mri ewing sarcoma
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31 7
M R Im ag in g o f O s teog en ic
an d E w in g ’s S arcom a
O res t B . B oyko 1
D a vid A . G o ry 1
M e rvy n D . Co h e n 1
A rth ur P rov iso r
D av id M irk in3
G . P au l D eR osa4
Rec e iv ed
F eb ru ary 2 7, 1 98 6; a cc ep te d
a fte r re -
v is io n S ep tem be r 1 0. 19 86
P rese nte d a t th e an nua l m ee tin g o f
t he A m e ri ca n
R o en tge n R ay S oc ie ty . B os to n . A p ril 19 85 .
1
D epa rtm en t o f R ad io log y. In dian a U nive rs ity
S c ho o l o f M e d ic ine , a nd R e ge ns tne f In s ti tu te , In d i-
an ap o lis , IN 4 62 23 . A d dre ss re p rin t re que sts to 0 .
B . B oyk o , D epa rtm en t o f R ad io lo gy , In d ian a Un i -
ve rs i ty
S ch oo l o f M e d ic ine , 92 6 W . M ich ig an S t.,
I nd ia na po lis , I N 4 62 23 .
2
D e pa rtm en t o f H e m a to lo gy a nd O n co log y , In -
d iana U n ive rs ity S ch oo l o f M e d ic ine , a nd R eg en -
s trie f Ins t itu te , Ind ian ap olis , IN 46 223 .
3 D epa rtm en t o f P a th o lo gy , Ind ian a U n ive rs ity
S c ho o l o f M e d ic ine , a nd R eg en strie f In s ti tu te , In d i-
anapo l i s , I N 4 6 22 3 .
4 D epa rtm en t o f O r tho pa ed ic S u rg e ry , Ind ian a
U n iv e rs ity S ch oo l o f M ed ic in e , a nd R e ge nstrie f In -
s t itu te , Ind ian ap olis , IN 46 22 3.
A JR
148:317 322
F ebr ua r y 1987
0 36 1 -8 03 x/8 7/1 4 82 -0 31 7
C A m e ric an R oe n tgen R a y S o c ie ty
T w en ty pa tie n ts w ith
b io p sy -p ro ven o steo g en ic 1 1
c as es )
o r E w in g ’s n in e cases
sa rco m a w e re eva lu a ted b y M R im ag in g o n a O .1 5 -T re s is tiv e u n it to de te rm in e th e va lue
o f M R in th e d iag n o s is an d tre a tm en t o f th e se tw o n e o p la s m s a n d to d e ve lo p th e b e s t
p ro to co l fo r M R im ag in g . In a ll 2 0
c as es ,
M R id en tified tu m o r sp re ad in to
b on e m arro w,
an d it w as sup e rio r to C T in five cases . E x ten s io n o f
t u m o r
into
th e s oft tis su es a dja ce nt
to b o n e w as sh o w n
be t te r
b y M R th an C T in s ix c ases . Im p ro ved an a to m ic in fo rm atio n
fro m M R is th e resu lt o f th e
abil i ty
to im ag e in th e ax ia l, co ro n a l, a nd
s ag itta l p la ne s.
C o m p ared w ith C T , M R iden tifies co rtica l d ise ase b u t h as in fe r io r sp a tia l re so lu tio n an d
d efin es c alc iu m
poor ly .
M R can b e u sed to m on ito r
tu m or res po nse
t o c h em o th e ra p y,
an d the re la t io n sh ip o f tu m or to ad jac en t va scu la tu re
c an be d e te rm ine d
w ith o u t th e
us e
o f co n tra s t ag en ts . T w o p u lse seq u en ces a re nec es s a r y fo r m ax im um d isp lay o f d is ease ,
s in ce , in g en e ra l, tu m o r in vo lv em en t o f th e b o n e m a rro w is b es t a ssessed o n T i-
w e ig h ted seq u en ces , an d tu m o r in vo lvem en t o f th e so ft tis su e is b es t se en o n T 2 -
w eig h te d se q u e n ce s . A d d itio n a l in fo rm atio n a bo u t b o n e -m arro w in v o lve m en t, so ft- tis su e
tum o r ex ten t, a nd th e re la tio n sh ip o f tum o r to b lo o d vesse ls m akes M R a va lu ab le
ad jun c t to C T in th e eva lu a tio n o f th ese n eop la sm s .
