advanced imaging of musculoskeletal tumors (mst) for orthopaedic surgeon
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Advanced Imaging ofMusculoskeletal Tumors (MST)
for Orthopaedic Surgeon
Paulus Rahardjo
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Paulus Rahardjo
Consultant Radiologist in MusculoskeletalImaging
Teaching Staff of Radiology Dept. School of
Medicine. Airlangga University - Surabaya
Membership:
ASIAN MUSCULOSKELETAL SOCIETY (AMS)-
(Executive committee)
Indonesian Musculoskeletal Tumor Society(Member-Founder)
Musculoskeletal Pathology Team Dr. Soetomo
Hospital-Surabaya (Secretary)
SPINE Team. Dr. Soetomo Hospital- Surabaya
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The objectives of radiologic
evaluation detection of suspected lesion: +/-,soft tissue or bone tumor
establishment of a diagnosis orformulation of an appropriate
differential diagnosis, and
radiologic staging of the lesion
post treatment evaluation
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MRI
CT Scan
Ultrasound
Plain
Radiograph
Scintigraphy
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Radiograph remains the most
reliable predictor of thehistologic nature of a given
lesion
Despite all of the imaging advances: CT,
MRI, Scintigraphy .
Sundaram M, McDonald DJ (1989) The Solitary tumor or tumor like lesion of bone. Topics Magn Reson
Imaging 1(4):17-29
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Tripple diagnosisMultidisciplinary
approach
FNA
Clinical Info Imaging
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Informations needed to formulate diangosis
or differential diagnosis
Growth Rate/ Activity
+
Periosteal reaction
AgeLocation
Matrix calcification
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Growth Rate/ Activity:
Lodwick et al. Radiology 134:577-583,1980
Geographic, moth-eaten, permeative
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Permeative Moth-eaten Geographic
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Periosteal reaction
Uninterupted Interupted Interupted
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Prof. Enneking:
Tell me the age Ill tell you the pathology
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Location
What bone?
Epi/Met/Dia?
Cortex/Med/par-ost/para-ost?
Multiple/single?
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LocationDiagnosis
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Calcification
Chondroblastic vs.
Osteoblastic
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Role of CT scan
Examine the presentor absence of nidus
Demonstrating lesion
in flat bones Confirming anycortical break inlesion with thin cortex
Help characterizedtype of matrixcalcification
Guide to Biopsy
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28/12/2013 Neoplasma Tulang/PRahardjo 17
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28/12/2013 Neoplasma Tulang/PRahardjo 18
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Staging:
MRI of
Bone tumor
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Soft tissue sarcoma with blood vessel encasement &extra-compartmental infiltration
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Bone
Marrow
Imaging
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Cortical thickening with normal
marrow signal
NORMAL
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MRI: 44 yrs M, malignant
degeneration of osteochondroma?
http://e/metastase_th_l_s/se011.jpg -
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Multiple sites
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Soft Tissue Tumors
And Tumor-like Lesions
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RELATION OF AGE TO INCIDENCE OF SARCOMA
SOFT TISSUE MALIGNANT TUMORS
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Soft tissue
tumors
Plain Film
MRI
Lipoma Probablehemangioma/
IM lipomaDoppler US
Other
Arteriography/ MR
angio
Biopsy
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Plain Radiography
To exclude a palpablelesion caused by an
underlying skeletaldeformity:
* Exuberant callus
* Bony exostosis
* Bone tumor withsoft tissue mass.
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Plain Radiography
Soft tissue calsification
characteristic of a specific
diagnosis:* Phleboliths
* Synovial
osteochondromatosis.
* Myositis ossificans.
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CT scan has been replaced
by MRI
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Soft tissue mass on the chest wall
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Spesific Diagnosis
in MRI
Lipomatous lesions
Angiomatous lesions Tumorlike lesions
Peripheral nerve lesions
Fibrous lesions
Synovial lesions
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Lipoma
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Hemangioma
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Sign of Malignant lesion
Larger
Deeper
More heterogenous Bone & neurovascular
involvement
I filt ti t dj t
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Infiltration to adjacent
compartment
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Neurofibroma
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Variable signal intensity
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Ultrasound + Doppler
Doppler and high resolution
ultrasonography challenges the role
of MRI. It has a few advantages compare to
MRI; low cost, real time scanning
and more available examination.
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Spesific Diagnosis(Soft tissue masses with pathognomonic
imaging appearance)
Angiomatous lesions
Lipomatous lesions Neurogenic tumors
cystic masses
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Phleboliths of hemangioma
Hemangioma
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Lipoma
HypoechoicHomogenous
Well defined margin
Oval
Long axis parallel to skin
Compressible
Neurogenic tumors
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Neurogenic tumors
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Big Bursitis
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Huge
Bakers Cyst
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A case study:
Triple
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ClinicalFindings
Radiology Pathology
TripleDiagnosis
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Terima KasihYou