lu Y, Chen G, Fan J, Li M, Ji C, Xiao X, Li J. Does joint-sparing tumor resection jeopardize oncologic and functional outcomes in non-metastatic high-grade osteosarcoma around the knee? World J Surg Oncol 2023; 21:185. [PMID: 37344861 DOI: 10.1186/s12957-023-03045-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 05/25/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND We previously reported joint-sparing tumor resection for osteosarcoma with epiphyseal involvement in which transepiphyseal osteotomy went through the in situ ablated epiphysis. However, we do not know whether this is a safe approach when compared with joint-sacrificed tumor resection. Our objective was to compare oncologic and functional outcomes between patients who underwent joint preservation (JP) and joint replacement (JR) tumor resection. Furthermore, we identified the risk factors of local recurrence, metastasis and survival. METHODS Eighty-nine patients with non-metastatic high-grade osteosarcoma around the knee were treated with limb-salvage surgery (JP in 47 and JR in 42). Age, gender, tumor location, pathologic fracture, plain radiographic pattern, limb diameter change, perivascular space alteration, surgical margin, local recurrence, metastasis, death, and the Musculoskeletal Tumor Society (MSTS)-93 scores were extracted from the records. Univariate analysis was performed to compare oncologic and functional outcomes. Binary logistic and cox regression models were used to identify predicted factors for local recurrence, metastasis, and survival. RESULTS Local recurrence, metastasis and overall survival were similar in the JP and JR group (p = 0.3; p = 0.211; p = 0.143). Major complications and limb survival were also similar in the JR and JP group (p = 0.14; p = 0.181). The MSTS score of 27.06 ± 1.77 in the JP group was higher than that of 25.88 ± 1.79 in the JR group (p = 0.005). The marginal margin of soft tissue compared with a wide margin was the only independent predictor of local recurrence (p = 0.006). Limb diameter increase and perivascular fat plane disappearance during neoadjuvant chemotherapy were independent predictors for metastasis (p = 0.002; p = 0.000) and worse survival (p = 0.000; p = 0.001). CONCLUSIONS Joint-sparing tumor resection with the ablative bone margin offers advantage of native joint preservation with favorable functional outcomes while not jeopardizing oncologic outcomes compared with joint-sacrificed tumor resection. Surgeon should strive to obtain adequate soft tissue surgical margin decreasing risk of local recurrence. Novel drug regimens might be reasonable options for patients with obvious limb diameter increase and perivascular fat disappearance during chemotherapy.
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Affiliation(s)
- Mengquan Huang
- Department of Orthopedics, Xi Jing Hospital, Air Force Medical University, Shaanxi, 710032, Xi'an, People's Republic of China
| | - Ziyang Ma
- Department of Orthopedics, Xi Jing Hospital, Air Force Medical University, Shaanxi, 710032, Xi'an, People's Republic of China
| | - Jie Yu
- Department of Orthopedics, 986 Hospital, Air Force Medical University, Shaanxi, 710032, Xi'an, People's Republic of China
| | - Yajie Lu
- Department of Orthopedics, Xi Jing Hospital, Air Force Medical University, Shaanxi, 710032, Xi'an, People's Republic of China
| | - Guojing Chen
- Department of Orthopedics, Xi Jing Hospital, Air Force Medical University, Shaanxi, 710032, Xi'an, People's Republic of China
| | - Jian Fan
- Department of Orthopedics, Xi Jing Hospital, Air Force Medical University, Shaanxi, 710032, Xi'an, People's Republic of China
| | - Minghui Li
- Department of Orthopedics, Xi Jing Hospital, Air Force Medical University, Shaanxi, 710032, Xi'an, People's Republic of China
| | - Chuanlei Ji
- Department of Orthopedics, Xi Jing Hospital, Air Force Medical University, Shaanxi, 710032, Xi'an, People's Republic of China
| | - Xin Xiao
- Department of Orthopedics, Xi Jing Hospital, Air Force Medical University, Shaanxi, 710032, Xi'an, People's Republic of China.
| | - Jing Li
- Department of Orthopedics, Xi Jing Hospital, Air Force Medical University, Shaanxi, 710032, Xi'an, People's Republic of China.
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He F, Xie L, Sun X, Xu J, Li Y, Liu R, Sun K, Shen D, Gu J, Ji T, Guo W. A Scoring System for Predicting Neoadjuvant Chemotherapy Response in Primary High-Grade Bone Sarcomas: A Multicenter Study. Orthop Surg 2022; 14:2499-2509. [PMID: 36017768 PMCID: PMC9531107 DOI: 10.1111/os.13469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 07/10/2022] [Accepted: 07/25/2022] [Indexed: 11/27/2022] Open
Abstract
Objective Currently, there is a lack of good clinical tools for evaluating the effect of chemotherapy preoperatively on primary high‐grade bone sarcomas. Our goal was to investigate the predictive value of the clinical findings and establish a scoring system to predict chemotherapy response. Methods We conducted a retrospective multicenter cohort study and reviewed 322 patients with primary high‐grade bone sarcomas. Patients who routinely received neoadjuvant chemotherapy and underwent primary tumor resection with an assessment of tumor necrosis rate (TNR) were enrolled in this study. The medical records of patients were collected from November 1, 2011, to March 1, 2018, at Peking University People's Hospital (PKUPH) and Peking University Shougang Hospital (PKUSH). The mean age of the patients was 16.2 years (range 3–52 years), of whom 65.5% were male. The clinical data collected before and after neoadjuvant chemotherapy included the degree of pain, laboratory inspection, X‐ray, CT, contrast‐enhanced magnetic resonance (MR), and positron emission tomography‐computed tomography (PET‐CT). Several machine learning models, including logistic regression, decision trees, support vector machines, and neural networks, were used to classify the chemotherapy responses. Area under the curve (AUC) of the scoring system to predict chemotherapy response is the primary outcome measure. Results For patients without events, a minimum follow‐up of 24 months was achieved. The median follow‐up time was 43.3 months, and it ranged from 24 to 84 months. The 5 years progression‐free survival (PFS) of the included patients was 54.1%. The 5 years PFS rate was 39.7% for poor responders and 74.9% for good responders. Features such as longest diameter reduction ratio (up to three points), clear bone boundary formation (up to two points), tumor necrosis measured by magnetic resonance (up to two points), maximum standard uptake value (SUVmax) decrease (up to three points), and significant alkaline phosphatase decrease (up to 1 point) were identified as significant predictors of good histological response and constituted the scoring system. A score ≥4 predicts a good response to chemotherapy. The scoring system based on the above factors performed well, achieving an AUC of 0.893. For nonmeasurable lesions (classified by the revised Response Evaluation Criteria in Solid Tumors [RECIST 1.1]), the AUC was 0.901. Conclusion We first devised a well‐performing comprehensive scoring system to predict the response to neoadjuvant chemotherapy in primary high‐grade bone sarcomas.
