Radiography
Frontal radiograph of the left fibula head demonstrates a lucent lesion that contains the typical chondroid matrix calcification. Low-grade tumor.
Frontal radiograph of the left acetabulum demonstrates an expansile lucent lesion with no internal matrix calcification. Low-grade central tumor.
Frontal radiograph of right side of upper abdomen demonstrates a destructive, expansile lesion of the 12th rib. The lesion contains irregular calcification. High-grade central tumor.
Frontal radiograph of the pelvis demonstrates extensive calcification overlying the left ilium and in the lateral soft tissues. No bone destruction is shown. High-grade secondary peripheral tumor.
Lateral radiograph of the distal femur in a patient with hereditary multiple exostoses. Several osteochondromas of varying appearances arise from the metaphyseal region; these typically grow away from the joint. Soft tissue calcification is shown overlying the most posterior osteochondroma. High-grade secondary peripheral tumor.
Findings
Radiographs typically show a lucent lesion, which frequently contains matrix calcification, particularly in well-differentiated tumors. The degree of organization of the matrix calcification may be correlated with the grade of the tumor. Aggressive tumors contain irregular calcifications, and they often have large areas showing no calcification at all. Well-differentiated lesions tend to have more developed matrix; the typical appearance is of rings and arcs (see Images above).
The margin of intramedullary lesions is determined by the degree of aggression of the tumor. It is frequently ill defined. Endosteal scalloping may be present; when its depth is more than two thirds the normal thickness of the cortex, this scalloping is useful in distinguishing chondrosarcoma from enchondroma, except in lesions of the hands and feet. Benign enchondromas in these areas may cause considerable cortical thinning; such enchondromas may occur as a pathologic fracture.
The presence of cortical destruction or a soft tissue mass is indicative of malignancy. Destruction of matrix calcification that was previously visible in an enchondroma is indicative of malignant transformation.
Degree of Confidence
Radiographs alone are often inadequate for assessing the size of the tumor; MRI is useful for demonstrating both the intramedullary extension and the soft tissue extension of the lesion. CT may be helpful in identifying matrix calcification in some lesions that appear entirely lucent on radiographs.
Computed Tomography
Bone-window CT scan of left acetabulum demonstrates matrix calcification in the expansile lucent lesion in the anterior column (see also Images 2, 4, and 5 in Multimedia Section). Low-grade central tumor.
CT of the right side of the upper abdomen demonstrates the expansile tumor with a large associated soft tissue mass containing foci of calcification (see also Image 6 in Multimedia Section). High-grade central tumor.
CT scan of the pelvis demonstrates a large soft tissue mass that contains calcification arising from a broad-based sessile osteochondroma on the posterior aspect of the ilium (see also Images 8 and 10 in Multimedia Section). High-grade secondary peripheral tumor.
CT scan of the distal femur demonstrates a broad-based osteochondroma with a thick overlying soft tissue cap that contains focal calcification. The metaphyseal contour is irregular because of the presence of several other osteochondromas in this patient with hereditary multiple exostoses (see also Images 11 and 13 in Multimedia Section). High-grade secondary peripheral tumor.
Findings
In as many as 90% of cases, tumors appear as lucent areas containing chondroid matrix calcification. Endosteal scalloping and cortical destruction are frequently easier to appreciate on CT scans than on radiographs (see Images above).9
CT may be used to guide percutaneous biopsy, and it is the modality of choice for investigating possible pulmonary metastatic disease.
Degree of Confidence
CT may often be used to successfully categorize the lesion as being of cartilaginous origin. The medullary extension of the lesion may be assessed more accurately with CT than with radiography. However, MRI is superior, and it is also the most useful modality for determining soft tissue extension.
Magnetic Resonance Imaging
T2-weighted axial MRI of the pelvis demonstrates the high signal intensity of the acetabular lesion (same patient as in Images 2-3, 5 in Multimedia). Low-grade central tumor.
T1-weighted axial MRI of the pelvis demonstrates the low signal intensity of the acetabular lesion (same patient as in Images 2-4 in Multimedia). Low-grade central tumor.
T2-weighted axial MRI of the pelvis demonstrates a lobulated high-signal-intensity soft tissue with local-signal-intensity septa arising from the osteochondroma on the posterior aspect of the ilium (same patient as in Image 9 in Multimedia). Several areas of low signal intensity are shown; these correspond to focal areas of dense calcification. This appearance is typical of cartilaginous material. High-grade secondary peripheral tumor.
Fast spin-echo T2-weighted axial MRI of the distal femur in a patient with hereditary multiple exostoses (same patient as in Images 11-12 in Multimedia). Image demonstrates the thick cartilage cap overlying a broad-based osteochondroma. Areas of focal reduced signal intensity in the cartilage cap correspond to foci of dense calcification. High-grade secondary peripheral tumor.
Findings
MRI typically demonstrates lobulated lesions of high signal intensity on T2-weighted images. Lobules are commonly separated by septa of low signal intensity. On T1-weighted images, the lesion generally displays low signal intensity (see Images above).10
Areas of matrix calcification are shown as signal voids on images obtained with all sequences, but small amounts of calcification may not be identifiable. MRI may demonstrate large aggregates of calcium, but tiny scattered calcifications may be completely missed because of partial-volume averaging. MRI may be used to assess soft tissue extension and the intramedullary extent of the tumor. MRIs may demonstrate endosteal cortical scalloping, but this feature is more easily assessed with CT.
