Robert Orth MD, PhD, Presenter: Nothing to Disclose

Lorna Browne MD, FRCR, Abstract Co-Author: Nothing to Disclose

Prakash Mohan Masand MD, Abstract Co-Author: Nothing to Disclose

To determine the degree to which contrast-enhanced MR images contribute to pre-surgical treatment planning accuracy in pediatric patients with extremity osteosarcoma following neoadjuvant chemotherapy.

Twenty-two patients with pre-surgical MR examinations for extremity osteosarcoma between 2005 and 2011 were identified through an institutional database and a PACS search algorithm (age range: 5 – 17 years, average = 11.6 years). An MR examination with nonenhanced and gadolinium-enhanced images was performed on all patients following neoadjuvant chemotherapy to guide surgical resection. Tumor extent on imaging was determined from T1-weighted, fat-saturated T2-weighted, and gadolinium-enhanced fat-saturated T1-weighted images. Surgical notes, pathology reports, and post-surgical radiographs were reviewed to determine actual tumor extent and compared to preoperative imaging.

In all 22 cases, there were no significant differences in intraosseous and extraosseous tumor extent on nonenhanced images, gadolinium-enhanced images, or pathological specimens. Punctate foci of abnormal signal intensity in the distal femoral epiphyses of two patients on nonenhanced images were not evident on gadolinium-enhanced images due to inhomogeneous fat-saturation. There were no suspicious regions of abnormal signal intensity on gadolinium-enhanced images that were not evident prospectively on nonenhanced images.

Contrast-enhanced images do not provide additional information beyond that obtained with conventional nonenhanced images for extremity osteosarcoma surgical planning in children.

Elimination of contrast-enhanced images from pre-surgical MR studies of children with extremity osteosarcoma will result in shorter examination times, decreased sedation times, and lower costs.

Orth, R, Browne, L, Masand, P, MR Imaging of Extremity Osteosarcoma in Children: Do Contrast-enhanced Images Affect Surgical Planning?.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11014132.html