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Affiliation(s)
- Fangzhou He
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, China
| | - Lu Xie
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, China
| | - Xin Sun
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, China
| | - Jie Xu
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, China
| | - Yuan Li
- Department of Radiology, Peking University People's Hospital, Beijing, China
| | - Rong Liu
- Department of Radiology, Peking University People's Hospital, Beijing, China
| | - Kunkun Sun
- Department of Pathology, Peking University People's Hospital, Beijing, China
| | - Danhua Shen
- Department of Pathology, Peking University People's Hospital, Beijing, China
| | - Jin Gu
- Department of Surgical Oncology, Peking University Shougang Hospital, Beijing, China
| | - Tao Ji
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, China
| | - Wei Guo
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, China
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Effect of Paclitaxel Combined with Doxorubicin Hydrochloride Liposome Injection in the Treatment of Osteosarcoma and MRI Changes before and after Treatment. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:5651793. [PMID: 35942377 PMCID: PMC9356788 DOI: 10.1155/2022/5651793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/07/2022] [Accepted: 07/12/2022] [Indexed: 11/26/2022]
Abstract
Objective The aim of this study is to investigate the effect of paclitaxel combined with doxorubicin hydrochloride liposome injection (DHLI) in the treatment of osteosarcoma and the MRI changes before and after treatment. Methods A total of 108 osteosarcoma patients treated in our hospital (January 2020–April 2022) were selected to carry out a single-center retrospective study. Among them, 54 patients receiving the combination chemotherapy (MDT) with high-dose methotrexate, ifosfamide, cisplatin, and ADM were selected as the control group (COG), while 54 patients receiving MDT with high-dose methotrexate, ifosfamide, cisplatin, paclitaxel, and DHLI were chosen as the study group (STG). The COG and STG had the same dose intensity and chemotherapy cycles, and clinical and MRI evaluations were performed after treatment. Results The evaluation of postoperative clinical efficacy showed that the disease control rate (DCR) of the STG was markedly higher than that of the COG (P < 0.05). The incidence of cardiac toxicity was remarkably lower in the STG than that in the COG (P < 0.05), with no between-group differences in the incidence of fever, abnormal liver function, myelosuppression, stomatitis, and alopecia (P > 0.05). Obvious differences were found in the semiquantitative parameters of MRI in the STG before and after chemotherapy (P < 0.05) and were also found in the SImax, TTP, SEE, PPE, WOR, and R values in the COG before and after chemotherapy (P < 0.05). After chemotherapy, statistical differences were observed in the semiquantitative parameters of MRI between the two groups, with lower parameters such as Slope, SImax, SEE, and R values and higher parameters such as TTP, PPE, and WOR values in the STG than those in the COG (P < 0.05). Conclusion Paclitaxel combined with DHLI has definite efficacy in osteosarcoma chemotherapy, which is conducive to narrowing the lesion, controlling the disease, and reducing the occurrence of cardiac-related risk events. In addition, the semiquantitative parameters of dynamic contrast-enhanced MRI (DCE-MRI) have a high predictive value for the efficacy of chemotherapy, which can reflect the degree of tumor necrosis and contribute to a timely and objective assessment of the efficacy of osteosarcoma chemotherapy.
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Wu J, Xiao P, Huang H, Gou F, Zhou Z, Dai Z. An artificial intelligence multiprocessing scheme for the diagnosis of osteosarcoma MRI images. IEEE J Biomed Health Inform 2022; 26:4656-4667. [PMID: 35727772 DOI: 10.1109/jbhi.2022.3184930] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Osteosarcoma is the most common malignant osteosarcoma, and most developing countries face great challenges in the diagnosis due to the lack of medical resources. Magnetic resonance imaging (MRI) has always been an important tool for the detection of osteosarcoma, but it is a time-consuming and labor-intensive task for doctors to manually identify MRI images. It is highly subjective and prone to misdiagnosis. Existing computer-aided diagnosis methods of osteosarcoma MRI images focus only on accuracy, ignoring the lack of computing resources in developing countries. In addition, the large amount of redundant and noisy data generated during imaging should also be considered. To alleviate the inefficiency of osteosarcoma diagnosis faced by developing countries, this paper proposed an artificial intelligence multiprocessing scheme for pre-screening, noise reduction, and segmentation of osteosarcoma MRI images. For pre-screening, we propose the Slide Block Filter to remove useless images. Next, we introduced a fast non-local means algorithm using integral images to denoise noisy images. We then segmented the filtered and denoised MRI images using a U-shaped network (ETUNet) embedded with a transformer layer, which enhances the functionality and robustness of the traditional U-shaped architecture. Finally, we further optimized the segmented tumor boundaries using conditional random fields. This paper conducted experiments on more than 70,000 MRI images of osteosarcoma from three hospitals in China. The experimental results show that our proposed methods have good results and better performance in pre-screening, noise reduction, and segmentation.
