Osteosarcoma MRI

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Overview

On MRI, osteosarcoma is characterized by intermediate intensity of soft tissue and low signal intensity of ossified components on T1. High signal intensity of soft tissue and low signal imtensity of ossified components on T2. Considerable contrast enhancement of solid components on T1 contrast.

MRI

• MRI is proving essential in accurate local staging and assessment for limb sparing resection, particularly for evaluation of intraosseous tumor extension and soft-tissue involvement.
• Assessment of the growth plate is also essential as up to 75-88% of metaphyseal tumors do cross the growth plate into the epiphysis.
• MRI is used to:

• Show how far a bone tumor has grown inside a bone.
• Show how much a bone tumor has grown outside the bone.
• MRI can help doctors see if a tumor has grown into blood vessels, nerves, bone marrow or other nearby tissues or structures.
• Determine if the tumor has developed in one or more sites within the same bone (skip metastases)
• MRI helps the surgeon plan for possible surgery.

On MRI, signal characteristics of osteosarcoma include:

• T1:

• Soft tissue, non-mineralized component: intermediate signal intensity.
• Mineralized/ossified components: low signal intensity.
• Peri-tumoral edema: intermediate signal intensity.
• Scattered regions of haemorrhage will have variable signal.

• T2:

• Soft tissue non-mineralised component: high signal intensity.
• Mineralised/ossified components: low signal intensity.
• peri-tumoral oedema: high signal intensity.

• T1 C+ (Gd):

• Solid components show considerable enhancement.

Images courtesy of RadsWiki

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  MRI T1
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  MRI T1
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  MRI T1 post gad
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  MRI T1 post gad
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  MRI T2 fat sat
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  MRI T2 fat sat

Extraskeletal osteosarcoma

• Well circumscribed heterogeneous mass lesion with presence of haemorrhage and necrotic areas.
• T1: isointense to muscles.
• T2: hyperintense.
• Hyperintense foci on both T1 and T2 sequences (due to methaemoglobin) or hypointense foci on T2 (due to haemosiderin).

In extreme cases of haemorrhage it can mimic hematoma.