Fat-saturated contrast-enhanced T1-weighted MRI in evaluation of osteosarcoma and Ewing sarcoma

To assess contrast-enhanced (C+), fat-saturated (FatSat), T1-weighted (T1W) imaging in the characterization of the soft tissue mass associated with primary bone tumors, we compared it with T2-weighted (T2W) imaging in patients with osteosarcoma (n = 36) and Ewing sarcoma family of tumors (Ewing sarcoma; n = 11). Periosseous tumor compared with normal muscle had greater contrast-to-noise ratio (CNR) on the FatSat T1W C+ image than on T2W for 81% (38/47; P < .0001) of patients. The CNR of periosseous tumor compared with subcutaneous fat was greater on FatSat T1W C+ for 98% (46/47; P < .0001). Radiologists found it easier to evaluate neurovascular bundle proximity to tumor with FatSat T1W C+ images than with T2W for 64% of patients (30/47; P < .0001). They judged FatSat T1W C+ superior to T2W for periosseous tumor conspicuity and visualization of soft tissue necrosis in 62% (29/47; P < .0001). In patients with osteosarcoma or Ewing sarcoma, FatSat T1W C+ imaging may replace T2W imaging for soft tissue mass evaluation, especially if contrast is being used for dynamic enhancement.