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Yajun F, Limin T, Ruizhi Z, Qi X, Haisong C. Differentiation of microinfiltration and simple-edema areas in VX2 bone tumors by diffusion kurtosis imaging in animal experiments: a preliminary study. Acta Radiol 2022; 63:794-801. [PMID: 34000825 DOI: 10.1177/02841851211017519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Dual-energy computed tomography, diffusion-weighted imaging (DWI), and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) can be used to distinguish microinvasion areas of malignant bone tumors. However, reports of diffusion kurtosis imaging (DKI) to determine the extent of intramedullary infiltration are relatively rare. PURPOSE To assess the application value of MR-DKI in differentiating areas of microinfiltration and simple edema in rabbit bone VX2 tumor models. MATERIAL AND METHODS Conventional MRI and DKI were performed on 25 successfully constructed rabbit VX2 bone tumor models. We acquired a midline sagittal section of the tumor for hematoxylin and eosin staining. Using pathological findings as the gold standard and combining them with MRI data, strict point-to-point control was performed to delineate regions of interest (ROIs) in the microinfiltration and simple-edema areas of bone tumors for quantitative measurement of mean diffusivity (MD) and mean kurtosis (MK). MD and MK values between microinfiltration and simple-edema areas were compared using an independent sample t-test, and the diagnostic values were evaluated by receiver operating characteristic (ROC) curve analysis. RESULTS In comparison with the simple-edema area, the micro-infiltration area demonstrated significantly smaller MD values and larger MK values (P < 0.05), and MD showed a better area under the curve (AUC) than MK (AUC = 0.884 vs. AUC = 0.690) for distinguishing the microinfiltration area from the simple-edema area. The optimal cutoff MD value was 1108.5 mm2/s with a sensitivity of 84% and specificity of 84%. CONCLUSION DKI can distinguish the microinfiltration and simple-edema areas of malignant bone tumors in animal experiments.
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Affiliation(s)
- Fang Yajun
- Department of Radiology, the Affiliated Hospital of Qingdao University,Qingdao, China
| | - Tang Limin
- Department of Radiology, the Affiliated Hospital of Qingdao University,Qingdao, China
| | - Zhou Ruizhi
- Department of Radiology, the Affiliated Hospital of Qingdao University,Qingdao, China
| | - Xu Qi
- Department of Radiology, the Affiliated Hospital of Qingdao University,Qingdao, China
| | - Chen Haisong
- Department of Radiology, the Affiliated Hospital of Qingdao University,Qingdao, China
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Bone Tumors. Radiol Clin North Am 2022; 60:221-238. [DOI: 10.1016/j.rcl.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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9
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Clemente EJI, Navarro OM, Navallas M, Ladera E, Torner F, Sunol M, Garraus M, March JC, Barber I. Multiparametric MRI evaluation of bone sarcomas in children. Insights Imaging 2022; 13:33. [PMID: 35229206 PMCID: PMC8885969 DOI: 10.1186/s13244-022-01177-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 02/07/2022] [Indexed: 12/22/2022] Open
Abstract
Osteosarcoma and Ewing sarcoma are the most common bone sarcomas in children. Their clinical presentation is very variable depending on the age of the patient and tumor location. MRI is the modality of choice to assess these bone sarcomas and has an important function at diagnosis and also for monitoring recurrence or tumor response. Anatomic sequences include T1- and T2-weighted images and provide morphological assessment that is crucial to localize the tumor and describe anatomical boundaries. Multiparametric MRI provides functional information that helps in the assessment of tumor response to therapy by using different imaging sequences and biomarkers. This review manuscript illustrates the role of MRI in osteosarcoma and Ewing sarcoma in the pediatric population, with emphasis on a functional perspective, highlighting the use of diffusion-weighted imaging and dynamic contrast-enhanced MRI at diagnosis, and during and after treatment.
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Affiliation(s)
- Emilio J Inarejos Clemente
- Department of Diagnostic Imaging. Hospital Sant Joan de Déu, Av. Sant Joan de Déu, 2, CP:08950, Esplugues de Llobregat, Barcelona, Spain.
