Presacral masses: multimodality imaging of a multidisciplinary space

Area of Science:

• Radiology
• Oncology
• Anatomy

Background:

• The presacral space is anatomically significant, intersecting the axial skeleton, neural axis, and pelvic soft tissues.
• This region is prone to various benign and malignant conditions affecting multiple medical disciplines.
• Accurate diagnosis of presacral space pathologies is crucial for effective patient management.

Purpose of the Study:

• To outline a systematic approach for formulating a differential diagnosis of presacral space lesions.
• To highlight key imaging features that aid in differentiating between various pathologies.
• To emphasize the role of demographic factors in the diagnostic process.

Main Methods:

• Review of imaging characteristics of presacral space tumors.
• Correlation of imaging findings with histopathological diagnoses.
• Analysis of demographic data associated with specific tumor types.

Main Results:

• Sacral involvement (remodeling or destruction) and soft-tissue mass presence help narrow differential diagnoses.
• Osteochondral and neurogenic tumors often involve the sacrum; mesenchymal tumors less commonly do.
• Specific imaging features like osseous/chondroid matrix, target sign, T1 hyperintensity, and macroscopic fat aid in diagnosis.

Conclusions:

• A comprehensive differential diagnosis for presacral space lesions can be achieved by integrating imaging features, sacral involvement patterns, and patient demographics.
• Recognizing specific imaging hallmarks facilitates the differentiation of entities such as osteosarcomas, chondrosarcomas, Ewing sarcomas, chordomas, neurofibromas, hemangiomas, and myelolipomas.
• This structured approach enhances diagnostic accuracy for presacral space pathologies.