Fig 2 - available via license: Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International
Content may be subject to copyright.
CT images of bone tumors. a. X-ray image of osteoid osteoma. Sclerotic change is observed in X-ray image. b. CT image of osteoid osteoma. Nidus formation is determined. c. Multiplanar reconstruction of CT image of giant cell tumor. d. Osteosarcoma.
Source publication
Imaging modalities including radiography, computed tomography (CT), and magnetic resonance imaging (MRI) are necessary for the diagnosis of bone and soft tissue tumors. The history of imaging began with the discovery of X-rays in the 19th century. The development of CT, MRI, ultrasonography, and positron emission tomography (PET) have improved the...
Contexts in source publication
Context 1
... information regarding the anatomical location of a tumor and the involvement of surrounding structures. The clear visualization of matrix mineralization, cortical scalloping, destruction, periosteal reaction, calcification, ossification, and extraskeletal mass assist in the diagnostic process in patients with bone and soft tissue lesions (Fig. ...
Context 2
... obscured by normal structures on X-ray imaging. On the other hand, cross-sectional CT images with high resolution enable the detection of small lesions, if the lesions are larger than 3 mm (Fig. 3). CT sometimes assists in the identification of a nidus in osteoid osteoma, and the existence of a nidus enables to make diagnosis without biopsy (Fig. 2). CT scans provide a great deal of anatomical information with a short scanning time, even during the performance of needle biopsy. The common percutaneous biopsy is a blind procedure, and carries the possibility of neurovascular injury or failure to obtain a sample of the target lesion. On the other hand, CT-guided percutaneous biopsy ...
Context 3
... enhancement, which can differentiate simple bone cysts (SBCs) and ganglion cysts from the other solid tumors. Differential diagnoses in cases with sclerotic changes on X-ray images include osteosarcoma, osteoid osteoma, and healing after a fracture. In such cases, the existence of a nidus on CT or MRI is helpful in determination of the diagnosis (Fig. 2). It has been reported that a cartilage cap thicker than 2 cm suggests chondrosarcoma, and the sensitivities and specificities were 100% and 98% for MRI and 100% and 95% for CT, respectively [14]. On the other hand, it is reported that tumor vessels evaluated by Doppler sonography are correlated with malignancy in soft tissue tumors ...
Citations
... These tumors often cause damage to skeletal structures, resulting in long-term functional disability and reduced quality of life for patients [3][4][5]. Currently, X-ray imaging, owing to its cost-effectiveness, is the most common imaging tool for diagnosing primary bone tumors [6,7]. Among all types of bone tumors, osteosarcoma (OS) is the most common primary malignancy of bone [8]. ...
Early and accurate diagnosis of osteosarcomas (OS) is of great clinical significance, and machine learning (ML) based methods are increasingly adopted. However, current ML-based methods for osteosarcoma diagnosis consider only X-ray images, usually fail to generalize to new cases, and lack explainability. In this paper, we seek to explore the capability of deep learning models in diagnosing primary OS, with higher accuracy, explainability, and generality. Concretely, we analyze the added value of integrating the biochemical data, i.e., alkaline phosphatase (ALP) and lactate dehydrogenase (LDH), and design a model that incorporates the numerical features of ALP and LDH and the visual features of X-ray imaging through a late fusion approach in the feature space. We evaluate this model on real-world clinic data with 848 patients aged from 4 to 81. The experimental results reveal the effectiveness of incorporating ALP and LDH simultaneously in a late fusion approach, with the accuracy of the considered 2608 cases increased to 97.17%, compared to 94.35% in the baseline. Grad-CAM visualizations consistent with orthopedic specialists further justified the model’s explainability.
... Alternative tools have been proposed to help the surgeon to evaluate margins perioperatively. In orthopedic oncology, intraoperative magnetic resonance imaging (MRI), ultrasonography, and computer-assisted tumor surgery (CATS) have been introduced [4]. All these options do, nevertheless, have important limitations such as increased operative time and high costs. ...
... Ultrasound (US) is not accurate in diagnosis of bone lesions, being more useful in evaluation of soft tissue mases; however, US can detect tumor extension in soft tissue and the tumor rapports with surrounding structures being also useful in performing guided biopsies [13,14]. Computed tomography (CT) allows detailed visualization of bone structure, periosteal reaction, detects tumor calcifications being a useful tool in differential diagnosis of these tumors [13,15]. Currently, after radiographic evaluation, magnetic resonance imaging (MRI) represents the main test used to evaluate musculoskeletal tumors, including the chondroid tumors, being able to define in detail tumor characteristics, local extension, vascularization being a preferred method in patient followup [13,16]. ...
