MRI Ewing Sarcoma

8/18/2019 MRI Ewing Sarcoma

1/6

31 7

M R Im ag in g o f O s teog en ic

an d E w in g ’s S arcom a

O res t B . B oyko 1

D a vid A . G o ry 1

M e rvy n D . Co h e n 1

A rth ur P rov iso r

D av id M irk in3

G . P au l D eR osa4

Rec e iv ed

F eb ru ary 2 7, 1 98 6; a cc ep te d

a fte r re -

v is io n S ep tem be r 1 0. 19 86

P rese nte d a t th e an nua l m ee tin g o f

t he A m e ri ca n

R o en tge n R ay S oc ie ty . B os to n . A p ril 19 85 .

1

D epa rtm en t o f R ad io log y. In dian a U nive rs ity

S c ho o l o f M e d ic ine , a nd R e ge ns tne f In s ti tu te , In d i-

an ap o lis , IN 4 62 23 . A d dre ss re p rin t re que sts to 0 .

B . B oyk o , D epa rtm en t o f R ad io lo gy , In d ian a Un i -

ve rs i ty

S ch oo l o f M e d ic ine , 92 6 W . M ich ig an S t.,

I nd ia na po lis , I N 4 62 23 .

2

D e pa rtm en t o f H e m a to lo gy a nd O n co log y , In -

d iana U n ive rs ity S ch oo l o f M e d ic ine , a nd R eg en -

s trie f Ins t itu te , Ind ian ap olis , IN 46 223 .

3 D epa rtm en t o f P a th o lo gy , Ind ian a U n ive rs ity

S c ho o l o f M e d ic ine , a nd R eg en strie f In s ti tu te , In d i-

anapo l i s , I N 4 6 22 3 .

4 D epa rtm en t o f O r tho pa ed ic S u rg e ry , Ind ian a

U n iv e rs ity S ch oo l o f M ed ic in e , a nd R e ge nstrie f In -

s t itu te , Ind ian ap olis , IN 46 22 3.

A JR

148:317 322

F ebr ua r y 1987

0 36 1 -8 03 x/8 7/1 4 82 -0 31 7

C A m e ric an R oe n tgen R a y S o c ie ty

T w en ty pa tie n ts w ith

b io p sy -p ro ven o steo g en ic 1 1

c as es )

o r E w in g ’s n in e cases

sa rco m a w e re eva lu a ted b y M R im ag in g o n a O .1 5 -T re s is tiv e u n it to de te rm in e th e va lue

o f M R in th e d iag n o s is an d tre a tm en t o f th e se tw o n e o p la s m s a n d to d e ve lo p th e b e s t

p ro to co l fo r M R im ag in g . In a ll 2 0

c as es ,

M R id en tified tu m o r sp re ad in to

b on e m arro w,

an d it w as sup e rio r to C T in five cases . E x ten s io n o f

t u m o r

into

th e s oft tis su es a dja ce nt

to b o n e w as sh o w n

be t te r

b y M R th an C T in s ix c ases . Im p ro ved an a to m ic in fo rm atio n

fro m M R is th e resu lt o f th e

abil i ty

to im ag e in th e ax ia l, co ro n a l, a nd

s ag itta l p la ne s.

C o m p ared w ith C T , M R iden tifies co rtica l d ise ase b u t h as in fe r io r sp a tia l re so lu tio n an d

d efin es c alc iu m

poor ly .

M R can b e u sed to m on ito r

tu m or res po nse

t o c h em o th e ra p y,

an d the re la t io n sh ip o f tu m or to ad jac en t va scu la tu re

c an be d e te rm ine d

w ith o u t th e

us e

o f co n tra s t ag en ts . T w o p u lse seq u en ces a re nec es s a r y fo r m ax im um d isp lay o f d is ease ,

s in ce , in g en e ra l, tu m o r in vo lv em en t o f th e b o n e m a rro w is b es t a ssessed o n T i-

w e ig h ted seq u en ces , an d tu m o r in vo lvem en t o f th e so ft tis su e is b es t se en o n T 2 -

w eig h te d se q u e n ce s . A d d itio n a l in fo rm atio n a bo u t b o n e -m arro w in v o lve m en t, so ft- tis su e

tum o r ex ten t, a nd th e re la tio n sh ip o f tum o r to b lo o d vesse ls m akes M R a va lu ab le

ad jun c t to C T in th e eva lu a tio n o f th ese n eop la sm s .

