Magnetic resonance imaging in differentiating between aggressive and non-aggressive bone tumors

Area of Science:

• Orthopedic oncology
• Radiology
• Medical imaging

Background:

• Radiography is crucial for initial bone lesion assessment, but indeterminate features often necessitate further investigation.
• Magnetic resonance imaging (MRI) offers superior delineation of tumorous tissues and bone marrow, aiding in the evaluation of ambiguous lesions.

Purpose of the Study:

• To investigate the association between specific MRI features and the aggressiveness of bone lesions.
• To determine the diagnostic performance of MRI in differentiating aggressive from non-aggressive bone tumors.

Main Methods:

• Retrospective analysis of 226 bone tumor MRI examinations (2008-2018).
• Musculoskeletal radiologists evaluated MR images for features like tumor margin, cortical changes, periosteal reaction, joint extension, and enhancement patterns.
• Lesions categorized as aggressive or non-aggressive; univariable and multivariable analyses performed.

Main Results:

• MRI demonstrated high sensitivity (98.89%) but moderate specificity (50%) for identifying aggressive bone lesions.
• Predictive MRI features for aggressive lesions included ill-defined margins, cortical breaks, specific periosteal reactions (sunburst, Codman's triangle), joint extension, and heterogeneous enhancement.

Conclusions:

• MRI is a valuable tool for differentiating aggressive from non-aggressive bone lesions.
• Utilizing MRI as an additional imaging modality can enhance diagnostic accuracy for indeterminate radiographic findings.
• MRI may help reduce the need for unnecessary invasive procedures in bone tumor diagnosis.