Terry M. Hudson

Magnetic resonance imaging of bone and soft tissue tumors: early experience in 31 patients compared with computed tomography.

In 31 patients with 21 soft tissue and 10 bone tumors, magnetic resonance imaging (MRI) and computed tomography (CT) were equally effective in delineating the margins of most soft tissue tumors, and the margins of bone tumors from fat and adjacent normal bone. However, MRI was superior to CT in delineating bone tumors from adjacent muscle, and in showing the relationships to bone of the deep margins of some soft tissue tumors. This was true because the quality of CT images around thick cortical bone often was severely degraded by streak artifact, which does not occur in MRI.Excellent anatomic detail was achieved on MRI by spin echo pulse sequences with short repetition times. Bone tumors were delineated best by spin echo 1000/30 images, and soft tissue tumors by spin echo 1000/30 or inversion recovery images.

Magnetic resonance imaging of fluid levels in an aneurysmal bone cyst and in anticoagulated human blood

Magnetic resonance imaging (MRI) demonstrated a fluid level within an aneurysmal bone cyst (ABC). Since the ABC contained gross blood at operation, an anticoagulated human blood sample was studied by MRI also, and a fluid level was again clearly visible. MRI pulse sequences emphasizing T1 contrast showed the fluid levels most clearly in both the ABC and the blood. Sequences emphasizing T2 contrast showed homogeneous, bright signals in the ABC and in the blood, with no visible fluid level in the ABC and a nearly invisible one in the blood. In the blood sample, the calculated plasma T1 value was 1585 ms, and that of the red cells was 794 ms.

The management of primary lymphoma of bone

From October 1962 through April 1982, 21 patients with the diagnosis of primary lymphoma of bone (18 monostotic, stages IE and IIE; 3 polyostotic) were treated with curative intent. A combination of chemotherapy and radiation therapy was used in 11 patients, local treatment alone in 9 patients, and chemotherapy alone in one patient. Overall 5-year survival for the patients treated with curative intent was 56%. Standard work-up has changed over the 20-year study period. Five-year survival for the subset of eight stage I and II patients with full pretherapy staging was 83%. Prognosis was significantly correlated with extent of pretherapy staging. Treatment parameters that also seemed to predict outcome were the aggressiveness of chemotherapy and the use of irradiation or surgery for local-regional disease; the only local failure occurred in the patient who received chemotherapy alone. Complications of radiation therapy alone and in combination with chemotherapy are discussed and correlated with irradiation dose. Radiation therapy techniques are described, and a management approach is recommended.

The correlation between the radiologic staging studies and histopathologic findings in aggressive stage 3 giant cell tumor of bone.

The histologic features of aggressive Stage 3 benign giant cell tumor of bone were correlated with their radiologic staging studies. Our series includes 24 patients treated at the University of Florida, Department of Orthopaedic Oncology, from January 1979 to July 1983. Particularly in 13 cases, results of routine specimen histologic as well as of the histologic study of macrosections containing the entire resected specimen (the tumor and surrounding bone and soft tissue) were evaluated. Surgical staging studies including plain radiographs, bone scintigrams, computerized axial tomography scans, tomography, and angiography were used to delineate the anatomic location of the lesion. Within this group of giant cell tumors, the general histologic features resemble those of the classic giant cell tumor. However, certain aggressive features best demonstrated on the macrosections, such as cortical and subchondral invasion, capsular and reactive bony zone iniltration, “digital extension” of the tumor, and neovascularity correlated well with the anatomic localization and aggressiveness found on the staging studies. Those findings emphasize the value of staging studies in the delineation of the histologic potential of these benign aggressive lesions.

Radiology of giant cell tumors of bone: Computed tomography, arthro-tomography, and scintigraphy

Radiologic studies of 50 giant cell tumors of bone in 48 patients were useful in assessing the anatomic extent for planning surgical treatment. Contrast-enhanced computed tomography (CT) provided the most useful and complete evaluation, including soft tissue extent and relationship to major vessels. Angiography was useful when the extraosseous extent and vascular relationships were not entirely clear on CT. Arthro-tomography was the best way to evaluate tumor invasion through subchondral cortex and articular cartilage. Reactive soft tissues, with edema and hyperemia, were difficult to distinguish from tumor tissue on CT and angiograms. Bone scintigrams often showed intense uptake beyond the true tumor limits.