C lin ic a l e xp e rie n ce w ith M R im a g in g o f p rim a ry b o n e tu m o rs is a cc u m u la tin g [i -

1 1

1.

M R is a lso b e c o m in g in cre a s in g ly im p o rta n t in th e im a g in g o f b o n e -m a rro w

d ise ase [1 1 -1 6 ]. M R p ro v ides m ultip lan a r im ag es , ide n tif ies b o n e -ma r ro w a nd s oft-

tissue ex ten s ion o f tum or, an d ho lds p rom ise a s a m e ans o f m on ito ring tum o r

respon se to the ra py [5 -8 ]. W e re v ie w ed the M R fin d in gs in 1 1 ca ses o f osteog en ic

sa rcom a an d n ine ca se s o f E w in g ’s sa rcom a to eva lu a te th e c lin ica l use fu lness o f

th e tech n iq ue a nd to de te rm ine the bes t M R im a g ing stra teg y fo r these tw o tu m ors.

M ateria ls an d M ethods

T w e n ty pa tie n ts a g e d 9 -2 1 y e a rs w ith e ith e r os te o g e n ic sa rc o m a (1 1 c a se s) o r E w in g ’s

sa rco m a (n in e ca se s ) h a d M R sc a n s b e fo re ch e m o th e ra p y o r ra d ia tio n th e ra p y . A 0 . 1 5-T

re s is tive sc ann er (T e ch n ic a re T es lac on )

w as

us ed .

A ll p a tie n ts w e re e xa m in e d w ith a t le a s t

on e T i

-

a n d on e T 2-w eigh ted s p in - ec ho (S E) p u ls e s equenc e , a nd th re e p a tie n ts w e re

e x a m in e d w ith inve rs ion -re cov e ry (IR ) p u ls e s equ en ce s. T h e ec ho -de lay tim e (T E ) w as 30 ,

3 2 , 6 0 , o r 1 2 0 m s e c; th e re p e tition tim e (T A ) w a s 2 5 0 , 5 0 0 , 5 5 0 , 1 0 0 0 , or 2 0 0 0 m s e c. (S E

2 5 0 /3 2 , 5 5 0 /3 2 , a n d 5 0 0 /3 0 a re T i w e ig h te d ; S E 1 0 0 0 /3 0 , 1 0 0 0 /6 0 , 2 0 0 0 /6 0 , a n d 20 0 0 /

1 2 0 a re m o re T 2 w e ig h te d.) F o r th e IR s e q u e n ce , a 9 0 {1 7 6 }- i0 {1 7 6 }ig n a l-re a d in g p u lse p a ir

fo llo wed the in itia l 1 80 {1 76 }n ve rtin g p ulse . T he in ve rs io n t ime (T I) w a s 4 5 0 m se c. T he 9 0 {1 7 6 }nd

1 8 0 { 1 7 6 }e foc us in g pu ls es w e re se pa ra te d b y 1 5 m s ec .

T h e T R w a s 1 50 0 m se c . IA im a g e s a re

h e a v ily T i w e ig hte d . In o n e c a se , m u ltie ch o im a g e s w e re o b ta in e d w ith a T A o f 2 0 0 0 m s e c

a n d a T E ra n g in g f rom 3 0 to 2 4 0 m se c.

C on tig uo us s lic es o f e ithe r 1 0 o r 1 5 m m w e re o b ta in e d in the co ro na l, ax ia l, o r s ag itta l

p la n e . Im a g e s w e re re co n s tru c te d in to a 2 5 6 x 1 2 8 m a tr ix a n d in te rp o la te d to 2 5 6 x 2 5 6 fo r

d isp la y . N o con tras t a ge n ts w e re us ed .