Benign and malignant cartilaginous bone tumors of the hand are rare findings, however representing a particular pathology due to the capacity to induce significant functional impairment. Even though a large proportion of tumors of the hand and wrist are benign, these may present destructive characteristics, deforming adjacent structures until compromising function. The most appropriate surgical approach for most benign tumors is intralesional lesion resection. Malignant tumors often require wide excision, up to segment amputation to obtain tumor control. A five-year retrospective study was performed on patients admitted in our Clinic with benign cartilaginous tumors of the hand, in which 15 patients were admitted within this period, 10 presenting with enchondroma, four presenting with osteochondroma, and lastly one with chondromatosis. After clinical and imaging evaluation, all the aforementioned tumors were surgically removed. Definitive diagnosis for all bone tumors, either benign or malignant, was established by tissue biopsy and histopathological examination, dictating therapeutic strategy.
... Computed tomography (CT) and magnetic resonance imaging (MRI) help to cover all these aspects. [8] An algorithm for the radiological diagnosis of bone tumors is presented in [ Figure 1]. ...
Since 1967, the World Health Organization (WHO) classification of tumors is regarded as a reference standard and practical guide and provides a precious resource not only for the histopathologists and oncosurgeons but also for the radiologists involved in cancer care. Primary bone tumors are a rare and heterogeneous group of neoplasms that have a broad spectrum of morphological, biological, genetic, and radiological features. Appropriate imaging workup and accurate histopathological diagnosis are crucial for appropriate management and prognostication. The fourth edition of the WHO classification of tumors of soft tissue and bone was introduced in 2013. In the past 7 years, there have been considerable advances in the understanding of this large and diverse group of tumors. With technological advances and the introduction of new molecular and genetic data about some bone tumors, there has been reorganization in the classification and introduction of a few new entities. The new WHO classification of soft tissue and bone tumors introduced in 2020 (fifth edition) has made essential refinements in the classification and has also introduced many new entities. Newly identified genetic alterations and corresponding immunohistochemical markers are included in the new classification, and this has helped in the reclassification of the existing tumor entities. These novel genetic alterations not only help in prognostication but are a target for potential therapeutic options which can bring a paradigm shift in the chemotherapeutic regimen for these entities in the future. The sole basis for the classification of bone tumors is histopathological. Although radiologists are not expected to know about the exquisite pathological details of bone tumors, a broad knowledge of the recent updates, including the reclassification of a few entities or the introduction of some, is vital for narrowing the differentials in imaging. A multidisciplinary approach including an orthopedic oncologist, radiologist, pathologist, surgical, and medical oncologist is required for accurate diagnosis and management of primary bone tumors. We hereby present a simplified review for the radiologists comprising the relevant details of the updates in bone tumors along with a simplified diagnostic algorithm to characterize these lesions.
... To evaluate soft tissue metastases, MRI is the most sensitive and specific imaging modality and enables assessment of tissue characteristics, tumor extent, and areas of reactivity (11,12). In our patient, MRI was highly suspicious for sarcoma but 18 F-FDG PET/CT suggested a lung primary, which was confirmed by biopsy. ...
Cutaneous and subcutaneous soft tissue metastases are rare in lung adenocarcinoma and suggest poor prognosis. We report a patient with lung adenocarcinoma who initially presented with cutaneous and subcutaneous metastases to the abdomen that were initially presumed to be herpes zoster and an occult subcutaneous soft tissue mass. Because the lesions progressed over 3 weeks despite routine herpes zoster treatment, magnetic resonance imaging was performed and showed a presumed sarcoma; however, ¹⁸F-fluourodeoxyglucose positron emission tomography/computed tomography demonstrated pulmonary lesions. Biopsy of the abdominal lesion confirmed poorly differentiated lung adenocarcinoma. Early diagnosis of soft tissue metastasis can be difficult. Clinicians should suspect internal organ malignancy when a progressive cutaneous or subcutaneous soft tissue lesion is encountered.
... The histological analysis revealed a limitation of the X-ray imaging since in some cases radiographic pictures did not show evident signs of tumor formation inside the medullar channel, where the resolution of the X-ray is not sensitive enough to distinguish the tumor mass, making its detection difficult and the corresponding quantification of the tumor area very challenging. Imaging modalities such as radiography have the ability to characterize tumors on the basis of information such as sclerotic changes, osteolysis, and periosteal reactions in diagnoses of bone lesions, or calcification and skeletal invasion in soft tissue lesions [33]. Moreover, in the treatment of malignant bone tumors, the chemotherapeutic effect can be qualitatively assessed by sclerotic changes and cortical bone remodeling with radiography. ...