C lin ic a l e xp e rie n ce w ith M R im a g in g o f p rim a ry b o n e tu m o rs is a cc u m u la tin g [i -
1 1
1.
M R is a lso b e c o m in g in cre a s in g ly im p o rta n t in th e im a g in g o f b o n e -m a rro w
d ise ase [1 1 -1 6 ]. M R p ro v ides m ultip lan a r im ag es , ide n tif ies b o n e -ma r ro w a nd s oft-
tissue ex ten s ion o f tum or, an d ho lds p rom ise a s a m e ans o f m on ito ring tum o r
respon se to the ra py [5 -8 ]. W e re v ie w ed the M R fin d in gs in 1 1 ca ses o f osteog en ic
sa rcom a an d n ine ca se s o f E w in g ’s sa rcom a to eva lu a te th e c lin ica l use fu lness o f
th e tech n iq ue a nd to de te rm ine the bes t M R im a g ing stra teg y fo r these tw o tu m ors.
M ateria ls an d M ethods
T w e n ty pa tie n ts a g e d 9 -2 1 y e a rs w ith e ith e r os te o g e n ic sa rc o m a (1 1 c a se s) o r E w in g ’s
sa rco m a (n in e ca se s ) h a d M R sc a n s b e fo re ch e m o th e ra p y o r ra d ia tio n th e ra p y . A 0 . 1 5-T
re s is tive sc ann er (T e ch n ic a re T es lac on )
w as
us ed .
A ll p a tie n ts w e re e xa m in e d w ith a t le a s t
on e T i
-
a n d on e T 2-w eigh ted s p in - ec ho (S E) p u ls e s equenc e , a nd th re e p a tie n ts w e re
e x a m in e d w ith inve rs ion -re cov e ry (IR ) p u ls e s equ en ce s. T h e ec ho -de lay tim e (T E ) w as 30 ,
3 2 , 6 0 , o r 1 2 0 m s e c; th e re p e tition tim e (T A ) w a s 2 5 0 , 5 0 0 , 5 5 0 , 1 0 0 0 , or 2 0 0 0 m s e c. (S E
2 5 0 /3 2 , 5 5 0 /3 2 , a n d 5 0 0 /3 0 a re T i w e ig h te d ; S E 1 0 0 0 /3 0 , 1 0 0 0 /6 0 , 2 0 0 0 /6 0 , a n d 20 0 0 /
1 2 0 a re m o re T 2 w e ig h te d.) F o r th e IR s e q u e n ce , a 9 0 {1 7 6 }- i0 {1 7 6 }ig n a l-re a d in g p u lse p a ir
fo llo wed the in itia l 1 80 {1 76 }n ve rtin g p ulse . T he in ve rs io n t ime (T I) w a s 4 5 0 m se c. T he 9 0 {1 7 6 }nd
1 8 0 { 1 7 6 }e foc us in g pu ls es w e re se pa ra te d b y 1 5 m s ec .
T h e T R w a s 1 50 0 m se c . IA im a g e s a re
h e a v ily T i w e ig hte d . In o n e c a se , m u ltie ch o im a g e s w e re o b ta in e d w ith a T A o f 2 0 0 0 m s e c
a n d a T E ra n g in g f rom 3 0 to 2 4 0 m se c.
C on tig uo us s lic es o f e ithe r 1 0 o r 1 5 m m w e re o b ta in e d in the co ro na l, ax ia l, o r s ag itta l
p la n e . Im a g e s w e re re co n s tru c te d in to a 2 5 6 x 1 2 8 m a tr ix a n d in te rp o la te d to 2 5 6 x 2 5 6 fo r
d isp la y . N o con tras t a ge n ts w e re us ed .