T h e d is trib u tio n o f th e 1 1 c a se s o f o s te o g e n ic sa rco m a w e re fe m ur (se ve n ), p e lv is ( tw o ),

h u m eru s (o n e ), a n d tib ia (o n e ). T h e n in e ca se s o f E w in g ’s sa rco m a w e re

l oc a ted

in th e fe m ur


2/6

F ig . 1 .-E w ing ’s s arc om a o f t h e le ft fib u la . C , SE 10 00 /60 im a ge sh ow s so ft- tis su e m as s

a r rows

a nd p er io ste al

A, S o ft- tiss ue -w ind ow C T sh ow s no so ft-t iss ue m a ss or m a rro w a bn or - e lev a tion a r r owhead , bu t fa ils to sh ow d if fe renc e be tw ee n no rm al tib ia

m ality . a nd a bno rm al fib u la m arrow a s w a s se en in B .

B,

IR 1 50 0 /4 50 im a ge s ho w s m arrow rep la ce m e n t by tum or a r r ow .

31 8

B O Y K O E T A L .

AJ R:148 , F eb ru ar y 1 98 7

( tw o), p e lv is ( five ), sp in e (o n e ), a n d fib u la (o n e ). A ll p a tie n ts h a d p la in -

f i lm e xam in a tion s , a nd i 9 p a tien ts h a d C T sca n s b e fo re M R im a g ing .

C T w a s p e rfo rm ed o n e ith e r a P h ilip s T o m osc a n 31 0 o r T e ch n ic a re

2 0 6 0 0 s ca n n e r. F o llo w -u p M R stu d ie s w e re p e rfo rm ed in n ine pa -

t ien ts to m on ito r res po n se to the ra py . D ia g no se s in a ll 2 0 ca ses w e re

p ro ve n b y b io p sy . T w o re se c te d o s te o g e n ic s a rco m a sp e c im en s w ere

s tu d ie d fo r p a th o lo g ic c o rre la tio n o f M R fin d in g s .

M A s tud ie s w e re re v ie w e d re tro sp e c tive ly b y tw o o f th e a u th o rs ;

th e ir o bse rva tio ns w e re co r re la te d w ith p la in film s an d C T sc an s

s im u lta ne ou s ly , and a c on se nsu s im pre ss ion w as rea che d . P res enc e

o f tu m o r in th e s o ft tiss u e s a n d b o n e m a rro w w a s co n firm e d a t th e

t ime o f o p e n b io p sy a n d /o r a m pu ta tio n .

Resu f ts

M R id en tifie d so ft-tissu e m asses in a ll 2 0 cases . In th e 19

ca ses in w h ich C T w as p erfo r’rned , M R sho w e d be tte r th e

so ft-tis su e m ass in s ix , inc lud ing on e case o f E w ing ’s w h ere

the m ass w as iso den se w ith m u sc le on C T (F ig . 1 A ). M a rrow

in vo lvem en t w as ev iden t in a ll cases im ag ed by M R and C T ,

b u t th e e x te n t w a s b e tte r sh o w n b y M R in five ca s e s . C T

sh o w ed m a rro w ab n o rm a litie s b e tte r th an M R in o n e

ca se .

B o th T i - and T 2 -w e igh ted im a ges w e re req u ire d in th e e va l-

ua tion o f tum o r in so ft tis su e a nd bon e m arrow , s ince on T i

-

w e ig h ted im ag es tum or th a t in filtra tes m usc le can have a

s ig n a l is o in te n se w ith m us c le (F ig . 1 B). T h e s ig n a l b e co m e s

m o re in ten se o n T 2 -w e ig h ted im ag es F ig . 1

C ) . C o n ve rs e ly ,

th e T 2 p u lse sequ ence cho sen can cause tum o r tha t is

in fi ltra tin g b o n e

m arro w to ha ve a brigh t s igna l s im ila r to

n o rm a l m arro w F ig . 1

C ).

In

on e

case o f a p e lv ic os teo gen ic sa rcom a , the extens ive

m arrow invo lvem en t sh ow n by M R cha nge d the su rg ica l

a p p ro a c h to a h em ipe lvec tom y. M R ca n a lso sho w m etas ta tic

s ite s o f osteoge n ic sa rco m a even w hen the re is ca lc i f ied

tumor m a tr ix (F ig . 2 ).

T h e s o ft-tis su e co m p o n e n t o f b o th o s te o g e n ic a n d E w in g ’s

sa rco m a h ad an inho m o gen eous s ig na l in ten s ity , an d these

tw o tu m o rs c o u ld n o t b e d is tin g u is h e d b a se d o n T i o r T 2

s ig na l i nt en sit y.