| | - Oscar M Navarro
- Department of Medical Imaging, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Maria Navallas
- Department of Diagnostic Imaging, Hospital 12 de Octubre, Madrid, Spain
| | - Enrique Ladera
- Department of Diagnostic Imaging. Hospital Sant Joan de Déu, Av. Sant Joan de Déu, 2, CP:08950, Esplugues de Llobregat, Barcelona, Spain
| | - Ferran Torner
- Department of Orthopaedics, Hospital Sant Joan de Déu. Av, Sant Joan de Déu, 2, CP:08950, Esplugues de Llobregat, Barcelona, Spain
| | - Mariona Sunol
- Department of Pathology, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Moira Garraus
- Department of Oncology, Hospital Sant Joan de Déu. Av, Sant Joan de Déu, 2, CP:08950, Esplugues de Llobregat, Barcelona, Spain
| | - Jordi Català March
- Department of Radiology, Instituto de Resonancia Magnetica Guirado, C/Muntaner, 531, CP:08022, Barcelona, Spain
| | - Ignasi Barber
- Department of Diagnostic Imaging. Hospital Sant Joan de Déu, Av. Sant Joan de Déu, 2, CP:08950, Esplugues de Llobregat, Barcelona, Spain
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Correlation of histopathology and multi-modal magnetic resonance imaging in childhood osteosarcoma: Predicting tumor response to chemotherapy. PLoS One 2022; 17:e0259564. [PMID: 35157711 PMCID: PMC8843228 DOI: 10.1371/journal.pone.0259564] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 10/21/2021] [Indexed: 11/23/2022] Open
Abstract
Background Osteosarcoma, which is the most common malignant pediatric bone cancer, remains dependent on an imprecise systemic treatment largely unchanged in 30 years. In this study, we correlated histopathology with magnetic resonance imaging (MRI), used the correlation to extract MRI-specific features representative of tumor necrosis, and subsequently developed a novel classification model for predicting tumor response to neoadjuvant chemotherapy in pediatric patients with osteosarcoma using multi-modal MRI. The model could ultimately serve as a testable biomarker for a high-risk malignancy without successful precision treatments. Methods Patients with newly diagnosed high-grade appendicular osteosarcoma were enrolled in a single-center observational study, wherein patients underwent pre-surgical evaluation using both conventional MRI (post-contrast T1-weighted with fat saturation, pre-contrast T1-weighted, and short inversion-time inversion recovery (STIR)) and advanced MRI (diffusion weighted (DW) and dynamic contrast enhanced (DCE)). A classification model was established based on a direct correlation between histopathology and MRI, which was achieved through histologic-MR image co-registration and subsequent extraction of MR image features for identifying histologic tumor necrosis. By operating on the MR image features, tumor necrosis was estimated from different combinations of MR images using a multi-feature fuzzy clustering technique together with a weighted majority ruling. Tumor necrosis calculated from MR images, for either an MRI plane of interest or whole tumor volume, was compared to pathologist-estimated necrosis and necrosis quantified from digitized histologic section images using a previously described deep learning classification method. Results 15 patients were enrolled, of whom two withdrew, one became ineligible, and two were subjected to inadequate pre-surgical imaging. MRI sequences of n = 10 patients were subsequently used for classification model development. Different MR image features, depending on the modality of MRI, were shown to be significant in distinguishing necrosis from viable tumor. The scales at which MR image features optimally signified tumor necrosis were different as well depending on the MR image type. Conventional MRI was shown capable of differentiating necrosis from viable tumor with an accuracy averaging above 90%. Conventional MRI was equally effective as DWI in distinguishing necrotic from viable tumor regions. The accuracy of tumor necrosis prediction by conventional MRI improved to above 95% when DCE-MRI was added into consideration. Volume-based tumor necrosis estimations tended to be lower than those evaluated on an MRI plane of interest. Conclusions The study has shown a proof-of-principle model for interpreting chemotherapeutic response using multi-modal MRI for patients with high-grade osteosarcoma. The model will continue to be evaluated as MR image features indicative of tumor response are now computable for the disease prior to surgery.
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11
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Menendez N, Epelman M, Shao L, Douglas D, Meyers AB. Pediatric Osteosarcoma: Pearls and Pitfalls. Semin Ultrasound CT MR 2022; 43:97-114. [PMID: 35164914 DOI: 10.1053/j.sult.2021.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Osteosarcoma is a malignant bone tumor most commonly presenting in children. It has a bimodal distribution with a peak incidence occurring during the ages of 10-14 years old and in adults greater than age 65. The first peak of osteosarcoma correlates with the increased proliferation of bone during the pubertal growth period. Osteosarcoma most frequently presents with localized bone pain, swelling, and an antalgic gait. The patient may attribute symptoms to trauma or strenuous exercise, causing the patient to be managed conservatively. In these cases, the pain persists and eventually leads to further evaluation. The most common type of osteosarcoma is the conventional high-grade osteosarcoma. For conventional osteosarcoma, the diagnosis is typically made or strongly suggested based upon the initial radiographic appearance. Other types of osteosarcomas include low grade central, telangiectatic, small-cell, surface and intracortical. Consequently, it is important for radiologists to be aware of these subtypes and the imaging features that differentiate them from other etiologies to prevent a delay in treatment.
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Affiliation(s)
- Nelson Menendez
- University of Central Florida College of Medicine, Orlando, FL; Department of Radiology, Nemours Children's Health System/Nemours Children's Hospital, Orlando, FL
| | - Monica Epelman
- University of Central Florida College of Medicine, Orlando, FL; Department of Radiology, Nemours Children's Health System/Nemours Children's Hospital, Orlando, FL
| | - Lei Shao
- University of Central Florida College of Medicine, Orlando, FL; Department of Pathology and Lab Medicine, Nemours Children's Health System/Nemours Children's Hospital, Orlando, FL
| | - Dorothea Douglas
- University of Central Florida College of Medicine, Orlando, FL; Department of Pediatrics, Nemours Children's Health System/Nemours Children's Hospital, Orlando, FL
| | - Arthur B Meyers
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Dept. of Radiology, Cincinnati, OH.
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12
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Intelligent Segmentation Medical Assistance System for MRI Images of Osteosarcoma in Developing Countries. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:7703583. [PMID: 35096135 PMCID: PMC8791734 DOI: 10.1155/2022/7703583] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 12/27/2021] [Indexed: 12/25/2022]
Abstract
Osteosarcoma is the most common primary malignant bone tumor in children and adolescents. It has a high degree of malignancy and a poor prognosis in developing countries. The doctor manually explained that magnetic resonance imaging (MRI) suffers from subjectivity and fatigue limitations. In addition, the structure, shape, and position of osteosarcoma are complicated, and there is a lot of noise in MRI images. Directly inputting the original data set into the automatic segmentation system will bring noise and cause the model's segmentation accuracy to decrease. Therefore, this paper proposes an osteosarcoma MRI image segmentation system based on a deep convolution neural network, which solves the overfitting problem caused by noisy data and improves the generalization performance of the model. Firstly, we use Mean Teacher to optimize the data set. The noise data is put into the second round of training of the model to improve the robustness of the model. Then, we segment the image using a deep separable U-shaped network (SepUNet) and conditional random field (CRF). SepUnet can segment lesion regions of different sizes at multiple scales; CRF further optimizes the boundary. Finally, this article calculates the area of the tumor area, which provides a more intuitive reference for assisting doctors in diagnosis. More than 80000 MRI images of osteosarcoma from three hospitals in China were tested. The results show that the proposed method guarantees the balance of speed, accuracy, and cost under the premise of improving accuracy.