T h e d is trib u tio n o f th e 1 1 c a se s o f o s te o g e n ic sa rco m a w e re fe m ur (se ve n ), p e lv is ( tw o ),
h u m eru s (o n e ), a n d tib ia (o n e ). T h e n in e ca se s o f E w in g ’s sa rco m a w e re
l oc a ted
in th e fe m ur
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F ig . 1 .-E w ing ’s s arc om a o f t h e le ft fib u la . C , SE 10 00 /60 im a ge sh ow s so ft- tis su e m as s
a r rows
a nd p er io ste al
A, S o ft- tiss ue -w ind ow C T sh ow s no so ft-t iss ue m a ss or m a rro w a bn or - e lev a tion a r r owhead , bu t fa ils to sh ow d if fe renc e be tw ee n no rm al tib ia
m ality . a nd a bno rm al fib u la m arrow a s w a s se en in B .
B,
IR 1 50 0 /4 50 im a ge s ho w s m arrow rep la ce m e n t by tum or a r r ow .
31 8
B O Y K O E T A L .
AJ R:148 , F eb ru ar y 1 98 7
( tw o), p e lv is ( five ), sp in e (o n e ), a n d fib u la (o n e ). A ll p a tie n ts h a d p la in -
f i lm e xam in a tion s , a nd i 9 p a tien ts h a d C T sca n s b e fo re M R im a g ing .
C T w a s p e rfo rm ed o n e ith e r a P h ilip s T o m osc a n 31 0 o r T e ch n ic a re
2 0 6 0 0 s ca n n e r. F o llo w -u p M R stu d ie s w e re p e rfo rm ed in n ine pa -
t ien ts to m on ito r res po n se to the ra py . D ia g no se s in a ll 2 0 ca ses w e re
p ro ve n b y b io p sy . T w o re se c te d o s te o g e n ic s a rco m a sp e c im en s w ere
s tu d ie d fo r p a th o lo g ic c o rre la tio n o f M R fin d in g s .
M A s tud ie s w e re re v ie w e d re tro sp e c tive ly b y tw o o f th e a u th o rs ;
th e ir o bse rva tio ns w e re co r re la te d w ith p la in film s an d C T sc an s
s im u lta ne ou s ly , and a c on se nsu s im pre ss ion w as rea che d . P res enc e
o f tu m o r in th e s o ft tiss u e s a n d b o n e m a rro w w a s co n firm e d a t th e
t ime o f o p e n b io p sy a n d /o r a m pu ta tio n .
Resu f ts
M R id en tifie d so ft-tissu e m asses in a ll 2 0 cases . In th e 19
ca ses in w h ich C T w as p erfo r’rned , M R sho w e d be tte r th e
so ft-tis su e m ass in s ix , inc lud ing on e case o f E w ing ’s w h ere
the m ass w as iso den se w ith m u sc le on C T (F ig . 1 A ). M a rrow
in vo lvem en t w as ev iden t in a ll cases im ag ed by M R and C T ,
b u t th e e x te n t w a s b e tte r sh o w n b y M R in five ca s e s . C T
sh o w ed m a rro w ab n o rm a litie s b e tte r th an M R in o n e
ca se .
B o th T i - and T 2 -w e igh ted im a ges w e re req u ire d in th e e va l-
ua tion o f tum o r in so ft tis su e a nd bon e m arrow , s ince on T i
-
w e ig h ted im ag es tum or th a t in filtra tes m usc le can have a
s ig n a l is o in te n se w ith m us c le (F ig . 1 B). T h e s ig n a l b e co m e s
m o re in ten se o n T 2 -w e ig h ted im ag es F ig . 1
C ) . C o n ve rs e ly ,
th e T 2 p u lse sequ ence cho sen can cause tum o r tha t is
in fi ltra tin g b o n e
m arro w to ha ve a brigh t s igna l s im ila r to
n o rm a l m arro w F ig . 1
C ).
In
on e
case o f a p e lv ic os teo gen ic sa rcom a , the extens ive
m arrow invo lvem en t sh ow n by M R cha nge d the su rg ica l
a p p ro a c h to a h em ipe lvec tom y. M R ca n a lso sho w m etas ta tic
s ite s o f osteoge n ic sa rco m a even w hen the re is ca lc i f ied
tumor m a tr ix (F ig . 2 ).
T h e s o ft-tis su e co m p o n e n t o f b o th o s te o g e n ic a n d E w in g ’s
sa rco m a h ad an inho m o gen eous s ig na l in ten s ity , an d these
tw o tu m o rs c o u ld n o t b e d is tin g u is h e d b a se d o n T i o r T 2
s ig na l i nt en sit y.