M R sh o w e d co rtica l th ick e n in g a n d tu m o r in filtra tio n o f th e

co rtex by bo th types o f tu m ors . In fo u r cases w he re co rtica l

d isease w as see n on p la in film and /o r C T , n o co rtica l d isea se

w a s e v id en t on M R . C ortica l invo lvem en t b y E w ing ’s o r

osteog en ic sa rco m a is id en tifie d on M R b y the re p la ce m en t

o f th e d a rk s ign a l o f th e co rte x w ith th e co m p a ra tive ly in -

crea se d s ig na l in tens ity o f the in va d in g tu m or.

B o th C T a n d p la in ra d io g ra p h s p ro v id e d b e tte r d e fin itio n

an d loca liza tion o f ca lc ifica tio ns in a ll ca ses . O n M R la rge foc i

o f c a lc ifica tio n p ro d u ce d d isc re te a re a s o f s ign a l vo id (F ig .

2 A ). S m all ca lc ifica t ions resu lte d in an inh o rno gen eou s ap -

pe aran ce in som e ca se s (F ig s . 3 a nd 4). T h e area s o f lo w e st

s igna l in tum ors on M R d id no t a lw ays co rrespon d to a rea s

o fc a lc ifica tio n (F ig . 4 ). F o urte e n c as e s ha d p e rio s te a l re a c tion

s e e n o n p la in film s o r C T , a n d th is co u ld b e id e n tifie d b y M R

in e ig h t c a se s (F ig . 1 C).

P ath o log ic - rad io lo g ic co rre la tio n in tw o c as es o f o ste og en ic

s a rco m a sh o w e d th e re lia b ility o f M R to d isp la y th e tru e

exte n t o f tum o r in bo ne m arrow an d so ft t issue . In one ca se ,

a la te ra l p la in film o f th e d is ta l fe m u r sh o w e d a n o ste o b la s tic

les ion w ith a w ide zo ne o f tran s it ion , p e rio s te a l rea ction , a nd

s o ft-tis su e m a ss (F ig . 5 ). C o m p a riso n o f a s a g itta l M R im a ge

w ith th e g ro ss spe c im en sho w e d tha t M R pre d ic ted th e

p rox im al ex ten t o f m arrow d ise ase w ith in se ve ra l m illim ete rs .

H is to lo g ica lly no tu m o r w as prese n t in th e ep ip hy s is . A la rg e

am o un t o f tum or ne cro s is w as pre se n t, w ith the g rea te st

am o un t o f v iab le tum or ad jace n t to th e ep iphyse a l line . C ho n-

d ro id a s w e ll as oste o id m atrix w ere p rese n t, bu t the ir d is tr i-

bu tion d id no t co rre la te d irec tly w ith th e inhom og ene ous

s ig na l o f in filtra te d m arrow . S o ft-tis su e ex tens io n and perio s-

tea l re action w e re s e e n o n M R . In th is c a se C T p ro v id e d


3/6

A J R :14 8 , F eb ru a ry 19 87

MR OF OSTEOGENIC AND EWING’S SARCOMA

31 9

F ig . 2 .-O s teo ge n ic sa rco m a o f th e rig h t hu -

m e w s .

A ,

c o ron a l S E 20 00 /60 im ag e sh ow s p rim ary

t umor

a r rows .

cak i f ie i a x illa ry n od e m eta s -

tases a r rowheads appear a s area s o f de -

creased

s igna l .

B ,

C hes t rad io grap h con firm s d ense ly ca lc i-

f ied a xilla ry no de m etas tas es a r r owheads .

F i g. 3 . -O s t eo g e ni c s a r c oma

o f

th e f emur .

A , Bone- w indow CT s c an

s h ow s s ev er al

s m a l l

a re as o f calc if icat ion a r r ows , an d tum or ex ten -

s io n in to m arrow

a n d s u rr o u nd in g

s of t tis su e.