Osteosarcoma treatment is moving towards more effective combination therapies. Nevertheless, these approaches present distinctive challenges that can complicate the clinical translation, such as increased toxicity and multi-drug resistance. Drug co-encapsulation within a nanoparticle formulation can overcome these challenges and improve the therapeutic index. We previously synthetized keratin nanoparticles functionalized with Chlorin-e6 (Ce6) and paclitaxel (PTX) to combine photo (PDT) and chemotherapy (PTX) regimens, and the inhibition of osteosarcoma cells growth in vitro was demonstrated. In the current study, we generated an orthotopic osteosarcoma murine model for the preclinical evaluation of our combination therapy. To achieve maximum reproducibility, we systematically established key parameters, such as the number of cells to generate the tumor, the nanoparticles dose, the design of the light-delivery device, the treatment schedule, and the irradiation settings. A 60% engrafting rate was obtained using 10 million OS cells inoculated intratibial, with the tumor model recapitulating the histological hallmarks of the human counterpart. By scheduling the treatment as two cycles of injections, a 32% tumor reduction was obtained with PTX mono-therapy and a 78% reduction with the combined PTX-PDT therapy. Our findings provide the in vivo proof of concept for the subsequent clinical development of a combination therapy to fight osteosarcoma.
... Despite the technological advances of sectional imaging methods, namely MRI, the clinical-radiological management of musculoskeletal tumors cannot disregard a multimodal approach, where radiographic examination still today remains a milestone [236][237][238][239][240][241][242] . In fact, plain films performed in orthogonal projections are fundamental in bone and soft tissue tumors to characterize basic semeiological features, such as the type of osteolysis, bone interface, periosteal reaction, and ossification/calcification patterns 240 . ...
... Despite the technological advances of sectional imaging methods, namely MRI, the clinical-radiological management of musculoskeletal tumors cannot disregard a multimodal approach, where radiographic examination still today remains a milestone [236][237][238][239][240][241][242] . In fact, plain films performed in orthogonal projections are fundamental in bone and soft tissue tumors to characterize basic semeiological features, such as the type of osteolysis, bone interface, periosteal reaction, and ossification/calcification patterns 240 . Multidetector CT examination is essential to integrate the radiographic findings in cases of lesions in complex anatomical areas, for matrix characterization, and to identify minor alterations in soft tissue tumors. ...
... Fluid-sensitive sequences (STIR or fat-suppressed T2-weighted) performed in two scan planes depict perilesional edema and soft tissues extension [244][245][246][247][248][249][250][251] . Gradient-echo sequences may be added to evaluate hemosiderin deposits (e.g., in PVNS or GCT), while chemical shift imaging may be helpful in some cases of differential diagnosis of bone marrow replacement [240][241][242][243][244] . DWI sequences provide useful functional information for both characterization (e.g., solid/cystic) and follow-up. ...
Magnetic resonance imaging (MRI) is a non-invasive imaging technique (non-ionizing radiation) with superior soft tissue contrasts and potential morphological and functional applications. However, long examination and interpretation times, as well as higher costs, still represent barriers to MRI use in clinical routine. Abbreviated MRI protocols have emerged as an alternative to standard MRI protocols. Abbreviated MRI protocols eliminate redundant sequences that negatively affect cost, acquisition time, patient comfort. However, the diagnostic information is generally not compromised. Abbreviated MRI protocols have already been utilized for hepatocellular carcinoma, for prostate cancer detection, and for nonalcoholic fatty liver disease screening.
... Soft tissue tumors (STTs) are a very heterogeneous group of tumors with various presentations, and still pose an important challenge in daily clinical practice [1,2]. Magnetic resonance imaging (MRI) is frequently used to characterize and grade soft tissue tumors. ...
Objective: To evaluate the diagnostic performance of standard diffusion-weighted imaging (DWI), intravoxel incoherent motion (IVIM), and diffusion kurtosis imaging (DKI), for differentiating benign and malignant soft tissue tumors (STTs).
Materials and methods: A thorough search was carried out to identify suitable studies published up to September 2020. The quality of the studies involved was evaluated using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). The pooled sensitivity (SEN), specificity (SPE), and summary receiver operating characteristic (SROC) curve were calculated using bivariate mixed effects models. A subgroup analysis was also performed to explore the heterogeneity.