M R sh o w e d co rtica l th ick e n in g a n d tu m o r in filtra tio n o f th e
co rtex by bo th types o f tu m ors . In fo u r cases w he re co rtica l
d isease w as see n on p la in film and /o r C T , n o co rtica l d isea se
w a s e v id en t on M R . C ortica l invo lvem en t b y E w ing ’s o r
osteog en ic sa rco m a is id en tifie d on M R b y the re p la ce m en t
o f th e d a rk s ign a l o f th e co rte x w ith th e co m p a ra tive ly in -
crea se d s ig na l in tens ity o f the in va d in g tu m or.
B o th C T a n d p la in ra d io g ra p h s p ro v id e d b e tte r d e fin itio n
an d loca liza tion o f ca lc ifica tio ns in a ll ca ses . O n M R la rge foc i
o f c a lc ifica tio n p ro d u ce d d isc re te a re a s o f s ign a l vo id (F ig .
2 A ). S m all ca lc ifica t ions resu lte d in an inh o rno gen eou s ap -
pe aran ce in som e ca se s (F ig s . 3 a nd 4). T h e area s o f lo w e st
s igna l in tum ors on M R d id no t a lw ays co rrespon d to a rea s
o fc a lc ifica tio n (F ig . 4 ). F o urte e n c as e s ha d p e rio s te a l re a c tion
s e e n o n p la in film s o r C T , a n d th is co u ld b e id e n tifie d b y M R
in e ig h t c a se s (F ig . 1 C).
P ath o log ic - rad io lo g ic co rre la tio n in tw o c as es o f o ste og en ic
s a rco m a sh o w e d th e re lia b ility o f M R to d isp la y th e tru e
exte n t o f tum o r in bo ne m arrow an d so ft t issue . In one ca se ,
a la te ra l p la in film o f th e d is ta l fe m u r sh o w e d a n o ste o b la s tic
les ion w ith a w ide zo ne o f tran s it ion , p e rio s te a l rea ction , a nd
s o ft-tis su e m a ss (F ig . 5 ). C o m p a riso n o f a s a g itta l M R im a ge
w ith th e g ro ss spe c im en sho w e d tha t M R pre d ic ted th e
p rox im al ex ten t o f m arrow d ise ase w ith in se ve ra l m illim ete rs .
H is to lo g ica lly no tu m o r w as prese n t in th e ep ip hy s is . A la rg e
am o un t o f tum or ne cro s is w as pre se n t, w ith the g rea te st
am o un t o f v iab le tum or ad jace n t to th e ep iphyse a l line . C ho n-
d ro id a s w e ll as oste o id m atrix w ere p rese n t, bu t the ir d is tr i-
bu tion d id no t co rre la te d irec tly w ith th e inhom og ene ous
s ig na l o f in filtra te d m arrow . S o ft-tis su e ex tens io n and perio s-
tea l re action w e re s e e n o n M R . In th is c a se C T p ro v id e d
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A J R :14 8 , F eb ru a ry 19 87
MR OF OSTEOGENIC AND EWING’S SARCOMA
31 9
F ig . 2 .-O s teo ge n ic sa rco m a o f th e rig h t hu -
m e w s .
A ,
c o ron a l S E 20 00 /60 im ag e sh ow s p rim ary
t umor
a r rows .
cak i f ie i a x illa ry n od e m eta s -
tases a r rowheads appear a s area s o f de -
creased
s igna l .
B ,
C hes t rad io grap h con firm s d ense ly ca lc i-
f ied a xilla ry no de m etas tas es a r r owheads .
F i g. 3 . -O s t eo g e ni c s a r c oma
o f
th e f emur .
A , Bone- w indow CT s c an
s h ow s s ev er al
s m a l l
a re as o f calc if icat ion a r r ows , an d tum or ex ten -
s io n in to m arrow
a n d s u rr o u nd in g
s of t tis su e.
