MR imaging of osteogenic and Ewing's sarcoma

Twenty patients with biopsy-proven osteogenic (11 cases) or Ewing's (nine cases) sarcoma were evaluated by MR imaging on a 0.15-T resistive unit to determine the value of MR in the diagnosis and treatment of these two neoplasms and to develop the best protocol for MR imaging. In all 20 cases, MR identified tumor spread into bone marrow, and it was superior to CT in five cases. Extension of tumor into the soft tissues adjacent to bone was shown better by MR than CT in six cases. Improved anatomic information from MR is the result of the ability to image in the axial, coronal, and sagittal planes. Compared with CT, MR identifies cortical disease but has inferior spatial resolution and defines calcium poorly. MR can be used to monitor tumor response to chemotherapy, and the relationship of tumor to adjacent vasculature can be determined without the use of contrast agents. Two pulse sequences are necessary for maximum display of disease, since, in general, tumor involvement of the bone marrow is best assessed on T1-weighted sequences, and tumor involvement of the soft tissue is best seen on T2-weighted sequences. Additional information about bone-marrow involvement, soft-tissue tumor extent, and the relationship of tumor to blood vessels makes MR a valuable adjunct to CT in the evaluation of these neoplasms.