Bone Tumor Imaging, Then and Now

Abstract

Background: Musculoskeletal tumor imaging is a focused subspecialty of musculoskeletal radiology. The goals of imaging and techniques employed are continually evolving and often slightly different from those used in other musculoskeletal diseases. As these techniques change, it is occasionally useful to review what is new. Questions/Purposes: The question addressed in this manuscript is what are the most interesting/relevant changes in each modality of musculoskeletal tumor imaging over the past 38 years, the length of time the newly emeritus chair of the Radiology and Imaging Department of Hospital for Special Surgery has been at the hospital. Methods: This review is primarily expert opinion based in examining techniques used at the institutions of the authors, with support from current literature. Results: The techniques of computed tomography (CT) and magnetic resonance imaging (MRI) are new to the imaging armamentarium, and ultrasound and nuclear medicine techniques have advanced considerably with technology. Although radiographs have also evolved, the changes are less apparent, except in how they are currently processed, viewed, and stored. Conclusions: Radiographic evaluation is still critical to evaluating bone tumors. Newer techniques also play an important role in diagnosing and treating these neoplasms.

Imaging of Bone Sarcomas and Soft-Tissue Sarcomas

“…However, radiographs of the entire bone in two orthogonal projections, together with the adjacent joint, remain essential for detecting skeletal lesions and should be obtained early in the diagnostic process in any symptomatic patient. For most osseous lesions, an appropriate differential diagnosis can be provided using the patient's age, lesion location, and radiographic appearance [25][26][27]29]. On CR, the bone destruction pattern (geographic vs. non-geographic), a zone of transition, cortical destruction, type of periosteal reaction, and softtissue and joint involvement are determined.…”

Authors’ reply

“…Ultrasonography is superior in the evaluation of soft tissue lesions, but we feel that CT and/or MR imaging are often more reproducible, and these two imaging techniques have superior specificity when evaluating bony lesions. (3,4) Yours sincerely, Chong…”

“…Further imaging allows for confident exclusion of other differential diagnoses such as bone tumours, which are often not well appreciated on ultrasonographic evaluation. (3,4) In summary, we feel that the role of ultrasonography in identifying cases of neurogenic heterotopic ossification is limited by the level of operator experience with regard to the imaging technique. Ultrasonography is superior in the evaluation of soft tissue lesions, but we feel that CT and/or MR imaging are often more reproducible, and these two imaging techniques have superior specificity when evaluating bony lesions.…”

Correlación entre el diagnóstico imagenológico e histológico de tumores óseos. Un estudio retrospectivo

“…1,2 The diagnostic approach to focal bone lesions usually implies: clinical information (such as age, gender and personal history of malignancy); lesion localization; and radiographic benign/malignant appearance, regarding evaluation of margins appearance, cortical expansion grade, periosteal reaction and bone mineralization. 5,6,7,8 Additionally, CT and MRI can be used to a better characterization of the bone matrix, detection of mineralization, differential diagnosis and to determine the extension of the lesion. 5,6,9 Bone scintigraphy is useful to detect biological activity of the bone and evaluate the multiplicity of the lesions.…”

“…5,6,7,8 Additionally, CT and MRI can be used to a better characterization of the bone matrix, detection of mineralization, differential diagnosis and to determine the extension of the lesion. 5,6,9 Bone scintigraphy is useful to detect biological activity of the bone and evaluate the multiplicity of the lesions. PET shows the local metabolic activity of the tissue, but it is not yet globally available.…”