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Osseous Invasion by Soft-Tissue Sarcoma: Assessment with MR Imaging¹

¹ From the Departments of Diagnostic Imaging (D.A.E., L.M.W., D.J.S.), Pathology and Laboratory Medicine (R.A.K.), and Medical Imaging and Public Health Sciences (G.T.), and University Musculoskeletal Oncology Unit (R.S.B., J.S.W.), Mount Sinai Hospital and the University Health Network, University of Toronto, 600 University Ave, Toronto, Ontario, Canada M5G 1X5. From the 2001 RSNA scientific assembly. Received March 28, 2002; revision requested June 10; final revision received January 16, 2003; accepted January 27. Address correspondence to L.M.W. (e-mail: lwhite@mtsinai.on.ca).

View larger version (111K): [in a new window]   Figure 1a. Leiomyosarcoma adjacent to the femur. Transverse (a) T1-weighted conventional spin-echo (417/10) MR image and (b) T2-weighted fast spin-echo (5,867/85) MR image with fat saturation show a thin layer of normal soft tissue (arrows)—in this case, fat—separating the lesion from cortical bone; the lesion therefore was considered negative for osseous abutment. Histologic findings were negative for osseous invasion.

View larger version (125K): [in a new window]   Figure 1b. Leiomyosarcoma adjacent to the femur. Transverse (a) T1-weighted conventional spin-echo (417/10) MR image and (b) T2-weighted fast spin-echo (5,867/85) MR image with fat saturation show a thin layer of normal soft tissue (arrows)—in this case, fat—separating the lesion from cortical bone; the lesion therefore was considered negative for osseous abutment. Histologic findings were negative for osseous invasion.

View larger version (143K): [in a new window]   Figure 2a. Malignant fibrous histiocytoma adjacent to the femur. Transverse (a) T1-weighted spin-echo (516/11) MR image and (b) T2-weighted fast spin-echo (5,833/80) MR image with fat saturation show no soft-tissue interface separating lesion from bone cortex. This lesion had a more than 50% circumferential abutment of the femur. Note signal intensity change in cortex adjacent to soft-tissue mass (arrows), which led to a false-positive imaging finding of cortical invasion. At histologic analysis, no cortical infiltration by malignant cells was identified, and only reactive remodeling of bone was evident. Increased medullary signal intensity seen in the femur in b, because it is not localized to the region of the tumor, is attributable to hematopoiesis. This tumor was not subjected to preoperative radiation therapy.

View larger version (152K): [in a new window]   Figure 2b. Malignant fibrous histiocytoma adjacent to the femur. Transverse (a) T1-weighted spin-echo (516/11) MR image and (b) T2-weighted fast spin-echo (5,833/80) MR image with fat saturation show no soft-tissue interface separating lesion from bone cortex. This lesion had a more than 50% circumferential abutment of the femur. Note signal intensity change in cortex adjacent to soft-tissue mass (arrows), which led to a false-positive imaging finding of cortical invasion. At histologic analysis, no cortical infiltration by malignant cells was identified, and only reactive remodeling of bone was evident. Increased medullary signal intensity seen in the femur in b, because it is not localized to the region of the tumor, is attributable to hematopoiesis. This tumor was not subjected to preoperative radiation therapy.

View larger version (120K): [in a new window]   Figure 3a. Malignant fibrous histiocytoma abutting the tibia and fibula. The tumor was treated with preoperative radiation therapy following MR imaging. Transverse (a) T1-weighted conventional spin-echo (417/9) image and (b) T2-weighted fast spin-echo (4,450/92) image with fat saturation. Cortical destruction and cortical signal intensity change are evident in the tibia on both images (arrow). In addition, the medulla of the tibia shows abnormally low signal intensity in a and abnormally high signal intensity in b. Histologic evaluation of the tibia, however, revealed only cortical involvement; medullary signal intensity change was caused by focal replacement of bone marrow through fibrosis and fat necrosis. The anteromedial cortex of the fibula in a (arrow) appears thinned, but this finding was not evident on the corresponding coronal images and was thought to result from partial volume averaging. No fibular involvement was identified at histologic assessment.

View larger version (134K): [in a new window]   Figure 3b. Malignant fibrous histiocytoma abutting the tibia and fibula. The tumor was treated with preoperative radiation therapy following MR imaging. Transverse (a) T1-weighted conventional spin-echo (417/9) image and (b) T2-weighted fast spin-echo (4,450/92) image with fat saturation. Cortical destruction and cortical signal intensity change are evident in the tibia on both images (arrow). In addition, the medulla of the tibia shows abnormally low signal intensity in a and abnormally high signal intensity in b. Histologic evaluation of the tibia, however, revealed only cortical involvement; medullary signal intensity change was caused by focal replacement of bone marrow through fibrosis and fat necrosis. The anteromedial cortex of the fibula in a (arrow) appears thinned, but this finding was not evident on the corresponding coronal images and was thought to result from partial volume averaging. No fibular involvement was identified at histologic assessment.

View larger version (142K): [in a new window]   Figure 4a. Synovial sarcoma adjacent to the calcaneus. Coronal (a) T1-weighted conventional spin-echo (600/9) MR image and (b) T2-weighted fast spin-echo (4,000/81) MR image with fat saturation show cortical destruction and medullary signal intensity change (arrows). At histologic evaluation, malignant involvement of both cortex and medulla was found.

View larger version (121K): [in a new window]   Figure 4b. Synovial sarcoma adjacent to the calcaneus. Coronal (a) T1-weighted conventional spin-echo (600/9) MR image and (b) T2-weighted fast spin-echo (4,000/81) MR image with fat saturation show cortical destruction and medullary signal intensity change (arrows). At histologic evaluation, malignant involvement of both cortex and medulla was found.