B ,
A xia l S E 10 00 /60 im age s h o w s i n h o m o g e -
ne ou s s ig na l f rom tum or
arrows
th a t can no t b e
co rre la ted w ith C T as be ing are as o f ca lc ific a -
tio n, w hic h s h o w s l imitat ion o f M R in t he e va lu -
at ion o f ca lc ium . Tum o r rep lac em en t o f no rm al
m a rro w s ig na l is s ee n .
be tte r d e fin ition than M R of ca lc iu m d epo s it ion in the tum o r
matrix.
E xa m in a tion o f a co ro na l sp ec im e n sec tio n in an o the r ca se
o f os teog en ic sa rcom a sh ow ed tu m or extens ion in to th e
e p ip h ys is (F ig . 6 ). T h e e x te n t o f tu m o r in vo lve m e n t o f th e
m a rrow a nd so ft tissue in the g ross spec im en d irec tly co rre -
la ted w ith the abn orm a l s igna l sho w n by M R .
F lo w in g b lo o d em itted n o s ig n a l an d ap p eared b lac k o n a ll
pu lse sequ ences . In 1 2 case s, M R sh ow ed th e re la t ion sh ip
o f tu m or to b lo od vesse ls m o re ea s ily th an C T d id . S ca nn ing
in th e sa g itta l p lan e w a s o fte n u se fu l fo r d e m o n stra tio n o f th e
su p e rfic ia l fe m o ra l a n d p o p lite a l a rte rie s . T h e co ro n a l p la n e
prov ide d exce lle n t de m on stra tion o f m ajo r pe lv ic vesse ls an d
d isp lacem en t o f p e lv ic s truc tu res (F ig . 7 ).
Im proved ana tom ic in fo rm a tion ca n be d erived from M R by
th e op p o rtu n ity to im a g e in se ve ra l p la n e s . In F ig u re 8 a
c oro n a l M R im a g e s h o w e d e xte n s io n o f a s p in a l E w in g ’s
sa rco m a b e h in d th e d ia p h ra g m a tic c ru s . T h e C T sc a n w a s
in itia lly in te rp re te d a s a n a d re n a l m a ss th a t w a s inv a d in g
b o n e .
R espon se to the rap y cou ld be m on ito re d fo r b o th E w in g ’s
(F ig . 8 ) an d o steo gen ic sa rcom as . In th ree cases o f os teo -
g e n ic s a rc o m a , tu m o r e n la rg e m e n t d o c u m e n te d b y M R a l-
l o w e d fo r the e a rly cessa tion o f m etho trexa te ch em othe ra py ,
fo llo we d b y a mp uta tio n.
Discuss ion
W e fo und in filt ra tio n o f th e b one m arrow b y o ste ogen ic and
E w in g ’s s a rc o m a to b e c le ar ly s h o w n b y M R ; in five ca se s it
w as superio r
to C T . T u m or has a lon g T i
re laxat ion
tim e a nd
th us ha s a s ign a l in ten s ity low er than tha t o f m arrow fa t on
T i-w e ig h te d im a g e s [1 6 ]. P a th o lo g ic co rre la tio n o f m a rro w
in vo lvem en t by tw o os teo gen ic sa rcom as (F igs . 5 a nd 6 )
show ed th e m arrow invo lvem e n t d em o nstra ted b y M R to be
w ith in se ve ra l m illim e te rs o f tha t docum e n te d on th e pa tho -
lo g ic sp e c im e n . T h is su p p o rts th e fin d in g s b y o th e r in ve s ti-
g a to rs o f th e re lia b ility o f M R in s h o w in g th e tru e mar row
e x ten t o f n eo p la sm [10 , 1 6 ].
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a r row and so ft-tiss ue m ass a r rowheads .
C , G ro ss sp ec im en . T um or ex ten ds
p rox im a lly in to m a rro w 1 2 cm an d
d oe s n o t in vo lve e p ip hys is
as
predic ted by M R
B .
3 20 B O Y K O E T A L . A JR :1 48 , F eb ru ary 1 98 7
In s ix ca s e s M R w a s su p e rio r to C T in d efin in g so ft- tis su e
F ig . 5 .-O steog en ic sa rco m a
o f th e
f emur .
A , P re op era tiv e ra dio gra ph sh ow s os teo b las tic m a rro w le s io n w ith p e r-
i os t ea l re ac tio n an d a s o ft- tiss ue m as s a r r ows .
