Correlation Between MRI Characteristic of Osteosarcoma with 2-Year Survival Outcomes

Background: Magnetic resonance imaging (MRI) plays a crucial role in staging and preoperative evaluation in osteosarcoma patient. Fewer studies have focused on 2-year survival, which reflects tumour aggressiveness and early disease progression. This study examines the association between MRI characteristics and 2-year survival outcomes in osteosarcoma to better understand the imaging characteristic of high-risk patients. Methods: A retrospective case-control study was conducted at a tertiary university hospital. Patients diagnosed with osteosarcoma between 2010 and 2022 were included if they had a pre-treatment MRI and at least 2 years of follow-up. MRI scans were reviewed by two blinded radiologists to assess tumour location, volume, growth pattern, presence of fluid-fluid levels (FFL), pathological fractures, skip metastases, neurovascular bundle involvement, regional lymphadenopathy, and physeal or joint involvement. Statistical analyses, including Fisher's exact test, Chi-square test, and Mann-Whitney U test, were performed to determine associations between MRI features and survival outcomes. Results: Twenty-eight patients (n = 28) met the inclusion criteria. Larger tumour volume (>300 mls) was significantly associated with poorer 2-year survival (p = 0.008). The presence of skip metastases also correlated with worse outcomes (p = 0.041). While presence of FFL, concentric growth pattern, regional lymphadenopathy, and physeal involvement showed trends toward poorer prognosis, these associations were not statistically significant. Conclusions: MRI characteristics, particularly tumour volume and skip metastases, are significant prognostic indicators of 2-year survival in osteosarcoma. These findings highlight the potential role of MRI in risk stratification and treatment planning, aiding in the identification of high-risk patients that can help with management.