title: The many faces of pulmonary metastases of osteosarcoma: Retrospective study on 283 lesions submitted to surgery.
abstract: OBJECTIVE
  CT is the recommended technique for the detection of pulmonary metastases in patients affected by osteosarcoma, though claimed to show several limits compared to manual palpation. We retrospectively analyzed CT features of suspected lesions submitted to surgery to address its current accuracy and to investigate criteria for predicting histology.
  
  
  METHODS
  CT scans of 70 patients submitted to thoracotomy between 2007-2013 were reviewed. Overall, 123 thoracotomies were performed and 283 lesions seen on CT were resected. Shape, size, presence and type of calcification, evolution of each lesion were analyzed. Number and histology of nodules detected at thoracotomy were recorded and compared to CT data.
  
  
  RESULTS
  234/283--82.7% Lesions were metastases; 143--61.1% were calcified; most metastases were nodular (201/234--85.9%), but in 33/234--14.1% other findings were detected (striae, consolidations, pleural plaques/masses, cavitations, ground glass opacities, irregular shapes, halo sign). Malignant lesions were more frequently calcified, larger, with progression over time--p<0.0001. Manual palpation identified 314 lesions, 248 metastatic--79.0%: CT missed 31/314--9.9% lesions, whereof 14/31--45.2% were metastases.
  
  
  CONCLUSIONS
  Though most lesions are nodular and calcified, up to 40% are not calcified and atypical findings are not uncommon (14.1%). The identification of the atypical radiological presentation of metastases could be the key for improving CT accuracy.
authors.affiliation: Radiology Unit, Cardio-Thoracic-Vascular Department, S. Orsola Malpighi University Hospital, via Masserenti 9, 40100 Bologna, Italy. Electronic address: ciccarese.f@gmail.com.
authors.forename: Federica
authors.initials: F
authors.lastname: Ciccarese
authors.affiliation: Diagnostic and Interventional Radiology, The Rizzoli Institute, via Pupilli 1, 40110 Bologna, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Bazzocchi
authors.affiliation: Diagnostic and Interventional Radiology, The Rizzoli Institute, via Pupilli 1, 40110 Bologna, Italy.
authors.forename: Rosanna
authors.initials: R
authors.lastname: Ciminari
authors.affiliation: Department of Pathology, The Rizzoli Institute, via Pupilli 1, 40110 Bologna, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Righi
authors.affiliation: Unit of General Surgery, The Rizzoli Institute, via Pupilli 1, 40110 Bologna, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Rocca
authors.affiliation: Diagnostic and Interventional Radiology, The Rizzoli Institute, via Pupilli 1, 40110 Bologna, Italy.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Rimondi
authors.affiliation: Department of Pathology, The Rizzoli Institute, via Pupilli 1, 40110 Bologna, Italy.
authors.forename: Piero
authors.initials: P
authors.lastname: Picci
authors.affiliation: Cardiology Institute, Cardio-Thoracic-Vascular Department, S.Orsola Malpighi University Hospital, via Masserenti 9, 40100 Bologna, Italy.
authors.forename: Maria L
authors.initials: ML
authors.lastname: Bacchi Reggiani
authors.affiliation: Diagnostic and Interventional Radiology, The Rizzoli Institute, via Pupilli 1, 40110 Bologna, Italy.
authors.forename: Ugo
authors.initials: U
authors.lastname: Albisinni
authors.affiliation: Radiology Unit, Cardio-Thoracic-Vascular Department, S. Orsola Malpighi University Hospital, via Masserenti 9, 40100 Bologna, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Zompatori
authors.affiliation: Diagnostic and Interventional Radiology, The Rizzoli Institute, via Pupilli 1, 40110 Bologna, Italy.
authors.forename: Daniel
authors.initials: D
authors.lastname: Vanel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000601:surgery; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012516:Osteosarcoma / Q000473:pathology*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013908:Thoracotomy; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: CT; Metastasectomy; Osteosarcoma; Pulmonary metastases; Thoracotomy