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Farina A, Gasperini C, Aparisi Gómez MP, Bazzocchi A, Fanti S, Nanni C. The Role of FDG-PET and Whole-Body MRI in High Grade Bone Sarcomas With Particular Focus on Osteosarcoma. Semin Nucl Med 2021; 52:635-646. [PMID: 34879906 DOI: 10.1053/j.semnuclmed.2021.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Sarcoma represents less than 2% of adult malignancies and about 15% to 20% of malignancies in children and adolescents/young adults. This neoplasm accounts for more than 80 different clinico-pathological entities with different clinical behavior; osteosarcoma and ewing sarcoma are the most frequent primary bone tumors. Because of the general poor prognosis, it is important to find out as many prognostic factors as possible to choose the best therapeutical approach and to correctly schedule the follow-up examinations. Third level imaging such as MRI and PET/CT are of utmost importance in the evaluation of sarcoma patients. The spine and bones in general are optimal sites to be evaluated with FDG PET/CT since the physiological background is low. The standardized uptake value (SUV max, a semiquantitave parameter) is used as a surrogate for proliferative cell rate, and the spatial heterogeneity of FDG distribution within the primary mass as a surrogate for malignancy. In several studies SUVmax was a predictive value for overall survival and progression-free survival. Whole-body MRI is a well-established technique for systemic, radiation-free evaluation, which is mostly applied in the oncological field. WB-MRI provides a combination of anatomical and functional sequences and is useful specifically in the evaluation of disease in organs with relatively high background activity such as the brain, liver, kidney, and spinal canal. These technologies provide accurate staging (also useful to drive the biopsy towards the most active foci in large heterogeneous masses), therapy assessment, relapse detection of local recurrence and distance metastasis but also prognostic indexes, in the context of whole body diagnostic procedures. This paper will provide an overview of the role and added value of PET/CT and WB-MRI in bone sarcomas particular focus on osteosarcoma. We also analyzed the role of the PET/CT and MRI for target delineation of radiation therapy and we and we will do an analysis of future prospects as new tracer non FDG.
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Affiliation(s)
- Arianna Farina
- Nuclear Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy
| | - Chiara Gasperini
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Maria Pilar Aparisi Gómez
- Department of Radiology, Auckland City Hospital,, Grafton, Auckland, New Zealand; Department of Radiology, Hospital Nueve de Octubre; Calle Valle de la Ballestera, Valencia, Spain
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Fanti
- Nuclear Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy
| | - Cristina Nanni
- Nuclear Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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14
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Parlak Ş, Ergen FB, Yüksel GY, Karakaya J, Aydın GB, Kösemehmetoğlu K, Aydıngöz Ü. Diffusion-weighted imaging for the differentiation of Ewing sarcoma from osteosarcoma. Skeletal Radiol 2021; 50:2023-2030. [PMID: 33797564 DOI: 10.1007/s00256-021-03741-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 02/07/2021] [Accepted: 02/07/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this study is to assess the ability of apparent diffusion coefficient (ADC) values in differentiating Ewing sarcoma and osteosarcoma. MATERIALS AND METHODS This retrospective cross-sectional observational study included a total of 35 patients with a recent diagnosis of Ewing sarcoma (n = 13) and osteosarcoma (n = 22) who underwent conventional MRI and diffusion-weighted imaging (DWI). Three ADC measurements from the areas of the lowest diffusivity in ADC maps (ADCmin), and other areas with low diffusivity (ADCother), were made independently by two observers on pre-treatment MRI, and the means of these measurements were compared using independent samples t-test. Intraclass correlation coefficient was calculated for inter-observer agreement. RESULTS There was a significant difference between the ADCmin (P < 0.001) and ADCother (P < 0.001) in Ewing sarcoma and osteosarcoma for both observers. For Ewing sarcoma and osteosarcoma, mean ADCmin was 0.566 ± 0.07 and 1.193 ± 0.33 × 10-3 mm2/s; 0.551 ± 0.08 and 1.182 ± 0.33 × 10-3 mm2/s; and mean ADCother was 0.813 ± 0.11 and 1.510 ± 0.35 × 10-3 mm2/s; 0811 ± 0.12 and 1.501 ± 0.33 × 10-3 mm2/s for observers 1 and 2, respectively. Inter-observer correlation coefficient for mean ADCmin was 0.994 and for mean ADCother was 0.995. CONCLUSION Diffusion-weighted imaging and ADC values could be used in the differentiation of Ewing sarcoma and osteosarcoma in borderline cases.
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Affiliation(s)
- Şafak Parlak
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
| | - F Bilge Ergen
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey.
| | - Gökçe Yıldırım Yüksel
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey.,Department of Radiology, Usak Education and Research Hospital, 64100, Uşak, Turkey
| | - Jale Karakaya
- Department of Biostatistics, Hacettepe University School of Medicine, 06100, Ankara, Turkey
| | - Güzide Burça Aydın
- Department of Pediatric Oncology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
| | - Kemal Kösemehmetoğlu
- Department of Pathology, Hacettepe University School of Medicine 06100, Ankara, Turkey
| | - Üstün Aydıngöz
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
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15
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Berkeley R, Andrei V, Saifuddin A. The rare primary bone sarcomas: imaging-pathological correlation. Skeletal Radiol 2021; 50:1491-1511. [PMID: 33410967 DOI: 10.1007/s00256-020-03692-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 02/02/2023]
Abstract
Rare primary bone sarcomas are challenging entities both radiologically and pathologically. These include the diagnoses of spindle cell sarcoma (leiomyosarcoma, fibrosarcoma, synovial sarcoma, and malignant peripheral nerve sheath tumor), pleomorphic liposarcoma, and undifferentiated pleomorphic sarcoma. The radiographic and cross-sectional imaging features of each of these tumors are presented, along with current key pathological concepts. Frequently non-specific, the radiological appearances must be correlated with all clinical and pathological information available to enable an accurate diagnosis.