B ,

A xia l S E 10 00 /60 im age s h o w s i n h o m o g e -

ne ou s s ig na l f rom tum or

arrows

th a t can no t b e

co rre la ted w ith C T as be ing are as o f ca lc ific a -

tio n, w hic h s h o w s l imitat ion o f M R in t he e va lu -

at ion o f ca lc ium . Tum o r rep lac em en t o f no rm al

m a rro w s ig na l is s ee n .

be tte r d e fin ition than M R of ca lc iu m d epo s it ion in the tum o r

matrix.

E xa m in a tion o f a co ro na l sp ec im e n sec tio n in an o the r ca se

o f os teog en ic sa rcom a sh ow ed tu m or extens ion in to th e

e p ip h ys is (F ig . 6 ). T h e e x te n t o f tu m o r in vo lve m e n t o f th e

m a rrow a nd so ft tissue in the g ross spec im en d irec tly co rre -

la ted w ith the abn orm a l s igna l sho w n by M R .

F lo w in g b lo o d em itted n o s ig n a l an d ap p eared b lac k o n a ll

pu lse sequ ences . In 1 2 case s, M R sh ow ed th e re la t ion sh ip

o f tu m or to b lo od vesse ls m o re ea s ily th an C T d id . S ca nn ing

in th e sa g itta l p lan e w a s o fte n u se fu l fo r d e m o n stra tio n o f th e

su p e rfic ia l fe m o ra l a n d p o p lite a l a rte rie s . T h e co ro n a l p la n e

prov ide d exce lle n t de m on stra tion o f m ajo r pe lv ic vesse ls an d

d isp lacem en t o f p e lv ic s truc tu res (F ig . 7 ).

Im proved ana tom ic in fo rm a tion ca n be d erived from M R by

th e op p o rtu n ity to im a g e in se ve ra l p la n e s . In F ig u re 8 a

c oro n a l M R im a g e s h o w e d e xte n s io n o f a s p in a l E w in g ’s

sa rco m a b e h in d th e d ia p h ra g m a tic c ru s . T h e C T sc a n w a s

in itia lly in te rp re te d a s a n a d re n a l m a ss th a t w a s inv a d in g

b o n e .

R espon se to the rap y cou ld be m on ito re d fo r b o th E w in g ’s

(F ig . 8 ) an d o steo gen ic sa rcom as . In th ree cases o f os teo -

g e n ic s a rc o m a , tu m o r e n la rg e m e n t d o c u m e n te d b y M R a l-

l o w e d fo r the e a rly cessa tion o f m etho trexa te ch em othe ra py ,

fo llo we d b y a mp uta tio n.

Discuss ion

W e fo und in filt ra tio n o f th e b one m arrow b y o ste ogen ic and

E w in g ’s s a rc o m a to b e c le ar ly s h o w n b y M R ; in five ca se s it

w as superio r

to C T . T u m or has a lon g T i

re laxat ion

tim e a nd

th us ha s a s ign a l in ten s ity low er than tha t o f m arrow fa t on

T i-w e ig h te d im a g e s [1 6 ]. P a th o lo g ic co rre la tio n o f m a rro w

in vo lvem en t by tw o os teo gen ic sa rcom as (F igs . 5 a nd 6 )

show ed th e m arrow invo lvem e n t d em o nstra ted b y M R to be

w ith in se ve ra l m illim e te rs o f tha t docum e n te d on th e pa tho -

lo g ic sp e c im e n . T h is su p p o rts th e fin d in g s b y o th e r in ve s ti-

g a to rs o f th e re lia b ility o f M R in s h o w in g th e tru e mar row

e x ten t o f n eo p la sm [10 , 1 6 ].


4/6

a r row and so ft-tiss ue m ass a r rowheads .

C , G ro ss sp ec im en . T um or ex ten ds

p rox im a lly in to m a rro w 1 2 cm an d

d oe s n o t in vo lve e p ip hys is

as

predic ted by M R

B .

3 20 B O Y K O E T A L . A JR :1 48 , F eb ru ary 1 98 7

In s ix ca s e s M R w a s su p e rio r to C T in d efin in g so ft- tis su e

F ig . 5 .-O steog en ic sa rco m a

o f th e

f emur .

A , P re op era tiv e ra dio gra ph sh ow s os teo b las tic m a rro w le s io n w ith p e r-

i os t ea l re ac tio n an d a s o ft- tiss ue m as s a r r ows .