Results: Eighteen studies investigating 1319 patients with musculoskeletal STTs (malignant, n=623; benign, n=696) were enrolled. Thirteen standard DWI studies using the apparent diffusion coefficient (ADC) showed that the pooled SEN and SPE of ADC were 0.80 (95% CI: 0.77-0.82) and 0.63 (95% CI: 0.60-0.67), respectively. The area under the curve (AUC) calculated from the SROC curve was 0.806. The subgroup analysis indicated that the percentage of myxoid malignant tumors, magnet strength, study design, and ROI placement were significant factors affecting heterogeneity. Four IVIM studies showed that the AUCs calculated from the SROC curves of the parameters ADC and D were 0.859 and 0.874, respectively. The AUCs for the IVIM parameters pseudo diffusion coefficient (D*) and perfusion fraction (f) calculated from the SROC curve were 0.736 and 0.573, respectively. Two DKI studies showed that the AUCs of the DKI parameter mean kurtosis (MK) were 0.97 and 0.89, respectively.
Conclusion: The DWI-derived ADC value and the IVIM DWI-derived D value might be accurate tools for discriminating musculoskeletal STTs, especially for non-myxoid SSTs, using more than two b values, with maximal b value ranging from 600 to 800 s/mm², additionally, a high-field strength (3.0 T) optimizes the diagnostic performance.
... However, GBCAs may provide information on the assessment of intramedullary extension, the extension to adjacent structures and can be useful in post-surgical follow-up imaging. 45,46 For selective bone tumors, such as osteosarcoma, gadolinium offers the potential for determining the efficacy of chemotherapy, by evaluating tumor necrosis prior and subsequent to chemotherapy. Sarcomas close to joints, gadolinium may aid in determining whether tumor resection should be intra-or extra-articular. ...
Magnetic resonance imaging has continued to evolve over the recent decades, in part, due to the evolution of gadolinium-based contrast agents and their use. These were initially thought to have a relatively low-risk profile. However, there is mounting evidence that trace amounts of gadolinium are retained within the body. To ascertain the current use of gadolinium in medical practice, we performed a survey of musculoskeletal radiologists, within the United Kingdom, Europe and India. The survey demonstrated varied practices amongst all radiologists with relatively indiscriminate use of gadolinium. In this review, we discuss the current evidence for and against the use of gadolinium in musculoskeletal magnetic resonance imaging.
... Imaging of bone lesions has heavily relied on radiographs for a long time (5). Nowadays, it comprises technologically more advanced armamentarium, including positron emission tomography (PET), ultrasound, magnetic resonance imaging (MRI), and computed tomography (CT) (5,6). From a diagnostic point of view, all of these imaging methods can contribute to tissue characterization by narrowing the range of differential diagnoses and then indicating the most appropriate course of action afterward (7). ...
... From a diagnostic point of view, all of these imaging methods can contribute to tissue characterization by narrowing the range of differential diagnoses and then indicating the most appropriate course of action afterward (7). In other words, these approaches have a limited capacity to achieve a final histopathological diagnosis (6). In particular, CT can help determine the calcification pattern in the bone lesion matrix, identify occult destruction, or even localize the nidus of an osteoid osteoma (5,6). ...
... In other words, these approaches have a limited capacity to achieve a final histopathological diagnosis (6). In particular, CT can help determine the calcification pattern in the bone lesion matrix, identify occult destruction, or even localize the nidus of an osteoid osteoma (5,6). However, if we consider all possible lesion types that can be encountered in clinical practice, it has a limited capability in tissue characterization. ...
Introduction:Currently, medical imaging has a limited capacity to achieve a final histopathological diagnosis of bone lesions. This study aimed to evaluate the use of machine learning (ML)-based computed tomography (CT) texture analysis to determine benign and malignant behaviors of lytic bone lesions needing a biopsy.Methods:This retrospective study included 58 patients with lytic bone lesions. Lesion segmentation was independently performed by two observers. After evaluating unenhanced CT images, a total of 744 texture features were obtained. Reproducibility analysis and feature selection were used for dimension reduction. A training data set with a nested cross-validation approach was used for feature selection, optimization, and validation. Testing was executed on the remaining unseen data set. Classifications were done using five base ML classifiers and three voting strategies.Results:The best predictive performance was achieved using the k-nearest neighbors algorithm with six features. The area under the curve, accuracy, sensitivity, and specificity of the best algorithm were, respectively, 0.774%, 78.1%, 78%, and 78.1% for the validation data set; and 0.861, 82.4%, 82.4%, and 81.5% for the unseen test data set.Conclusion:The ML-based CT texture analysis may be a promising non-invasive technique for determining benign and malignant behaviors of lytic bone lesions that need a biopsy.