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Affiliation(s)
- Rupert Berkeley
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK.
| | - Vanghelita Andrei
- Department of Pathology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
| | - Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
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16
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Al-Qassab S, Lalam R, Botchu R, Bazzocchi A. Imaging of Pediatric Bone Tumors and Tumor-like Lesions. Semin Musculoskelet Radiol 2021; 25:57-67. [PMID: 34020468 DOI: 10.1055/s-0041-1723965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Bone lesions are commonly seen when reporting pediatric skeletal imaging. Distinguishing aggressive from nonaggressive lesions is essential in making the diagnosis. Not all aggressive lesions are neoplastic; indeed, osteomyelitis frequently presents with aggressive appearances and is far more commonly seen in the pediatric population than neoplastic lesions. In this article, we discuss an approach for the diagnosis of pediatric bone tumors and tumor-like conditions. The most common pediatric benign and malignant bone tumors are discussed in more detail.
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Affiliation(s)
- Sinan Al-Qassab
- Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, United Kingdom
| | - Radhesh Lalam
- Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, United Kingdom
| | - Rajesh Botchu
- The Royal Orthopaedic Hospital, Birmingham, United Kingdom
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17
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Saifuddin A, Santiago R, van Vucht N, Pressney I. Comparison of T1-weighted turbo spin echo and out-of-phase T1-weighted gradient echo Dixon MRI for the assessment of intra-medullary length of appendicular bone tumours. Skeletal Radiol 2021; 50:993-1005. [PMID: 33078239 DOI: 10.1007/s00256-020-03654-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/11/2020] [Accepted: 10/15/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Intra-medullary tumour length is accurately assessed on T1-weighted turbo spin echo (T1W TSE) MRI which can be relatively time consuming, whilst the gradient echo Dixon (T1W GrE Dixon) technique is a rapid sequence (imaging time ~ 30 s). The aim of this study was to determine if the out-of-phase Dixon (OP T1W GrE Dixon) sequence can produce equivalent measurements of intra-medullary tumour length compared to the T1W TSE sequence. MATERIALS AND METHOD Tumour length was assessed in 90 patients undergoing MRI for staging of primary bone tumours with both T1W TSE and OP T1W GrE Dixon MRI sequences at 3 T (n = 42) and 1.5 T (n = 48). Tumour length was measured independently by different observers allowing assessment of inter-observer correlation, and the correlation between measurements on T1W TSE and OP T1W GrE Dixon sequences was also determined. RESULTS There were 53 males and 37 females (mean age 36.4 years; range 2-77 years). Inter-observer correlation for tumour length on both the T1W TSE and T1W OP GrE Dixon sequences was very good (ICC = 0.94-0.98), and measurement of tumour length comparing T1W TSE and T1W GrE Dixon was also very good (ICC = 0.91-0.99). In 4 cases, tumour length was significantly overestimated on T1W TSE images due to extensive reactive marrow oedema, but more accurately determined on the OP sequence when compared to resection specimens. CONCLUSIONS The OP T1W GrE Dixon sequence is comparable to T1W TSE for assessment of the intra-medullary length of appendicular bone tumours, and more accurate in the presence of extensive reactive marrow oedema.
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Affiliation(s)
- A Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
| | - R Santiago
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
| | - N van Vucht
- Department of Radiology, University College Hospital, London, UK
| | - I Pressney
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK.
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Abstract
We present a review of several bone (osteoid)-forming tumors including enostosis, osteoid osteoma, osteoblastoma, and osteosarcoma. These entities were chosen because they are reasonably common-neither seen every day nor rare. When applicable, recent information about the lesions is included.
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Affiliation(s)
- Behrang Amini
- Department of Musculoskeletal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Raul Fernando Valenzuela
- Department of Musculoskeletal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Justin E Bird
- Department of Orthopaedic Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Tamara Miner Haygood
- Department of Musculoskeletal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
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19
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Diffusion Kurtosis Imaging as a Prognostic Marker in Osteosarcoma Patients with Preoperative Chemotherapy. BIOMED RESEARCH INTERNATIONAL 2020; 2020:3268138. [PMID: 33029501 PMCID: PMC7533782 DOI: 10.1155/2020/3268138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 04/28/2020] [Accepted: 08/27/2020] [Indexed: 11/26/2022]
Abstract
Background The accurate prediction of prognosis is key to prompt therapy adjustment. The purpose of our study was to investigate the efficacy of diffusion kurtosis imaging (DKI) in predicting progression-free survival (PFS) and overall survival (OS) in osteosarcoma patients with preoperative chemotherapy. Methods Thirty patients who underwent DKI before and after chemotherapy, followed by tumor resection, were retrospectively enrolled. The patients were grouped into good responders (GRs) and poor responders (PRs). The Kaplan-Meier and log-rank test were used for survival analysis. The association between the DKI parameters and OS and PFS was performed by univariate and multivariate Cox proportional hazards models. Results Significantly worse OS and PFS were associated with a lower mean diffusivity (MD) after chemotherapy (HR, 5.8; 95% CI, 1.5-23.1; P = 0.012 and HR, 3.5; 95% CI, 1.2-10.1: P = 0.028, respectively) and a higher mean kurtosis (MK) after chemotherapy (HR, 0.3; 95% CI, 0.1-0.9; P = 0.041 and HR, 0.3; 95% CI, 0.1-0.8; P = 0.049, respectively). Likewise, shorter OS and PFS were also significantly associated with a change rate in MD (CR MD) of less than 13.53% (HR, 8.6; 95% CI, 1.8-41.8; P = 0.007 and HR, 2.9; 95% CI, 1.0-8.2; P = 0.045, respectively). Compared to GRs, PRs had an approximately 9- and 4-fold increased risk of death (HR, 9.4; 95% CI, 1.2-75; P = 0.034) and progression (HR, 4.2; 95% CI, 1.2-15; P = 0.026), respectively. Conclusions DKI has a potential to be a prognostic tool in osteosarcoma. Low MK and high MD after chemotherapy or high CR MD indicates favorite outcome, while prospective studies with large sample sizes are warranted.