B ,

Sag i t t a l

S E 500 /30 im ag e sh o w s

prox im a l tum or e x ten t in m arrow

T h e i n h o mo g e n e o u s M R signa l o f os teo gen ic sa rcom a d id

n o t co rre la te w ith th e h is to lo g ic d is trib u tio n o f ch o n d ro id o r

o s te o id tu m o r m a trix . W e d id fin d o n M R th a t tu m o r sp re a d

in to the bo ne m arro w can ex ten d be yon d the co rtica l o r so ft-

tiss u e co m p o n e n t o f b o th o f th e s e n e o p la sm s. D e c re a se d

F ig . 4 .-E w in g ’s s arco m a o f th e

l ef t i li um .

A , C T s ho w s a rea s o f calc if icat ion

arrows

w ith in tum or

w ith p er io ste al r ea ctio n

a nd so ft-

t is su e m a ss .

B , Ax ia l S E 5 00 /30 im a ge s ho ws in ho mo ge -

n e o u s s ig na l in tum or,

b ut a re as o f lo wes t s ig na l

a r r owheads d o n ot c or re sp on d to calc if icat ions

s ee n o n CT . T her e

is

m arro w re pla ce me nt

b y

t u m o r a r row .

s ig n a l in b o n e m a rro w o n T i -w e ig h te d im a g e s, h o w e v e r, is

no t

speci f ic

fo r tu m o r s in ce a va s cu la r n e cro s is o r a n y m a rro w -

re p la c in g p ro c e ss ca n p ro d u ce th e sa m e s ig n a l d e c re a se [1 4 ,

16].


5/6

A B

A J R: 1 4 8 F e br u ar y 1 9 87

M R O F O S T E O G E N IC A N D E W IN G ’S S A R C O M A

3 2i

F ig . 7 .-E w in g ’s sa rco m a a ris in g from il iac

w ing s in tw o d iffe ren t pa t ien ts sh ow s d is p la ce -

m en t o f r ig h t

A

an d le f t

B i li ac a rt er ie s a r-

r ows ,

in fe rio r ve na ca va A ,

ar r owhead , an d

b ladde r

B , a rr ow h ea d .

co n tras t and tum or ex ten s io n . T 2 -w eigh te d im age s en han ced

so ft-tis sue con tras t be tw e en tum or and m usc le b e tte r than

T i -w e ig h ted im ag es .

M R w as fo un d

to be in fe rio r to C T in sho w ing so ft-tis sue

ca lc i f ica t ion

an d tum o r m atrix m ine ra liza tion in a ll i 6 case s in

w h ich ca lc iu m w a s sh o w n b y e ith e r C T o r p la in film s . T h is

w as m ore o f a p rob lem in the in te rp re ta tion o f osteoge n ic

s a rc o ma s .

M R can sh o w th ick en in g , in filtra tio n , an d d es tru c tio n

o f th e

c orte x b y b o th o s te o g e n ic s a rc o m a a n d E w in g ’s s arco m a .

B on e cortex lacks m ob ile p ro ton s and th us h as d ark s igna l

o n a ll p u lse s e q u e n ce s . T u m o r in va s ion o f b o n e c o rte x ca n

b e id e n tifie d b e ca u s e o f its p ro lo n g e d T i a n d T 2 re la xa tio n

tim es . A lth oug h Z im me r e t a l. [5 ] b e lie ve d tha t co rtica l d isease

w as m o re o b v io u s ly sh o w n o n lo n g er S E s eq ue nc es (T E =

6 0 m s e c, T R

= 2 ,0 00 m sec ), in 1 5 cases w ith e v iden t co rtica l

d isease on M R th is w as s e e n a s w e ll o n T i

-

as o n T 2-

w e igh ted M R p u lse sequ ences. C o rtica l d isease w a s app re -

c ia ted m ore con s is ten tly on ax ia l im ag es s ince p rob le m s

a ro s e w ith pa rtia l vo lu m in g o f s ign a l in ten s ity o n co rona l a nd

sag i t ta l

im ages ; an d co rtica lou thne w a s no t as sha rp ly de fin ed

w h en the long ax is o f the b one took a m o re an g le d o r ob lique

c o u rs e ,

as ha s

b ee n re po rte d b y o th er w o rke rs [1 4 ]. P e rio s -

tea l re action cou ld b e iden tified in e ig h t cases by M R .

