Abstract
BackgroundThe purpose of this study is to evaluate the role of MRI in musculoskeletal tumours, especially, in prediction of malignancy & to compare whether the diagnosis made on MRI correlates with the cytological/histopathological diagnosis.Methods50 consecutive patients presenting in the Outpatient and Inpatient department of the Department of Orthopaedics or Casualty of Jawaharlal Nehru Medical College and Hospital, AMU, Aligarh, India were included in this study. They were subjected to MR examination on 1.5 Tesla superconducting system (MAGNETOM Avanto, Siemens). After localizer sequences, T1W and STIR images were obtained in longitudinal planes followed by T2W and post contrast T1W images in axial planes. Additional sequences were taken when required. Various imaging characteristics of tumours were evaluated statistically and their respective sensitivity and specificity in prediction of malignancy were obtained.ResultsFeatures associated with benign diagnosis in a large percentage of cases, are size less than 8 cm, sharp margination, homogeneous T2 signal, absence of oedema, necrosis, calcification and fluid-fluid levels. Similarly, malignant tumours are commonly associated with presence of irregular margins, inhomogeneous signal intensity, oedema, necrosis, haemorrhage, fascial penetration, bone changes and neurovascular involvement. A correct histological diagnosis is reached on the basis of imaging studies alone in 65% to 75% of cases. The sensitivity for a MRI diagnosis of malignant tumour was 95% and specificity was 84%.ConclusionDifferentiation of malignant from benign lesions of musculoskeletal system is best made by a combination of clinical and imaging parameters rather than by any single MR characteristic. When a lesion has a non-specific MR imaging appearance, it is useful to formulate a suitably ordered differential diagnosis based on tumour prevalence, patient age, and anatomic location. A systematic approach markedly improves diagnostic results.
Highlights
The purpose of this study is to evaluate the role of MRI in musculoskeletal tumours, especially, in prediction of malignancy & to compare whether the diagnosis made on MRI correlates with the cytological/histopathological diagnosis
There is a wide range of specificity values of MR imaging in differentiation of benign from malignant musculoskeletal lesions reported in the literature
A number of features were associated with a benign diagnosis, including size less than 8 cm, sharp margination, homogeneous T2 signal, absence of edema, and absence of necrosis or calcification and fluidfluid levels (FFLs)
Summary
The purpose of this study is to evaluate the role of MRI in musculoskeletal tumours, especially, in prediction of malignancy & to compare whether the diagnosis made on MRI correlates with the cytological/histopathological diagnosis. There is a wide range of specificity values of MR imaging in differentiation of benign from malignant musculoskeletal lesions reported in the literature. Other researchers have reported that MR imaging has low specificity in differentiation between benign and malignant masses, and most lesions demonstrate a nonspecific appearance [5]. The role of MRI in predicting malignancy has been inadequately studied in literature and here we venture to find out suitable imaging characteristics or a combination of them for prediction of malignancy and to compare whether the diagnosis made on MRI correlates with the histopathological/cytological diagnosis
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