Imaging Assessment of Osteosarcoma in Childhood and Adolescence: Diagnosis, Staging, and Evaluating Response to Chemotherapy
Osteosarcoma is an aggressive tumor of mesenchymal origin, capable of producing osteoid and immature bone. It is the most frequent primary malignant skeletal neoplasm in children and adolescents. Imaging studies play a major role in initial diagnosis, staging, and assessment of tumor response to chemotherapy. Conventional radiography is the prime imaging modality for diagnosis of bony tumors. Radionuclide bone scan is used in detection of metastatic lesions in the other bones. Computed tomography may be used as an adjunct to conventional radiography, but its main role is detection of pulmonary metastasis. The standard magnetic resonance imaging is the most specific modality for local staging and monitoring response to chemotherapy, and distinguishing postsurgical changes from residual tumor. Dynamic contrast-enhanced magnetic resonance imaging has been introduced to quantify the percentage of tumor necrosis, identify early responders, and thus predict survival. The role of 18F fluorodeoxyglucose positron emission tomography (PET) in the staging and management of osteosarcoma is evolving. It has the advantage of total body imaging and may have an overall role in tumor staging and grading, detection of early response, and therefore, in the prognosis and detection of recurrence.
KeywordsPositron Emission Tomography Conventional Radiography Aneurysmal Bone Cyst Local Staging Myositis Ossificans
The author wishes to thank Dr. Norman Jaffe for his continued support, Drs. Haesun Choi and Leonardo Marcal for sharing their research on DCE-MRI, Kristi Speights for editorial assistance, Mary Carr for secretarial assistance, and Juan Loya for assistance in illustration assistance.
- 1.Mira JM. Osseous tumors of intramedullary origin. In: Mira JM, ed. Bone Tumors: Clinical, Radiologic, and Pathologic Correlations. Philadelphia, Pa: Lea & Febriger; 1989:248-438.Google Scholar
- 2.Resnick D, Kyriakos M, Greenway GD. Tumor-like diseases of bone: imaging and pathology of specific lesions. In: Resnick D, ed. Diagnosis of Bone and Joint Disorders. 3rd ed. Philadelphia: Saunders; 1995:3662-3697.Google Scholar
- 3.Huvos AG. Osteogenic sarcoma. Bone Tumors: Diagnosis, Treatment, and Prognosis. Philadelphia, Pa: Saunders; 1991:85-156.Google Scholar
- 4.Dahlin DC, Coventy MB. Osteogenic sarcoma. A study of six hundred cases. J Bone Joint Surg [Am]. 1967;49:101-110.Google Scholar
- 13.Chung VP, Benjamin R, Jaffe N, et al. Radiographic and angiographic changes in oseosarcoma after intraarterial chemotherapy. AJR. 1982;139:1065-1069.Google Scholar
- 20.Marcal L, Choi H, Jackson E, et al. Use of Quantitative Dynamic Contrast MR Imaging to Monitor Musculoskeletal Sarcomas: Correlation with FDG PET and Pathology. E-poster. International Society for Magnetic Resonance in Medicine (ISMRM), Kyoto, Japan. 2004, May 15–21.Google Scholar