Sacrococcygeal chordoma: MR imaging in 30 patients.
OBJECTIVE
To evaluate MR imaging of sacrococcygeal chordoma.


METHODS
Thirty patients (age range 22-80 years) underwent MR imaging for the diagnosis and preoperative evaluation of sacrococcygeal chordomas. Eight patients had follow-up MR examination after treatment. The MR images were performed with T1- and T2-weighted imaging, and gadolinium (Gd)-enhanced imaging. The MR images were analyzed for the signal intensity, enhancing pattern, tumor size, growth pattern of the soft tissue component, and tumor extension.


CONCLUSIONS
T1-weighted images showed low signal masses with foci of high signal intensity in 73% of cases. Tumors enhanced in a variety of patterns after the administration of Gd. Soft tissue masses extending anteriorly were seen in all cases with posterior extension in 77% of cases. The posterior masses involved the surrounding muscles and extended toward the greater sciatic notch, appearing with pseudopodia (87%). Sacroiliac joints were involved in 23% of cases. Four lesions showed intraspinal extension and involvement of the posterior spinal muscles above the level of bony involvement. In 6 patients recurrent tumors were found at or around the surgical margin of the tumor 6 months to 5 years after resection of the sacral tumor. In two of the patients, nodular metastases to the pelvic bones and femur were found 1-4 years after initial examination. In conclusion, MR imaging is useful in the diagnosis and preoperative assessment of sacrococcygeal chordoma. Characteristic findings included sacral mass with heterogeneously high signal intensity with crisscrossing septa on long-repetition-time imaging, well-encapsulated pseudopodia-like or lobulated appearance, and gluteal muscle infiltration. Follow-up MR imaging is helpful to assess for recurrent or metastatic lesions of chordomas.
Department of Radiology, The Catholic University of Korea, Holy Family Hospital, Sosa-dong, Pucheon, Kyunggi-do 420-717, Korea. mssung99@catholic.ac.kr
Mi Sook
MS
Sung
Gyung Kyu
GK
Lee
Heung Sik
HS
Kang
Soon Tae
ST
Kwon
Jin Gyoon
JG
Park
Jin Suk
JS
Suh
Gil Ho
GH
Cho
Sung Moon
SM
Lee
Myung Hee
MH
Chung
Donald
D
Resnick
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002817:Chordoma / Q000175:diagnosis*; D003050:Coccyx / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D005682:Gadolinium; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019042:Muscle Neoplasms / Q000175:diagnosis; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis; D019275:Radiopharmaceuticals / Q000627:therapeutic use; D012445:Sacrococcygeal Region / Q000000981:diagnostic imaging / Q000473:pathology; D012446:Sacroiliac Joint / Q000000981:diagnostic imaging / Q000473:pathology; D012447:Sacrum / Q000000981:diagnostic imaging / Q000473:pathology; D013125:Spinal Neoplasms / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed
D019275:Radiopharmaceuticals; D005682:Gadolinium