B ,
Sag i t t a l
S E 500 /30 im ag e sh o w s
prox im a l tum or e x ten t in m arrow
T h e i n h o mo g e n e o u s M R signa l o f os teo gen ic sa rcom a d id
n o t co rre la te w ith th e h is to lo g ic d is trib u tio n o f ch o n d ro id o r
o s te o id tu m o r m a trix . W e d id fin d o n M R th a t tu m o r sp re a d
in to the bo ne m arro w can ex ten d be yon d the co rtica l o r so ft-
tiss u e co m p o n e n t o f b o th o f th e s e n e o p la sm s. D e c re a se d
F ig . 4 .-E w in g ’s s arco m a o f th e
l ef t i li um .
A , C T s ho w s a rea s o f calc if icat ion
arrows
w ith in tum or
w ith p er io ste al r ea ctio n
a nd so ft-
t is su e m a ss .
B , Ax ia l S E 5 00 /30 im a ge s ho ws in ho mo ge -
n e o u s s ig na l in tum or,
b ut a re as o f lo wes t s ig na l
a r r owheads d o n ot c or re sp on d to calc if icat ions
s ee n o n CT . T her e
is
m arro w re pla ce me nt
b y
t u m o r a r row .
s ig n a l in b o n e m a rro w o n T i -w e ig h te d im a g e s, h o w e v e r, is
no t
speci f ic
fo r tu m o r s in ce a va s cu la r n e cro s is o r a n y m a rro w -
re p la c in g p ro c e ss ca n p ro d u ce th e sa m e s ig n a l d e c re a se [1 4 ,
16].
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A B
A J R: 1 4 8 F e br u ar y 1 9 87
M R O F O S T E O G E N IC A N D E W IN G ’S S A R C O M A
3 2i
F ig . 7 .-E w in g ’s sa rco m a a ris in g from il iac
w ing s in tw o d iffe ren t pa t ien ts sh ow s d is p la ce -
m en t o f r ig h t
A
an d le f t
B i li ac a rt er ie s a r-
r ows ,
in fe rio r ve na ca va A ,
ar r owhead , an d
b ladde r
B , a rr ow h ea d .
co n tras t and tum or ex ten s io n . T 2 -w eigh te d im age s en han ced
so ft-tis sue con tras t be tw e en tum or and m usc le b e tte r than
T i -w e ig h ted im ag es .
M R w as fo un d
to be in fe rio r to C T in sho w ing so ft-tis sue
ca lc i f ica t ion
an d tum o r m atrix m ine ra liza tion in a ll i 6 case s in
w h ich ca lc iu m w a s sh o w n b y e ith e r C T o r p la in film s . T h is
w as m ore o f a p rob lem in the in te rp re ta tion o f osteoge n ic
s a rc o ma s .
M R can sh o w th ick en in g , in filtra tio n , an d d es tru c tio n
o f th e
c orte x b y b o th o s te o g e n ic s a rc o m a a n d E w in g ’s s arco m a .
B on e cortex lacks m ob ile p ro ton s and th us h as d ark s igna l
o n a ll p u lse s e q u e n ce s . T u m o r in va s ion o f b o n e c o rte x ca n
b e id e n tifie d b e ca u s e o f its p ro lo n g e d T i a n d T 2 re la xa tio n
tim es . A lth oug h Z im me r e t a l. [5 ] b e lie ve d tha t co rtica l d isease
w as m o re o b v io u s ly sh o w n o n lo n g er S E s eq ue nc es (T E =
6 0 m s e c, T R
= 2 ,0 00 m sec ), in 1 5 cases w ith e v iden t co rtica l
d isease on M R th is w as s e e n a s w e ll o n T i
-
as o n T 2-
w e igh ted M R p u lse sequ ences. C o rtica l d isease w a s app re -
c ia ted m ore con s is ten tly on ax ia l im ag es s ince p rob le m s
a ro s e w ith pa rtia l vo lu m in g o f s ign a l in ten s ity o n co rona l a nd
sag i t ta l
im ages ; an d co rtica lou thne w a s no t as sha rp ly de fin ed
w h en the long ax is o f the b one took a m o re an g le d o r ob lique
c o u rs e ,
as ha s
b ee n re po rte d b y o th er w o rke rs [1 4 ]. P e rio s -
tea l re action cou ld b e iden tified in e ig h t cases by M R .