MRI is useful in assessing the thickness of the cartilage cap of osteochondromas to identify chondrosarcoma transformation. Chondrosarcomas show variable patterns of enhancement after the administration of contrast material.
Degree of Confidence
MRI is the method of choice for clarifying the intramedullary and extraosseous extension of a chondrosarcoma; features related to cortical bone and matrix calcification are more accurately assessed with CT.
Ultrasonography
Findings
Ultrasonography has no role in the evaluation of intramedullary lesions confined to the bone. It may demonstrate soft tissue extension; therefore, it may be useful in guiding percutaneous biopsy.
Ultrasonography is useful as a means of assessing the thickness of the cartilage cap overlying an osteochondroma, although access to the lesion may be difficult in certain areas. If the cap measures more than 1.5 cm in a skeletally mature patient, transformation to chondrosarcoma may have occurred.
Nuclear Imaging
Findings
Central chondrosarcomas typically show significantly increased uptake of the radioisotope on isotopic bone scans, but differentiation between chondrosarcoma and enchondroma is unreliable. Uptake on isotopic bone scanning may indicate either metabolic activity in an osteochondroma or malignant transformation; these two conditions cannot be distinguished on the basis of such a finding. In the absence of an increase in uptake, malignancy is highly unlikely.
Degree of Confidence
See Findings, above.
Angiography
Findings
Angiography is generally not required in the staging of chondrosarcoma.
More on Chondrosarcoma |
| Overview: Chondrosarcoma |
 Imaging: Chondrosarcoma |
| Follow-up: Chondrosarcoma |
| Multimedia: Chondrosarcoma |
| References |
| Further Reading |
| « Previous Page | Next Page » |
References
Flemming DJ, Murphey MD. Enchondroma and chondrosarcoma. Semin Musculoskelet Radiol. 2000;4(1):59-71. [Medline].
Marco RA, Gitelis S, Brebach GT, Healey JH. Cartilage tumors: evaluation and treatment. J Am Acad Orthop Surg. Sep-Oct 2000;8(5):292-304. [Medline].
Gelderblom H, Hogendoorn PC, Dijkstra SD, van Rijswijk CS, Krol AD, Taminiau AH, et al. The clinical approach towards chondrosarcoma. Oncologist. Mar 2008;13(3):320-9. [Medline].
Giuffrida AY, Burgueno JE, Koniaris LG, Gutierrez JC, Duncan R, Scully SP. Chondrosarcoma in the United States (1973 to 2003): an analysis of 2890 cases from the SEER database. J Bone Joint Surg Am. May 2009;91(5):1063-72. [Medline].
Murphey MD, Flemming DJ, Boyea SR, et al. Enchondroma versus chondrosarcoma in the appendicular skeleton: differentiating features. Radiographics. Sep-Oct 1998;18(5):1213-37; quiz 1244-5. [Medline].
Resnik D, Kyriakos M, Greenaway GD. Tumors and tumor-like lesions of bone: imaging and pathology of specific lesions. In: Diagnosis of Bone and Joint Disorders. 4th ed. Philadelphia, Pa: WB Saunders Co;2002: 3897-919.
Wang XL, De Beuckeleer LH, De Schepper AM, Van Marck E. Low-grade chondrosarcoma vs enchondroma: challenges in diagnosis and management. Eur Radiol. 2001;11(6):1054-7. [Medline].
Saki N, Akhlagh SN, Mostofi NE, Ahmadi K. Chondrosarcoma of the hyoid bone: imaging, surgical, and histopathologic correlation. Laryngoscope. Jul 2008;118(7):1211-3. [Medline].
Langheinrich AC, Stolle C, Kampschulte M, Lommel D, Rau WS, Bassaly B. Diagnostic Value of Ex-Vivo Three-Dimensional Micro-Computed Tomography Imaging of Primary Nonhematopoietic Human Bone Tumors: Osteosarcoma versus Chondrosarcoma. Acta Radiol. Jul 11 2008;1-8. [Medline].
Murata H, Horie N, Matsui T, Akai T, Ueda H, Oshima Y, et al. Clinical usefulness of thallium-201 scintigraphy and magnetic resonance imaging in the diagnosis of chondromyxoid fibroma. Ann Nucl Med. Apr 2008;22(3):221-4. [Medline].
Bauer HC, Brosjo O, Kreicbergs A, Lindholm J. Low risk of recurrence of enchondroma and low-grade chondrosarcoma in extremities. 80 patients followed for 2-25 years. Acta Orthop Scand. Jun 1995;66(3):283-8. [Medline].
Walden MJ, Murphey MD, Vidal JA. Incidental enchondromas of the knee. AJR Am J Roentgenol. Jun 2008;190(6):1611-5. [Medline].
Further Reading
Related eMedicine topics:
Chondrosarcoma (from Orthopedic Surgery)
Chondroma
Related Medscape topics:
Radiology CME and News
Specialty Site Radiology
Specialty Site Oncology
Keywords
chondrosarcoma, bone tumors, primary bone tumor, bone malignancy, primary osseous neoplasms, sarcomas, chondroid, conventional chondrosarcomas, central chondrosarcoma, peripheral chondrosarcoma, enchondroma, osteochondroma, clear cell chondrosarcoma, myxoid chondrosarcoma, mesenchymal chondrosarcoma, dedifferentiated chondrosarcoma