In b o th o s te o g e n ic an d E w in g ’s s a rc o m a , M R c a n sh o w

th e re la tio n sh ip o f tu m o r to v a scu la ture w ith o u t th e u s e o f


6/6

322 B O Y K O E T A L. A JR :1 48 , F eb ru ary 19 87

1 .

B rad y T J , G eb ha rd t M C , P yke tt IL , e t a I. N M R im ag in g o f fo rea rm s

in

h ea lth y v o lun tee rs a n d p a tien ts w ith g ian t-ce ll tu m or o f b on e . Rad io logy

ig 8 .-E w ing ’s s arco m a a ris ing fro m s p ine .

A , C o ro na l S E 500 /30

im ag e s ho ws s oft-tis -

s ue m as s

a r rows

an d dec re as ed m a rro w s ig na l

o f i nv ol ve d v er te br al

b o d y a r r owhead .

B , Cor ona l

S E 2000 /3 0 im ag e afte r

t he r apy

s h o w s

d ec rea se in

s ize o f s oft-t is su e m as s

a r-

r ows .

co n tras t ag en ts . P a rt o f th is a dva n ta ge rests w ith the ab ility

o f M R to im a g e in th e c o ro n a l a n d s a g itta l p la n e s . P e tte rsso n

e t a l. [1 0 ] ha ve a lso com m en ted on the a dva n ta ge o f M R in

p rov id ing in fo rm ation on tum or re la tion sh ip to m ajo r vesse ls .

A lthou gh C T can be u s e d in fo llo w -u p to m o n ito r th e

res po n se to th e rap y o f os teo ge n ic sa rco m a [1 7 ], w e fou n d

M R to be a su ita b le a lte rna tive . In te rva l g row th o f tum or

sh ow n by M R a llo w e d cessa tion o f chem oth e rapy and e arly

am pu ta tio n in th ree ca ses o f o ste oge n ic sa rcom a . M R w as

use fu l as a fo llow -up to m o n ito r therapy re sp onse o f th re e

case s o f E w ing ’s sa rco m a.

In sum m ary , w e ha ve fo und M R to p rov ide ad junc t in fo r-

m a tio n in the p reop era tive p lan n in g and po stthe rap y fo llow -

u p in ca s e s o f E w in g ’s a n d o s te o g e n ic sa rco m a . Im a g es

o b ta ined in m ultip le p lan es an d w ith b o th T i- an d T 2 -w e igh ted

p uls e s eq ue nc es

ar e

ne cessa ry to eva lua te the b one-m arrow

a nd so ft-tissue e xte n t o f these tw o tum ors . T he a x ia l p la ne

a llow s be st a ssessm en t o f bon e co rtex w ith ou t pa rt ia l-vo lum e

a rtifa c ts . S a g itta l a nd c o ro n a l p la ne s p ro v id e an e xce llen t

d isp la y o f the re la tionsh ip o f tum or to m a jo r vesse ls an d

p ro v ide im age s o f the e n tire leng th o f a bon e fo r eva lua tion

o f p ro x im a l b o n e-m a rro w o r e p ip h yse a l e x te n t o f tu m o r a n d

sk ip les ions . In ge nera l, T i -w e igh ted im age s p rov ide the

g rea test con tra s t b e tw ee n tu m o r and m arrow , T 2 -w e igh ted

im ag es show the m ost co n tras t b e tw een tum o r and m u sc les ,

an d tu m or-in filtra tin g -b o n e co rtex m ay b e s e e n

w ith e ith er.

O ne lim ita tio n o f M R , com pared w ith C T , is the ina b ility o f

M R to de fin itive ly

id en tify tum o r m atrix ca lc ifica tion and

p e n o ste a l re a c tio n in a ll ca se s .

R E F E R E N C E S

1982 ;144 :549 - 552

2. M o o n K L J r. G en an t H K , H e lm s C A , C ha fe tz N I, c roo ks LE , K a u fm a n L .

M u sc ulo sk ele ta l a pp lic ati on s

o f n uc le ar

m ag ne tic re so na nce . Rad io logy

1983 ;147 :161 -17 i

3 . B rad y T J , R o se n B R , Py k e t t IL , M cG uire M H, M an k in H J, R o se n th a l D l.

