Differential Diagnosis of Spine Tumors: My Favorite Mistake

Albano, Domenico; Messina, Carmelo; Gitto, Salvatore; Papakonstantinou, Olympia; Sconfienza, Luca Maria

doi:10.1055/s-0038-1675551

Cited by 22 publications

(26 citation statements)

References 79 publications

(89 reference statements)

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“…The use of DWI for bone tumors (BTs) has been advocated for several scenarios, including the differentiation of benign from malignant tumors or vertebral fractures, and the therapeutic follow-up evaluation [ 92 , 93 ].…”

Section: Bone Tumorsmentioning

confidence: 99%

Diffusion-Weighted Imaging in Oncology: An Update

Messina

Bignone

Bruno

et al. 2020

Cancers

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To date, diffusion weighted imaging (DWI) is included in routine magnetic resonance imaging (MRI) protocols for several cancers. The real additive role of DWI lies in the “functional” information obtained by probing the free diffusivity of water molecules into intra and inter-cellular spaces that in tumors mainly depend on cellularity. Although DWI has not gained much space in some oncologic scenarios, this non-invasive tool is routinely used in clinical practice and still remains a hot research topic: it has been tested in almost all cancers to differentiate malignant from benign lesions, to distinguish different malignant histotypes or tumor grades, to predict and/or assess treatment responses, and to identify residual or recurrent tumors in follow-up examinations. In this review, we provide an up-to-date overview on the application of DWI in oncology.

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Section: Bone Tumorsmentioning

confidence: 99%

Diffusion-Weighted Imaging in Oncology: An Update

Messina

Bignone

Bruno

et al. 2020

Cancers

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“…The low ADC values in GCTs are due to the reduction of extracellular space from histiocytes, multi-nucleated giant cells, hemosiderin granules, and collagenous strands [3,[16][17]. High ADC values were observed in chondroid lesions, probably due to high free extracellular water content, regardless of their cellularity and histological grading [18][19][20]. The malignant chondroid tumors usually show higher ADC values than benign chondroid tumors [17] because of the high content of the chondroid matrix [16][17].…”

Section: Discussionmentioning

confidence: 99%

Added Value of Diffusion-Weighted Magnetic Resonance Imaging in Differentiating Musculoskeletal Tumors Using Sensitivity and Specificity: A Retrospective Study and Review of Literature

Boruah¹,

Gogoi²,

Patni³

et al. 2021

Cureus

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Background: Diffusion-weighted imaging (DWI) provides added value to conventional MRI imaging in diagnosing and differentiating various benign and malignant musculoskeletal tumors. Objective: The study aims to evaluate the diagnostic efficacies of diffusion-weighted imaging along with the conventional MRI sequences for differentiating benign and malignant musculoskeletal tumors using sensitivity and specificity. Materials and methods: This retrospective study was carried out on 73 histopathologically proven patients of various musculoskeletal tumors who presented to a tertiary care center between March 2017 to October 2018. Relevant clinical examinations and MRI scan of the requested body part of the musculoskeletal system were performed. Mean apparent diffusion coefficient (ADC) values were calculated in the bone as well as soft tissue tumors after placing uniform-sized region of interest (ROI) in the non-necrotic portion of the tumor. Statistical analysis: Independent t-test and one-way analysis of variance (ANOVA) test were used to compare the mean ADC values of the various tumors with the histopathology. Receiver operating characteristic (ROC) curve analysis was done to determine the cut-off mean ADC values in the various bone and soft tissue tumors. Results: Of 73 patients with musculoskeletal tumors (benign=20, malignant = 53), 47 patients were bone tumors (benign=12, malignant=35) and 26 patients were soft tissue tumors (benign=eight, malignant=18). Mean ADC value of benign bone tumor was 1.257±0.327[SD] x 10 -3 mm2/s and malignant was 0.951 ± 0.177[SD] x 10 -3 mm2/s. The mean ADC value of benign soft tissue tumor was 1.603±0.444[SD] x 10 -3 mm2/s and malignant was 1.036 ± 0.186[SD] x 10 -3 mm2/s. The cut-off mean ADC value was 1.058 x 10 -3 mm2/s for differentiating benign from malignant bone tumor with a sensitivity of 83.3%, specificity of 66.7% and accuracy of 78.7% while the cut-off mean ADC value of 1.198 x 10 -3 mm2/s for differentiating benign from malignant soft tissue tumors with a sensitivity of 83.3%, specificity of 87.5% and accuracy of 84.6%. Conclusions: DWI with ADC mapping can be used as an additional reliable tool along with conventional MRI sequences in discriminating benign and malignant musculoskeletal tumors.

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“…Moreover, the adjacent bone marrow oedema seen on MRI may be misinterpreted as signal of aggressive pathology. Furthermore, identification of marrow oedema in the site of RFA is not helpful in the follow-up, as nearly 70% of successfully treated OO present residual oedema at imaging [17]. Thus, a combination of MRI and CT findings may be helpful to rule out doubtful cases.…”

Section: Discussionmentioning

confidence: 99%

Multicentric, multifocal, and recurrent osteoid osteoma of the hip: first case report

Cortese

Albano

Messina

et al. 2019

BMC Musculoskelet Disord

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Background Osteoid osteoma is a benign bone-forming tumour, which very unfrequently has multifocal or multicentric presentation. We report the first known case of a multicentric, multifocal and recurrent osteoid osteoma treated using radiofrequency ablation. Case presentation A 39-year-old man with two-year history of left hip pain was admitted at our Institution. The pain was more intense during the night and partially relieved by salicylates. Pelvis CT demonstrated two lytic lesions (8 and 7 mm, respectively) with surrounding sclerotic reactive bone, both with a central focal area of high attenuation, located in the femoral neck and along the anterior portion of the acetabulum, respectively. Both lesions had clinical and imaging findings consistent with multicentric osteoid osteoma. Thus, the two lesions were biopsied – with pathologic confirmation of osteoid osteoma – and treated using radiofrequency ablation. Hip pain decreased but did not disappear, actually increasing a few months after treatment. CT and MRI were performed showing a smaller lesion (5 mm) with the same imaging features, surrounded by marrow oedema, along the posterior column of the acetabulum. The lesion was considered suspicious for osteoid osteoma, overlooked on previous examinations. Therefore, a diagnosis of multicentric and multifocal osteoid osteoma was established. The new lesion was again treated with radiofrequency ablation with symptom disappearance. However, hip pain relapsed after 18 months, and CT and MRI showed an osteoid osteoma recurrence on the posterior column of the acetabulum, which was biopsied and successfully treated using radiofrequency ablation. Conclusions To our knowledge, this is the first reported case of multicentric, multifocal, recurrent osteoid osteoma. Our case report highlights the importance of considering a diagnosis of multifocal osteoid osteoma when dealing with multifocal lytic lesions of the bone and with pain persistence after treatment. It also emphasises the combined role of CT and MRI in this setting.

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Differential Diagnosis of Spine Tumors: My Favorite Mistake

Cited by 22 publications

References 79 publications

Diffusion-Weighted Imaging in Oncology: An Update

Diffusion-Weighted Imaging in Oncology: An Update

Added Value of Diffusion-Weighted Magnetic Resonance Imaging in Differentiating Musculoskeletal Tumors Using Sensitivity and Specificity: A Retrospective Study and Review of Literature

Multicentric, multifocal, and recurrent osteoid osteoma of the hip: first case report

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