An integrated approach to the evaluation of osseous tumors

Multi-detector computed tomography in evaluating locally aggressive and malignant bone tumours

OBJECTIVE

To evaluate the ability of Multi-Detector Computed Tomography in preoperative evaluation of locally aggressive and malignant bone tumours in correlation with histopathological findings.

MATERIALS AND METHODS

Twenty patients suspected of malignant bone tumours on the basis of their clinical profile were selected. Following a plain radiograph evaluation, all of them were subjected to CT scan examination. Multi Planar Reconstruction (MPR) was done in sagittal and coronal planes and also three-dimensional Volume Rendering (VR) and Maximum Intensity Projection (MIP) images were obtained.

RESULTS

Of the 20 patients, 18 underwent surgery, and their histopathological findings were compared and correlated with MDCT findings. MDCT was 92.8% sensitive and 100% specific in determining the vascularity of the tumour and also can detect displacement/ encasement/ involvement of adjacent vessels. It has a sensitivity and specificity of 100% in determining cortical break, calcification and periosteal reaction. However, it is less sensitive in detecting joint involvement. Post contrast enhancement gives details of the extent of the soft tissue component.

CONCLUSION

Although MRI is a preferred modality in preoperative evaluation of bone tumours, CT may be used an alternative in case of non-availability of MRI, which has faster acquisition time and better resolution. Using three dimensional MPR imaging, the location and extent of the tumour can be studied. It is also useful in determining cortical discontinuity, periosteal reaction, and calcification. By virtue of MIP and VR imaging, vascularity of the tumour and its relationship with the adjacent vasculature can be established. However, it is inferior to MRI in soft tissue characterization and has poor sensitivity in detecting marrow and joint involvement.

Diagnosing bone lesions: a practical non-pathology centric formulaic approach

Bone lesions are perceived to be some of the most difficult lesions that pathologists encounter. The reasons for this are multiple and include lack of experience/familiarity, the need to rely heavily on non-pathology information and data, and the fact that many lesions are associated with either procedures or treatments with significant morbidity. However, in fact, the majority of bone lesions can be accurately assessed on the basis of data not directly related to traditional pathologic based assessment. In order to achieve this state, the pathologist must understand the consistent clinical parameters of most bone lesions, including their clinical presentation, the bone involved, particularly the anatomic site of the bone involved, and a fundamental, basic understanding of imaging studies, especially the plain radiograph. Once these principles are understood and mastered, the pathologist can easily diagnose most bone lesions, using traditional pathologic assessment to confirm the diagnosis.

Clinical and radiographic evaluation of bone tumors

Timely diagnosis of osseous tumors is essential in providing proper management. Appropriate imaging studies are essential to this process, however, if inconclusive, they can be superceded by information obtained through the patient history and physical examination.