eMedicine Specialties > Radiology > Musculoskeletal

Osteosarcoma, Variants: Imaging

Author: Geoff Hide, MBBS, MRCP, FRCR, Consultant Musculoskeletal Radiologist, Department of Radiology, Freeman Hospital; Honorary Clinical Lecturer, Faculty of Medical Sciences, University of Newcastle upon Tyne
Contributor Information and Disclosures

Updated: May 21, 2007

Radiography

Findings

Telangiectatic osteosarcoma is generally lytic, with a periosteal reaction and soft-tissue mass. When the tumor margins are well defined, it may mimic an aneurysmal bone cyst. Small-cell osteosarcoma appears similar to a conventional osteosarcoma; it often has mixed areas of sclerosis and lysis. Intraosseous low-grade osteosarcoma may be lytic, sclerotic, or mixed; it often has deceptively benign features of well-defined margins and the absence of periosteal changes or a soft-tissue mass.

Gnathic tumors may be lytic, sclerotic, or mixed, and bone destruction, periosteal reaction, and soft-tissue extension are common. Intracortical osteosarcomas are described as radiolucent and geographic, and they contain a small amount of internal mineralization. High-grade surface osteosarcomas are shown as broad-based soft-tissue masses with varying degrees of mineralization arising from the surface of the bone.

Parosteal osteosarcomas are typically densely ossified tumors arising from a broad base on the adjacent bone. Unlike osteochondromas, parosteal osteosarcomas involve no continuation of the medullary cavity into the tumor.

Computed Tomography

Findings

CT scanning is helpful in the evaluation of a variety of the osteosarcoma variants. It may demonstrate fluid levels in telangiectatic osteosarcoma, and a contrast-enhanced CT scan can be helpful in discriminating such a lesion from an aneurysmal bone cyst. Telangiectatic osteosarcoma differs from an aneurysmal bone cyst in that the former has a rim of tumor cells that surrounds the cystic spaces. This tissue rim shows typically nodular enhancement after the intravenous administration of contrast material.

CT scanning is useful in the evaluation of bone changes occurring in areas of complex anatomy. Examples are the changes in the maxilla or mandible that are associated with gnathic osteosarcoma and those in the pelvis that are associated with secondary osteosarcoma. CT scanning provides useful information about the surface osteosarcoma variants, including parosteal, periosteal, and surface high-grade tumors.

When appropriate and performed in consultation with an orthopedic oncologist, CT scanning can be useful in guiding biopsy.

Magnetic Resonance Imaging

Findings

MRI is the optimum technique for local staging of osteosarcomas. In certain cases, MRI is combined with CT scanning. MRI accurately demonstrates the extent of a tumor within bone and soft tissue.

At least 1 sequence, either a T1-weighted or a short-tau inversion recovery (STIR) sequence, should be performed to image the entire bone. This is necessary to exclude skip lesions that are present within the same bone but are distant from the primary lesion. Periosteal osteosarcoma is typically a chondroblastic lesion, and the tumor usually has high signal intensity on T2-weighted MRIs.

Degree of Confidence

MRI is more sensitive than CT scanning in demonstrating fluid-fluid levels in telangiectatic osteosarcoma because of its greater intrinsic soft-tissue contrast.

False Positives/Negatives

Fluid-fluid levels can be seen in benign bone lesions as well, particularly aneurysmal bone cysts.

Ultrasonography

Findings

Ultrasonography can demonstrate the soft-tissue extent of the tumor, but it cannot be used to evaluate the intramedullary component of the lesion. Ultrasonography is not routinely used in staging such lesions. Sonography can be useful in guiding percutaneous biopsy of the soft-tissue component of the tumor, again in consultation with an orthopedic oncologist.

Nuclear Imaging

Findings

Osteosarcomas typically show increased uptake of radioisotope; this characteristic makes bone scans sensitive but not specific. Bone scans are most useful in excluding multifocal disease. Multiple-gated acquisition (MUGA) cardiac scans may be required to monitor the toxic effects of certain chemotherapeutic agents.

Angiography

Findings

Angiography is no longer used in the staging of osteosarcoma.

More on Osteosarcoma, Variants

Overview: Osteosarcoma, Variants
Imaging: Osteosarcoma, Variants
Follow-up: Osteosarcoma, Variants
Multimedia: Osteosarcoma, Variants
References
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References

  1. Murphey MD, Robbin MR, McRae GA, et al. The many faces of osteosarcoma. Radiographics. Sep-Oct 1997;17(5):1205-31. [Medline].

  2. White LM, Kandel R. Osteoid-producing tumors of bone. Semin Musculoskelet Radiol. 2000;4(1):25-43. [Medline].

  3. Ayala AG, Ro JY, Raymond AK, et al. Small cell osteosarcoma. A clinicopathologic study of 27 cases. Cancer. Nov 15 1989;64(10):2162-73. [Medline].

