Osseous invasion by soft-tissue sarcoma: assessment with MR imaging.
OBJECTIVE
To assess magnetic resonance (MR) imaging signs and overall accuracy of MR imaging for detection of osseous invasion by soft-tissue sarcoma, with histopathologic correlation as the reference standard.


METHODS
Preoperative MR images (1.5 T, transverse and longitudinal planes, T1 and T2 weighted) of 56 osseous sites in 51 patients who underwent bone resection at surgery for soft-tissue sarcoma were assessed retrospectively for signs of osseous invasion, by consensus of two readers who were blinded to clinical and histopathologic findings. Delay between MR imaging and surgery averaged 34 days (range, 2-112 days). MR signs assessed included osseous abutment by tumor, maximal diameter of osseous abutment, extent of circumferential abutment of long bones (<25%, 25%-50%, >50%), cortical destruction, and cortical and medullary signal intensity change on T1- and T2-weighted images. Imaging findings were correlated with histopathologic findings. Sensitivities, specificities, positive and negative predictive values (PPV, NPV), and P values were calculated.


RESULTS
Eleven sites (20%) showed osseous invasion histologically (two, cortical; nine, both cortical and medullary). Tumor abutted bone at 44 lesion sites (sensitivity, 100%; specificity, 27%). Maximal diameter of osseous abutment and extent of circumferential abutment did not significantly affect osseous invasion (P =.09 and.11, respectively). On T1- and T2-weighted images, 13 lesion sites showed cortical signal intensity change (sensitivity, 100%; specificity, 96%) and 10 showed cortical destruction (sensitivity, 82%; specificity, 98%). Eleven sites showed decreased medullary T1 signal intensity (sensitivity, 100%; specificity, 96%), and 12 showed increased medullary T2 signal intensity (sensitivity, 100%; specificity, 94%). MR imaging overall had a sensitivity of 100%, specificity of 93%, PPV of 79%, and NPV of 100% for detection of osseous invasion on the basis of any finding of cortical destruction or cortical or medullary signal intensity change on T1- or T2-weighted images (P <.001).


CONCLUSIONS
On T1- and T2-weighted MR images, findings of cortical and medullary signal intensity change and cortical destruction were sensitive and specific for detection of osseous invasion by soft-tissue sarcoma.
Elias
David A
DA
Departments of Diagnostic Imaging, Pathology and Laboratory Medicine, Mount Sinai Hospital and the University Health Network, University of Toronto, 600 University Ave, Toronto, Ontario, Canada M5G 1X5.
White
Lawrence M
LM
Simpson
David J
DJ
Kandel
Rita A
RA
Tomlinson
George
G
Bell
Robert S
RS
Wunder
Jay S
JS
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000175:diagnosis*; D001842:Bone and Bones / Q000473:pathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012509:Sarcoma / Q000175:diagnosis* / Q000473:pathology; D012680:Sensitivity and Specificity; D012983:Soft Tissue Neoplasms / Q000175:diagnosis / Q000473:pathology*