Osteosarcoma MRI

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammadmain Rezazadehsaatlou[2].

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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 intensity 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.
• Observe 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).
• 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 hemorrhage will have variable signal.

• T2:

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

• T1 C+ (Gd):

• Solid components show considerable enhancement.

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• The following table illustrates the findings on MRI for the subtypes of osteosarcoma:

Subtype	MRI findings
Intracortical osteosarcoma	It was believed that intracortical osteosarcoma was confined to the cortex of bone and does not show intramedullary or superficial involvement but it may involve medullary canal as well as surrounding soft tissue. It shows peripheral enhancement after intravenous contrast administration. T1 - hypointense. T2 - intermediate to high signal intensity.
Parosteal osteosarcoma	It exhibits predominantly low signal intensity both on T1 and T2 weighted imaging. High signal intensity on T2 is suggestive of high grade tumor.
Periosteal osteosarcoma	Typically hypointense on both T1 and T2 sequences: may see bony spicules radiating from surface lesion (sunburst pattern). It may appear hyperintense on T2 sequence which represents its chondroid matrix. Reactive marrow changes are commonly observed, but true marrow invasion is rare. It is difficult to differentiate periosteal osteosarcoma from the conventional high grade osteosarcoma at imaging, however conventional osteosarcomas involve entire circumference of cortex and show intramedullary extension.
Telangiectatic osteosarcoma	Commonly shows fluid-fluid levels within the lesion (~90% of cases) with variable signal intensity. Allows appreciation of surrounding soft tissue components. Signal characteristics are often heterogeneous. Enhancement of septations as well as the soft tissue component may be observed. Hemorrhage appears as hyperintense on T1 and variable signal intensity on T2.
Extra skeletal 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 hemorrhage it can mimic hematoma.