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Saifuddin A, Sharif B, Oliveira I, Kalus S, Barnett J, Pressney I. The incidence of skip metastases on whole bone MRI in high-grade bone sarcomas. Skeletal Radiol 2020; 49:945-954. [PMID: 31919587 DOI: 10.1007/s00256-019-03369-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 12/21/2019] [Accepted: 12/29/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Skip metastases have been described with osteosarcoma, Ewing sarcoma and rarely chondrosarcoma. The aim of this study was to determine the incidence of skip metastases on whole bone MRI in all primary high-grade sarcomas of the major long bones. MATERIALS AND METHOD Retrospective review of patients from April 2007 to April 2019 with high-grade primary bone sarcomas of the humerus, radius, ulna, femur, tibia or fibula who had whole bone MRI at initial staging. Data collected included age, sex, tumour type, presence and location of skip metastases based on whole bone MRI and presence of distant metastases (the skeleton and lung). RESULTS The study included 216 males and 171 females with mean age 30.6 years (range 4-92 years). Tumour types were as follows: High-grade osteosarcoma n = 202, Ewing sarcoma n = 68, high-grade chondrosarcoma n = 44, dedifferentiated chondrosarcoma n = 37, high-grade spindle cell sarcoma n = 29 and angiosarcoma n = 7. Skip lesions were identified in 63 (16.3%). However, after taking into account the presence of distant skeletal (n = 11) and pulmonary (n = 33) metastases, the overall incidence of skip metastases was 6.5%, occurring in 15 (7.5%) high-grade osteosarcomas, 3 (4.5%) Ewing sarcoma, 1 (2.8%) high-grade chondrosarcoma, 4 (10.8%) dedifferentiated chondrosarcomas, and 2 (6.9%) high-grade spindle cell sarcomas. A false positive MRI diagnosis of skip metastasis was made in 4 cases, 3 enchondromata and one focal nodular marrow hyperplasia. CONCLUSION The current study has documented the incidence of skip metastases in common types of high-grade primary bone sarcoma. The possibility of false positive skip metastases has also been highlighted.
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Affiliation(s)
- Asif Saifuddin
- Department of Imaging, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Ban Sharif
- Department of Imaging, Northwick Park Hospital, Harrow, UK.
| | - Ines Oliveira
- Department of Imaging, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Sarah Kalus
- Department of Imaging, Royal National Orthopaedic Hospital, Stanmore, UK
| | - James Barnett
- Department of Orthopaedics, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Ian Pressney
- Department of Imaging, Royal National Orthopaedic Hospital, Stanmore, UK
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21
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The sensitivity, specificity, and diagnostic accuracy of whole-bone MRI for identifying skip metastases in appendicular osteosarcoma and Ewing sarcoma. Skeletal Radiol 2020; 49:913-919. [PMID: 31900513 DOI: 10.1007/s00256-019-03364-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 12/06/2019] [Accepted: 12/09/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Pre-operative whole-bone MRI is required to assess intra-osseous tumour extent and to identify skip metastases in cases of bone sarcoma. The current study aims to determine the sensitivity, specificity, and diagnostic accuracy of whole-bone MRI for the identification of skip metastases. MATERIALS AND METHOD Review of 162 patients with long bone osteosarcoma or Ewing sarcoma who had undergone whole-bone MRI to assess intra-osseous tumour length and identify skip metastases. Comparison was made with post-chemotherapy MRI to look for a change in the appearance of suspected skip metastases, and resection specimens were assessed for the presence of skip metastases. The presence of local osseous recurrence was determined at final follow-up. RESULTS There were 112 males and 50 females (mean age 18.8 years), with 119 osteosarcomas and 43 Ewing sarcomas. Skip metastases were diagnosed on whole-bone MRI in 23 cases (14.2%). In 2 cases, pre-operative needle biopsy diagnosed enchondromata, resulting in false positive diagnoses. Skip metastases were diagnosed in the resection specimens in 3 cases, and based on comparison with post-chemotherapy MRI in 12. There was no evidence of local osseous recurrence in 160 patients, while late recurrence occurred in 2 patients. Sensitivity was calculated as 88.2%, specificity as 97.6%, and diagnostic accuracy as 96.7%. CONCLUSION Whole-bone MRI has a high sensitivity, specificity, and diagnostic accuracy for the identification of skip metastases in osteosarcoma and Ewing sarcoma. The possibility of false positive skip lesions and late local osseous recurrence is also highlighted.