In b o th o s te o g e n ic an d E w in g ’s s a rc o m a , M R c a n sh o w
th e re la tio n sh ip o f tu m o r to v a scu la ture w ith o u t th e u s e o f
-
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322 B O Y K O E T A L. A JR :1 48 , F eb ru ary 19 87
1 .
B rad y T J , G eb ha rd t M C , P yke tt IL , e t a I. N M R im ag in g o f fo rea rm s
in
h ea lth y v o lun tee rs a n d p a tien ts w ith g ian t-ce ll tu m or o f b on e . Rad io logy
ig 8 .-E w ing ’s s arco m a a ris ing fro m s p ine .
A , C o ro na l S E 500 /30
im ag e s ho ws s oft-tis -
s ue m as s
a r rows
an d dec re as ed m a rro w s ig na l
o f i nv ol ve d v er te br al
b o d y a r r owhead .
B , Cor ona l
S E 2000 /3 0 im ag e afte r
t he r apy
s h o w s
d ec rea se in
s ize o f s oft-t is su e m as s
a r-
r ows .
co n tras t ag en ts . P a rt o f th is a dva n ta ge rests w ith the ab ility
o f M R to im a g e in th e c o ro n a l a n d s a g itta l p la n e s . P e tte rsso n
e t a l. [1 0 ] ha ve a lso com m en ted on the a dva n ta ge o f M R in
p rov id ing in fo rm ation on tum or re la tion sh ip to m ajo r vesse ls .
A lthou gh C T can be u s e d in fo llo w -u p to m o n ito r th e
res po n se to th e rap y o f os teo ge n ic sa rco m a [1 7 ], w e fou n d
M R to be a su ita b le a lte rna tive . In te rva l g row th o f tum or
sh ow n by M R a llo w e d cessa tion o f chem oth e rapy and e arly
am pu ta tio n in th ree ca ses o f o ste oge n ic sa rcom a . M R w as
use fu l as a fo llow -up to m o n ito r therapy re sp onse o f th re e
case s o f E w ing ’s sa rco m a.
In sum m ary , w e ha ve fo und M R to p rov ide ad junc t in fo r-
m a tio n in the p reop era tive p lan n in g and po stthe rap y fo llow -
u p in ca s e s o f E w in g ’s a n d o s te o g e n ic sa rco m a . Im a g es
o b ta ined in m ultip le p lan es an d w ith b o th T i- an d T 2 -w e igh ted
p uls e s eq ue nc es
ar e
ne cessa ry to eva lua te the b one-m arrow
a nd so ft-tissue e xte n t o f these tw o tum ors . T he a x ia l p la ne
a llow s be st a ssessm en t o f bon e co rtex w ith ou t pa rt ia l-vo lum e
a rtifa c ts . S a g itta l a nd c o ro n a l p la ne s p ro v id e an e xce llen t
d isp la y o f the re la tionsh ip o f tum or to m a jo r vesse ls an d
p ro v ide im age s o f the e n tire leng th o f a bon e fo r eva lua tion
o f p ro x im a l b o n e-m a rro w o r e p ip h yse a l e x te n t o f tu m o r a n d
sk ip les ions . In ge nera l, T i -w e igh ted im age s p rov ide the
g rea test con tra s t b e tw ee n tu m o r and m arrow , T 2 -w e igh ted
im ag es show the m ost co n tras t b e tw een tum o r and m u sc les ,
an d tu m or-in filtra tin g -b o n e co rtex m ay b e s e e n
w ith e ith er.
O ne lim ita tio n o f M R , com pared w ith C T , is the ina b ility o f
M R to de fin itive ly
id en tify tum o r m atrix ca lc ifica tion and
p e n o ste a l re a c tio n in a ll ca se s .
R E F E R E N C E S
1982 ;144 :549 - 552
2. M o o n K L J r. G en an t H K , H e lm s C A , C ha fe tz N I, c roo ks LE , K a u fm a n L .
M u sc ulo sk ele ta l a pp lic ati on s
o f n uc le ar
m ag ne tic re so na nce . Rad io logy
1983 ;147 :161 -17 i
3 . B rad y T J , R o se n B R , Py k e t t IL , M cG uire M H, M an k in H J, R o se n th a l D l.