  4. Dorfman HD, Czerniak B. Osteosarcoma. In: Dorfman HD, Czerniak B, eds. Bone Tumors. St. Louis, Mo: Mosby-Year Book; 1998:128-252.

  5. Enneking WF, Kagan A. "Skip" metastases in osteosarcoma. Cancer. Dec 1975;36(6):2192-205. [Medline].

  6. Glasser DB, Lane JM, Huvos AG, et al. Survival, prognosis, and therapeutic response in osteogenic sarcoma. The Memorial Hospital experience. Cancer. Feb 1 1992;69(3):698-708. [Medline].

  7. Huvos AG, Rosen G, Bretsky SS, et al. Telangiectatic osteogenic sarcoma: a clinicopathologic study of 124 patients. Cancer. Apr 15 1982;49(8):1679-89. [Medline].

  8. Jaffe HL. Intracortical osteogenic sarcoma. Bull Hosp Joint Dis. Oct 1960;21:189-97. [Medline].

  9. Mirra JM. Osseous tumours of intramedullary origin. In: Mirra JM, ed. Bone Tumours: Clinical, Radiologic and Pathologic Correlations. Philadelphia, Pa: Lea & Febiger; 1989:248-438.

  10. Okada K, Frassica FJ, Sim FH, et al. Parosteal osteosarcoma. A clinicopathological study. J Bone Joint Surg Am. Mar 1994;76(3):366-78. [Medline].

  11. Panuel M, Gentet JC, Scheiner C, et al. Physeal and epiphyseal extent of primary malignant bone tumors in childhood. Correlation of preoperative MRI and the pathologic examination. Pediatr Radiol. 1993;23(6):421-4. [Medline].

  12. Parham DM, Pratt CB, Parvey LS, et al. Childhood multifocal osteosarcoma. Clinicopathologic and radiologic correlates. Cancer. Jun 1 1985;55(11):2653-8. [Medline].

  13. Raymond AK, Chawla SP, Carrasco CH, et al. Osteosarcoma chemotherapy effect: a prognostic factor. Semin Diagn Pathol. Aug 1987;4(3):212-36. [Medline].

  14. 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. vol 4. 4th ed. Philadelphia, Pa: WB Saunders Co; 2002:3800-33.

  15. Ries LA, Smith MA, Gurney JG. Cancer incidence and survival among children and adolescents: United States SEER Program 1975-1995. Washington, DC: National Institutes of Health; 1999.

  16. Sim FH, Unni KK, Beabout JW, et al. Osteosarcoma with small cells simulating Ewing's tumor. J Bone Joint Surg Am. Mar 1979;61(2):207-15. [Medline].

  17. Unni KK. Osteosarcoma. In: Unni KK, ed. Dahlin's Bone Tumors: General Aspects and Data on 11,087 Cases. 5th ed. Philadelphia, Pa: Lippincott-Raven; 1996:143-84.

  18. Unni KK, Dahlin DC, Beabout JW. Periosteal osteogenic sarcoma. Cancer. May 1976;37(5):2476-85. [Medline].

  19. Unni KK, Dahlin DC, McLeod RA, et al. Intraosseous well-differentiated osteosarcoma. Cancer. Sep 1977;40(3):1337-47. [Medline].

  20. Wold LE, Unni KK, Beabout JW, et al. High-grade surface osteosarcomas. Am J Surg Pathol. Mar 1984;8(3):181-6. [Medline].

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Further Reading

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Keywords

primary malignant tumor of bone, bone tumor, bone malignancy

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Contributor Information and Disclosures

Author

Geoff Hide, MBBS, MRCP, FRCR, Consultant Musculoskeletal Radiologist, Department of Radiology, Freeman Hospital; Honorary Clinical Lecturer, Faculty of Medical Sciences, University of Newcastle upon Tyne
Geoff Hide, MBBS, MRCP, FRCR is a member of the following medical societies: British Medical Association, Royal College of Physicians, and Royal College of Radiologists
Disclosure: Nothing to disclose.

Medical Editor

Amilcare Gentili, MD, Clinical Professor of Radiology, University of California at San Diego; Consulting Staff, Department of Radiology, Thornton Hospital
Amilcare Gentili, MD is a member of the following medical societies: American Roentgen Ray Society, Radiological Society of North America, and Society of Skeletal Radiology
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Murali Sundaram, MBBS, FRCR, FACR, Consulting Staff, Department of Diagnostic Radiology, The Cleveland Clinic Foundation
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Felix S Chew, MD, MBA, EdM, Professor, Department of Radiology, Vice Chairman for Radiology Informatics, Section Head of Musculoskeletal Radiology, University of Washington
Felix S Chew, MD, MBA, EdM is a member of the following medical societies: American Roentgen Ray Society, Association of University Radiologists, and Radiological Society of North America
Disclosure: Nothing to disclose.

 
 
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