N M R im ag ing o f leg tum ors . Rad io logy

1983 ;

149 :181 -187

4 . B erq uis t T H. M ag ne tic res on an ce im ag ing : p re lim in ary ex per ien ce in o r -

th op ed ic ra dio lo gy . M ag ne tic R eson an ce Im a g 1 98 4;2 : 41 -5 2

5 . Z im rne r W D , B e rq u is t T H , M c Le od R A , e t a l. B on e tu m o rs : m a gn e tic

re so na nce im ag in g

ve rsus

co mp ute d to mo gra ph y. Rad io logy 1 9 8 5 ;

155 :709 - 718

6.

Bloem

JL , F alk e T HM , T am in iau A HM , e t a l. M agn e tic res on an ce im ag in g

o f p rim ary m align an t bo ne tum ors . Rad iog r aph ic s 1 98 5; 5 : 8 53 -8 86

7 . B ake r H L Jr, B erqu is t T H, K ispe rt D B, e t a l. M agn e tic reso n an ce im ag in g

in a ro utin e c lin ica l s e tting . M a yo C lin P roc 1985 ;60 :75 - 90

8.

Huds on

T M ,

H am lin D J, E nn ek ing W F, P ette rss on H . M ag ne tic res on an ce

im ag in g o f bon e a nd so ft t issue tum ors : e a rly e xpe rie nc e in 31 p a t ien ts

c om pa re d w ith co m pu te d tom og rap hy . S ke le ta l R ad io l 1 98 5;1 3: 1 34 -1 46

9. P e tte rss on H , H u dso n T ,

H am lin D , e t a l. M ag ne tic res on an ce im ag in g o f

s ac ro co ccyg ea l tu mo rs . A cta R ad io l D ia gn ] (S to ckh ) 1 98 5;2 6:

161-165

1 0 . P e tte rsso n H , H a m lin D J , M an cu so A , Sc o t t K N. M agn etic re so na nce

im a g in g o f the m us cu losk e le ta l sy s te m . A cta R a d io l D ia gn ] ( S toc k h )

1985 ;26 :225 - 234

1 1 . M cM ilIin K I, P en n es D R . A ise n A , B ra un s te in , M a rte l W . M R I a nd C T

e va lu at io n o f p ri ma ry bo ne and so ft t iss ue tum ors . P rese nte d a t th e a nnu al

m eetin g o f the A me ric an R oe n tg en R ay S oc ie ty , B os ton , A pril 19 85

12 . C oh en M D, K la tte E C , B a e hn er R , e t a l. M ag ne tic

re so na nce im ag in g

of

b on e m arrow d is ea se in c h ild re n . Rad io logy 1 9 84 ;1 5 1: 71 5 -7 1 8

13 . F le tche r B D, Sc o les P V , N els on A D . O ste om ye lit is in ch ild re n: d ete ctio n

b y m a gn et ic r es on an ce . Rad io logy 1984 ;150 :57 - 60

14 . T o tty W G , M u rph y W A , G a nz W Y , K u m a r B , D au m W J, S ie ge l B A .

M ag n e tic res on an ce im ag in g o f th e no rm al an d isc he mic fe mo ra l h e a d .

A JR 1984 ;143 :1273- 1280

1 5. T jo n -A -T ham R T, B loe m JL , F alke T HM , e t a l. M agn e tic re so na nc e im ag ing

in P a ge t d is eas e o f the sk u ll. AJ N R 1985 ;6 :879 - 881

16 . D affne r R H , L u pe tin A R , D a sh N , D ee b Z L , S e fc zek R J, Sc hap i r o R L . M RI

in the de te c tio n

o f m a lign a n t in fi ltra tion o f bo n e m a rro w .

Ai R

1986 ;146 :353 - 358

17 . M ail J T , C oh en M D, M irk in D , P rov iso r A J . R e sp on se o f o s te os a rco m a to

p re ope ra tive in tra ve no us h igh -do se m eth o trex a te ch em othe rap y : C T e va l-

ua t ion . A iR 1985 ;144 :89 - 93

MRI Ewing Sarcoma

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