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Putta T, Gibikote S, Madhuri V, et al. Accuracy of Various MRI Sequences in Determining the Tumour Margin in Musculoskeletal Tumours. Pol J Radiol. 2016;81:540-548doi: 10.12659/PJR.898108.
Putta, T., Gibikote, S., Madhuri, V., & Walter, N. (2016). Accuracy of Various MRI Sequences in Determining the Tumour Margin in Musculoskeletal Tumours. Polish journal of radiology, 81540-548. https://doi.org/10.12659/PJR.898108
Putta, Tharani, et al. "Accuracy of Various MRI Sequences in Determining the Tumour Margin in Musculoskeletal Tumours." Polish journal of radiology vol. 81 (2016): 540-548. doi: https://doi.org/10.12659/PJR.898108
Putta T, Gibikote S, Madhuri V, Walter N. Accuracy of Various MRI Sequences in Determining the Tumour Margin in Musculoskeletal Tumours. Pol J Radiol. 2016 Nov 16;81:540-548. doi: 10.12659/PJR.898108. eCollection 2016. PMID: 28058070; PMCID: PMC5181551.
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Pol J Radiol. 2016 Nov 16;81:540-548. doi: 10.12659/PJR.898108. eCollection 2016.

Accuracy of Various MRI Sequences in Determining the Tumour Margin in Musculoskeletal Tumours.

Polish journal of radiology

Tharani Putta, Sridhar Gibikote, Vrisha Madhuri, Noel Walter

Affiliations

  1. Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India.
  2. Department of Paediatric Orthopaedics, Christian Medical College, Vellore, Tamil Nadu, India.
  3. Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, India.

PMID: 28058070 PMCID: PMC5181551 DOI: 10.12659/PJR.898108

Abstract

BACKGROUND: It is imperative that bone tumour margin and extent of tumour involvement are accurately assessed pre-operatively in order for the surgeon to attain a safe surgical margin. In this study, we comprehensively assessed each of the findings that influence surgical planning, on various MRI sequences and compared them with the gold standard - pathology.

MATERIAL/METHODS: In this prospective study including 21 patients with extremity bone tumours, margins as seen on various MRI sequences (T1, T2, STIR, DWI, post-gadolinium T1 FS) were measured and biopsies were obtained from each of these sites during the surgical resection. The resected tumour specimen and individual biopsy samples were studied to assess the true tumour margin. Margins on each of the MRI sequences were then compared with the gold standard - pathology. In addition to the intramedullary tumour margin, we also assessed the extent of soft tissue component, neurovascular bundle involvement, epiphyseal and joint involvement, and the presence or absence of skip lesions.

RESULTS: T1-weighted imaging was the best sequence to measure tumour margin without resulting in clinically significant underestimation or overestimation of the tumour extent (mean difference of 0.8 mm; 95% confidence interval between -0.9 mm to 2.5 mm; inter-class correlation coefficient of 0.998). STIR and T1 FS post-gadolinium imaging grossly overestimated tumour extent by an average of 16.7 mm and 16.8 mm, respectively (P values <0.05). Post-gadolinium imaging was better to assess joint involvement while T1 and STIR were the best to assess epiphyseal involvement.

CONCLUSIONS: T1-weighted imaging was the best sequence to assess longitudinal intramedullary tumour extent. We suggest that osteotomy plane 1.5 cm beyond the T1 tumour margin is safe and also limits unwarranted surgical bone loss. However, this needs to be prospectively proven with a larger sample size.

Keywords: Bone Neoplasms; Magnetic Resonance Imaging; Osteosarcoma

Conflict of interest statement

None.

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