N M R im ag ing o f leg tum ors . Rad io logy
1983 ;
149 :181 -187
4 . B erq uis t T H. M ag ne tic res on an ce im ag ing : p re lim in ary ex per ien ce in o r -
th op ed ic ra dio lo gy . M ag ne tic R eson an ce Im a g 1 98 4;2 : 41 -5 2
5 . Z im rne r W D , B e rq u is t T H , M c Le od R A , e t a l. B on e tu m o rs : m a gn e tic
re so na nce im ag in g
ve rsus
co mp ute d to mo gra ph y. Rad io logy 1 9 8 5 ;
155 :709 - 718
6.
Bloem
JL , F alk e T HM , T am in iau A HM , e t a l. M agn e tic res on an ce im ag in g
o f p rim ary m align an t bo ne tum ors . Rad iog r aph ic s 1 98 5; 5 : 8 53 -8 86
7 . B ake r H L Jr, B erqu is t T H, K ispe rt D B, e t a l. M agn e tic reso n an ce im ag in g
in a ro utin e c lin ica l s e tting . M a yo C lin P roc 1985 ;60 :75 - 90
8.
Huds on
T M ,
H am lin D J, E nn ek ing W F, P ette rss on H . M ag ne tic res on an ce
im ag in g o f bon e a nd so ft t issue tum ors : e a rly e xpe rie nc e in 31 p a t ien ts
c om pa re d w ith co m pu te d tom og rap hy . S ke le ta l R ad io l 1 98 5;1 3: 1 34 -1 46
9. P e tte rss on H , H u dso n T ,
H am lin D , e t a l. M ag ne tic res on an ce im ag in g o f
s ac ro co ccyg ea l tu mo rs . A cta R ad io l D ia gn ] (S to ckh ) 1 98 5;2 6:
161-165
1 0 . P e tte rsso n H , H a m lin D J , M an cu so A , Sc o t t K N. M agn etic re so na nce
im a g in g o f the m us cu losk e le ta l sy s te m . A cta R a d io l D ia gn ] ( S toc k h )
1985 ;26 :225 - 234
1 1 . M cM ilIin K I, P en n es D R . A ise n A , B ra un s te in , M a rte l W . M R I a nd C T
e va lu at io n o f p ri ma ry bo ne and so ft t iss ue tum ors . P rese nte d a t th e a nnu al
m eetin g o f the A me ric an R oe n tg en R ay S oc ie ty , B os ton , A pril 19 85
12 . C oh en M D, K la tte E C , B a e hn er R , e t a l. M ag ne tic
re so na nce im ag in g
of
b on e m arrow d is ea se in c h ild re n . Rad io logy 1 9 84 ;1 5 1: 71 5 -7 1 8
13 . F le tche r B D, Sc o les P V , N els on A D . O ste om ye lit is in ch ild re n: d ete ctio n
b y m a gn et ic r es on an ce . Rad io logy 1984 ;150 :57 - 60
14 . T o tty W G , M u rph y W A , G a nz W Y , K u m a r B , D au m W J, S ie ge l B A .
M ag n e tic res on an ce im ag in g o f th e no rm al an d isc he mic fe mo ra l h e a d .
A JR 1984 ;143 :1273- 1280
1 5. T jo n -A -T ham R T, B loe m JL , F alke T HM , e t a l. M agn e tic re so na nc e im ag ing
in P a ge t d is eas e o f the sk u ll. AJ N R 1985 ;6 :879 - 881
16 . D affne r R H , L u pe tin A R , D a sh N , D ee b Z L , S e fc zek R J, Sc hap i r o R L . M RI
in the de te c tio n
o f m a lign a n t in fi ltra tion o f bo n e m a rro w .
Ai R
1986 ;146 :353 - 358
17 . M ail J T , C oh en M D, M irk in D , P rov iso r A J . R e sp on se o f o s te os a rco m a to
p re ope ra tive in tra ve no us h igh -do se m eth o trex a te ch em othe rap y : C T e va l-
ua t ion . A iR 1985 ;144 :89 - 93
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