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Updated: Aug 21, 2026
Intraoperative Ultrasound in Spinal Surgery
Published on: August 17, 2022
Sacrococcygeal chordoma: MR imaging in 30 patients
Mi Sook Sung1, Gyung Kyu Lee, Heung Sik Kang
1Department of Radiology, The Catholic University of Korea, Holy Family Hospital, Sosa-dong, Pucheon, Kyunggi-do 420-717, Korea. mssung99@catholic.ac.kr
Objective:
To evaluate MR imaging of sacrococcygeal chordoma.
Design And Patients:
Thirty patients (age range 22-80 years) underwent MR imaging for the diagnosis and preoperative evaluation of sacrococcygeal chordomas. Eight patients had follow-up MR examination after treatment. The MR images were performed with T1- and T2-weighted imaging, and gadolinium (Gd)-enhanced imaging. The MR images were analyzed for the signal intensity, enhancing pattern, tumor size, growth pattern of the soft tissue component, and tumor extension.
Results And Conclusions:
T1-weighted images showed low signal masses with foci of high signal intensity in 73% of cases. Tumors enhanced in a variety of patterns after the administration of Gd. Soft tissue masses extending anteriorly were seen in all cases with posterior extension in 77% of cases. The posterior masses involved the surrounding muscles and extended toward the greater sciatic notch, appearing with pseudopodia (87%). Sacroiliac joints were involved in 23% of cases. Four lesions showed intraspinal extension and involvement of the posterior spinal muscles above the level of bony involvement. In 6 patients recurrent tumors were found at or around the surgical margin of the tumor 6 months to 5 years after resection of the sacral tumor. In two of the patients, nodular metastases to the pelvic bones and femur were found 1-4 years after initial examination. In conclusion, MR imaging is useful in the diagnosis and preoperative assessment of sacrococcygeal chordoma. Characteristic findings included sacral mass with heterogeneously high signal intensity with crisscrossing septa on long-repetition-time imaging, well-encapsulated pseudopodia-like or lobulated appearance, and gluteal muscle infiltration. Follow-up MR imaging is helpful to assess for recurrent or metastatic lesions of chordomas.
Insights
Magnetic resonance (MR) imaging effectively diagnoses and assesses sacrococcygeal chordomas. This study highlights characteristic MR findings and the utility of follow-up imaging for detecting recurrence or metastasis.
Area of Science:
- Oncology
- Radiology
- Medical Imaging
Background:
- Sacrococcygeal chordomas are rare bone tumors requiring accurate diagnostic and preoperative assessment.
- Magnetic resonance (MR) imaging is a key modality for evaluating these complex tumors.
Purpose of the Study:
- To evaluate the utility of MR imaging in the diagnosis and preoperative assessment of sacrococcygeal chordomas.
- To identify characteristic MR imaging findings associated with sacrococcygeal chordomas.
Main Methods:
- Thirty patients with sacrococcygeal chordomas underwent MR imaging, including T1-weighted, T2-weighted, and gadolinium-enhanced sequences.
- Image analysis focused on signal intensity, enhancement patterns, tumor size, soft tissue component, and tumor extension.
Main Results:
- MR imaging revealed characteristic findings such as sacral masses with heterogeneously high signal intensity and crisscrossing septa on long-repetition-time imaging.
- Tumors exhibited varied enhancement patterns, anterior soft tissue extension in all cases, and posterior extension with pseudopodia in 77%.
- Recurrent or metastatic lesions were identified on follow-up MR imaging.
Conclusions:
- MR imaging is valuable for diagnosing and preoperatively assessing sacrococcygeal chordomas.
- Characteristic MR findings aid in diagnosis and understanding tumor behavior.
- Follow-up MR imaging is crucial for detecting recurrence and metastasis.