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Musculoskeletal Imaging |
1 From the Depts of Radiologic Pathology (M.D.M.) and Orthopedic Pathology (F.H.G.), Armed Forces Inst of Pathology, 6825 16th St NW, Bldg 54, Rm M127A, Washington, DC 20306; Depts of Radiology and Nuclear Medicine (M.D.M.) and Surgery (H.T.T.), Uniformed Services Univ of the Health Sciences, Bethesda, Md; Dept of Radiology, Ramathibodi Hospital, Mahidol Univ, Bangkok, Thailand (S.W.J.); Dept of Radiology, Univ of Maryland Med Ctr, Baltimore (M.D.M.); Dept of Surgery, Orthopedic Service, Walter Reed Army Med Ctr, Washington, DC (H.T.T.); Washington Hospital Ctr, Washington, DC (J.J.J.); and Washington Hospital Ctr, Washington Cancer Inst, Washington, DC (M.M.M.). From the 1996 RSNA scientific asssembly. Received September 3, 2002; revision requested November 6; revision received February 18, 2003; accepted March 13. Address correspondence to M.D.M. (e-mail: murphey@afip.osd.mil).
PURPOSE: To describe the imaging characteristics of a large series of telangiectatic osteosarcomas with pathologic findings for comparison.
MATERIALS AND METHODS: The authors retrospectively reviewed 40 pathologically confirmed telangiectatic osteosarcomas. Patient demographics and images from radiography (n = 36), bone scintigraphy (n = 17), angiography (n = 4), computed tomography (CT) (n = 25), and magnetic resonance (MR) imaging (n = 27) were evaluated by three authors in consensus for lesion location, size, and intrinsic characteristics. There were 27 men (68%) and 13 women (32%) in the study, with an age range of 4–83 years (mean age, 24 years).
RESULTS: Lesions frequently affected the femur, tibia, and humerus. Radiographs showed geographic bone lysis, a wide zone of transition, and matrix mineralization. CT demonstrated low attenuation, MR demonstrated high signal intensity on T2-weighted images, and both demonstrated hemorrhage, which simulated the appearance of aneurysmal bone cyst. Viable sarcomatous tissue surrounding hemorrhagic and/or necrotic regions was best seen at contrast material–enhanced CT and MR imaging, with thick peripheral, septal, and nodular enhancement in all cases. Subtle matrix mineralization in this viable tissue was best seen at CT. An associated soft-tissue mass was also seen in 19 of 25 cases (76%) at CT and in 24 of 27 cases (89%) at MR imaging.
CONCLUSION: CT and MR imaging findings of telangiectatic osteosarcoma often include thick nodular tissue (and matrix mineralization at CT) in a largely hemorrhagic and/or necrotic osseous lesion with an associated soft-tissue mass, which allows distinction from aneurysmal bone cyst.
Index terms: Bone neoplasms, CT, 40.12111, 40.12112 • Bone neoplasms, MR, 40.121411, 40.12143 • Osteosarcoma, 40.3221
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