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van Vucht N, Santiago R, Lottmann B, Pressney I, Harder D, Sheikh A, Saifuddin A. The Dixon technique for MRI of the bone marrow. Skeletal Radiol 2019; 48:1861-1874. [PMID: 31309243 DOI: 10.1007/s00256-019-03271-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 06/25/2019] [Accepted: 06/27/2019] [Indexed: 02/02/2023]
Abstract
Dixon sequences are established as a reliable MRI technique that can be used for problem-solving in the assessment of bone marrow lesions. Unlike other fat suppression methods, Dixon techniques rely on the difference in resonance frequency between fat and water and in a single acquisition, fat only, water only, in-phase and out-of-phase images are acquired. This gives Dixon techniques the unique ability to quantify the amount of fat within a bone lesion, allowing discrimination between marrow-infiltrating and non-marrow-infiltrating lesions such as focal nodular marrow hyperplasia. Dixon can be used with gradient echo and spin echo techniques, both two-dimensional and three-dimensional imaging. Another advantage is its rapid acquisition time, especially when using traditional two-point Dixon gradient echo sequences. Overall, Dixon is a robust fat suppression method that can also be used with intravenous contrast agents. After reviewing the available literature, we would like to advocate the implementation of additional Dixon sequences as a problem-solving tool during the assessment of bone marrow pathology.
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Affiliation(s)
- Niels van Vucht
- Department of Medical Imaging, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK.
| | - Rodney Santiago
- Department of Medical Imaging, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
| | - Bianca Lottmann
- Department of Medical Imaging, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
| | - Ian Pressney
- Department of Medical Imaging, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
| | - Dorothee Harder
- Clinic of Radiology and Nuclear Medicine, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Adnan Sheikh
- Department of Medical Imaging, The Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Ottawa, Ontario, K1Y 4E9, Canada
| | - Asif Saifuddin
- Department of Medical Imaging, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
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Zhang Y, Tan Y, Dong C, Gao S, Xu W, Chen H. Evaluating the scope of intramedullary invasion of malignant bone tumor by DCE-MRI quantitative parameters in animal study. J Bone Oncol 2019; 19:100269. [PMID: 31799112 PMCID: PMC6881657 DOI: 10.1016/j.jbo.2019.100269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 11/14/2019] [Accepted: 11/16/2019] [Indexed: 02/07/2023] Open
Abstract
UNLABELLED The purpose was to analyze the value of quantitative parameters of DCE-MRI in evaluating micro-infiltration of malignant bone tumors. METHODS Thirty-nine New Zealand white rabbits were used to establish malignant bone tumor models by implanting VX2 tumor fragments into the right tibiae. After three weeks, models were examined by conventional MRI and DCE-MRI; then the right tibiae were cut into sagittal sections and partitioned into histology slices for comparison with microscopic findings. Micro-infiltration groups were selected and the range of infiltration was determined under the microscope, and corresponding DCE images analyzed to obtain the quantitative parameters include Ktrans, Kep, ve and vp in parenchyma areas, micro-infiltration areas and simple edema areas. One-way ANOVA was used to compare the differences of the parameters between the three areas. Receiver operating characteristic curves (ROCs) were plotted to determine the accuracy of different parameters by area under curves (AUCs). RESULTS 22 cases (22/39, 56.4%) were included in the micro-infiltration group and the infiltration depth ranged from 1.3 mm to 4.6 mm, with an average depth of 3.2 mm ± 0.8 mm. The statistical results of quantitative parameters in the three areas were as follows: Ktrans values were (0.494 ± 0.052), (0.403 ± 0.049), (0.173 ± 0.047) min-1 (p = =0.000), Kep values were (1.959 ± 0.65), (1.528 ± 0.372), (1.174 ± 0.486) min-1 (p = =0.000), ve values were (0.247 ± 0.068), (0.283 ± 0.057), (0.168 ± 0.062) min-1 (p = =0.000), vp values were (0.125 ± 0.036), (0.108 ± 0.033), (0.098 ± 0.025) min-1 (p = =0.022), respectively. Ktrans and Kep values had significant difference in the three areas after comparing between-groups, respectively. However, there were no significant difference in vp values between parenchyma and micro-infiltration areas (p = =0.078), micro-infiltration and simple edema areas (p = =0.315), and ve values between parenchyma and micro-infiltration areas (p = =0.056). The ve values were higher in parenchyma and micro-infiltration areas then simple edema areas. Ktrans had highest accuracy in differentiating different areas (AUC > 0.9), respectively. CONCLUSION Quantitative parameters Ktrans, Kep and ve can assess the extent of intramedullary invasion of malignant bone tumors. Ktrans have highest accuracy in differentiating different regions.
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Affiliation(s)
- Yuan Zhang
- Department of Radiology, Wuhan Third Hospital (Tongren Hospital of Wuhan University), Wuhan, 430000, Hubei, China
- Department of Radiology, the Affiliated Hospital of Qingdao University, Qingdao 266003, China
| | - Yiqing Tan
- Department of Radiology, Wuhan Third Hospital (Tongren Hospital of Wuhan University), Wuhan, 430000, Hubei, China
| | - Cheng Dong
- Department of Radiology, the Affiliated Hospital of Qingdao University, Qingdao 266003, China
| | - Sai Gao
- Department of Radiology, the Affiliated Hospital of Qingdao University, Qingdao 266003, China
| | - Wenjian Xu
- Department of Radiology, the Affiliated Hospital of Qingdao University, Qingdao 266003, China
| | - Haisong Chen
- Department of Radiology, the Affiliated Hospital of Qingdao University, Qingdao 266003, China
- Corresponding author.
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Vieth V. [The importance of radiology in bone sarcoma diagnostics : Initial and advanced diagnostics]. DER ORTHOPADE 2019; 48:727-734. [PMID: 31392388 DOI: 10.1007/s00132-019-03786-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
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.
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Affiliation(s)
- Volker Vieth
- Klinik für Radiologie, Klinikum Ibbenbüren, Große Straße 41, 49477, Ibbenbüren, Deutschland.
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