Radionuclide imaging of soft tissue neoplasms

Two classes of radiopharmaceuticals may be used for imaging tumors of the musculoskeletal system. The first is comprised of soft tissue or tumor specific agents such as gallium-67, bleomycin, and radionuclide-labeled antibodies, which may be useful for detecting and localizing these tumors. The other class of tracer is comprised of those with avidity for bone. The 99mTc-labeled-phosphate skeletal imaging compounds have been found to localize in a variety of soft tissue lesions, including benign and malignant tumors. In 1972, Enneking began to include bone scans in the preoperative evaluation of soft tissue masses. Later, he and his associates reported that these scans were useful in planning operative treatment of sarcomas by detecting involvement of bone by the tumors. Nearly all malignant soft tissue tumors take up bone-seeking radiopharmaceuticals, and bone involvement was indicated in two-thirds of the scans we reviewed. About half of benign soft tissue lesions had normal scans, but the other half showed uptake within the lesion and a few also showed bone involvement. Careful, thorough imaging technique is essential to proper evaluation. Multiple, high-resolution static gamma camera images in different projections are necessary to adequately demonstrate the presence or absence of soft tissue abnormality and to define the precise relationship of the tumor to the adjacent bone.

Radiologic imaging of osteosarcoma: role in planning surgical treatment.

We reviewed radiographic studies of 50 central osteosarcomas to assess their accuracy and contributions to surgical treatment planning. Accurate anatomic delineation was especially important when limb-sparing tumor resection was considered. The plain roentgenograms yielded most of the diagnostic information, and often showed large masses located so that major neurovascular involvement was inevitable. Conventional tomography added little. Computed tomography (CT) usually was accurate in showing tumor extent and relationships to major nerves and vessels. However, CT was less useful when vessels were not seen, when edema and hemorrhage (especially after biopsy) blurred tumor margins, or when tumor margin and soft tissue planes blended together without clear definition. Angiography was essential when vascular relationships were unclear on CT. Scintigraphy occasionally revaled subtle intramarrow tumor extension, but nonspecific increased uptake beyond the true tumor limits was more common than occult tumor spread.

Limitations of computed tomography following excisional biopsy of soft tissue sarcomas

Twenty-one patients were evaluated by computed tomography (CT) following complete or incomplete excisional biopsy of soft tissue sarcomas. Since the surgical margins were inadequate, additional treatment was required, and CT was intended to identify and delineate any residual tumor. Thirteen patients had no palpable mass in the operative area. In these, eleven CTs showed no tumor, but microscopic tumor was found in seven. The other two CTs showed masses, but both proved to be hematomas. Eight patients had palpable masses and seven proved to be residual tumor. Of these, two CTs failed to show the residual tumor. Five CTs correctly identified residual tumor, but two of them failed to show the entire tumor extent. Computed tomography did not correctly predict the presence or absence of microscopic residual tumor when there was no palpable mass, and was at least partly inaccurate in delineating residual tumor in four of eight patients with palpable masses.

Radiology of medullary chondrosarcoma: Preoperative treatment planning

We evaluated the radiologic studies of 30 medullary chondrosarcomas with respect to their accuracy in diagnosis and surgical staging. There were 30 sets of plain radiographs, 14 conventional tomograms, 26 radionuclide bone scans, 19 arteriograms, and 15 computed tomograms (CT). Plain radiographs provided most of the diagnostic information although many tumours looked benign. CT provided the most complete anatomic staging, including intra- and extraosseous tumor, and neurovascular involvement. However, it was difficult to be sure about subtle soft tissue invasion. Arteriography remained useful for evaluating major vessel involvement of cortical penetration when CT and conventional tomography were equivocal. Scintigrams disclosed increased uptake, usualy corresponding to the true tumor extent; “extended uptake” beyond the tumor was uncommon. Conventional tomography has been largely replaced by CT, but was occasionally useful when the tumor was near the end of a bone.

Angiography of malignant fibrous histiocytoma of bone.

Angiograms of 10 cases of malignant fibrous histiocytoma of bone were reviewed and correlated with surgical and pathological findings. Nine tumors were hypervascular. Seven demonstrated malignant characteristics (laking in one and coarse tumor vessels in 6). Seven tumors displaced adjacent normal vessels. All angiograms accurately delineated soft-tissue masses and cortical breakthrough but intraosseous extent was less clearly defined. Tumor thrombi within draining veins were evident retrospectively in one instance. Angiography in these cases contributed substantially to surgical management.