Osteosarcoma: interventional radiology in diagnosis and management

An integrated approach to the evaluation of osseous tumors

Modern treatment techniques for musculoskeletal neoplasms require significant imaging information to determine the nature and extent of tumors. The imaging investigation should be selected according to the information needed. Conventional radiographic techniques remain of fundamental importance in the analysis of bone tumors and tumor-like lesions, whereas advance imaging techniques such as CT and MR imaging can provide information regarding the extent of lesions.

Thallium-201 SPECT in differentiating bone infarction from metastatic lesions in osteosarcoma

The authors present a case of bone infarction in the proximal epiphysis of the right tibia, which was caused by preoperative intraarterial chemotherapy for osteosarcoma. MR imaging revealed that suspected metastases had inhomogeneous signal intensity similar to that of the primary tumor, which made a metastatic lesion difficult to exclude. On TI-201 SPECT, no accumulation was found in the lesions, confirming that they were not osseous metastases. Consequently, this enabled limb salvage surgery to be performed with joint preservation. Intraoperative biopsy revealed no viable tumor cells in the lesion, and bone infarction was suspected. TI-201 SPECT was very useful, not only in differentiating bone infarction from tumor progression, including metastatic lesions, but also in the determination of the operative technique.

Femoral infarction following intraarterial chemotherapy for osteosarcoma of the leg: a possible pitfall in magnetic resonance imaging

Bone infarction of the distal femur is reported in two patients with osteosarcoma of the leg (1 tibia, 1 fibula) treated by preoperative chemotherapy including intraarterial chemotherapy (IAC) by Cis-platinum. Both patients were examined by magnetic resonance imaging before chemotherapy and again prior to limb salvage surgery. The location of these lesions in the distal femur must suggest bone infarction especially if the tumor has decreased in size under treatment.