Abstract
Teaching PointsBone tumours and tumour-like lesions are frequently encountered by radiologists. Although radiographs are the primary screening technique, magnetic resonance imaging (MRI) can help narrow the differential or make a specific diagnosis when a lesion is indeterminate or shows signs of aggressiveness. MRI can extend the diagnostic evaluation by demonstrating several tissue components. Even when a specific diagnosis cannot be made, the differential diagnosis can be narrowed. MRI is superior to the other imaging modalities in detecting bone marrow lesions and tumoral tissue (faint lytic/sclerotic bone lesions can be difficult to visualise using only radiographs). Contrast-enhanced MRI can reveal the most vascularised parts of the tumour and MRI guidance makes it possible to avoid biopsing necrotic areas. MRI is very helpful in local staging and surgical planning by assessing the degree of intramedullary extension and invasion of the adjacent physeal plates, joints, muscle compartments and neurovascular bundles. It can be used in assessing response to neoadjuvant therapy and further restaging. The post-therapeutic follow-up should also be done using MRI. Despite the high quality of MRI, there are a few pitfalls and limitations of which one should be aware. Applications of MRI in bone tumours will probably continue to grow as new sequences are further studied.• When a lesion is indeterminate or shows signs of aggressiveness, MRI is indicated.• When MRI does not lead to a diagnosis, biopsy is indicated.• MRI is superior to the other imaging modalities in detecting bone marrow lesions.• MRI is very helpful in local staging and surgical planning.• MRI is used in assessing the response to neoadjuvant therapy, restaging and post-therapeutic follow-up.
Highlights
magnetic resonance imaging (MRI) is superior to the other imaging modalities in detecting bone marrow lesions
Radiographs are the primary screening technique used for bone tumours and tumour-like lesions [1]
Even when a specific diagnosis cannot be made, MRI can help by narrowing the differential diagnosis
Summary
Serviço de Radiologia do Hospital Mãe de Deus, Rua José de Alencar, 286, Menino Deus, Porto Alegre RS, 90880-480, Brazil. Our purposes are: (1) to discuss MRI features that can help narrow the differential or make a specific diagnosis of bone tumours and tumour-like lesions; (2) explain why MRI is the optimal imaging method for sensitive detection of tumoral tissue, local staging, preoperative evaluation, assessing the response to neoadjuvant therapy, restaging and follow-up, and (3) to discuss potential pitfalls and limitations. MRI is superior to the other imaging modalities in detecting primary and secondary bone lesions [2] because it can conspicuously show areas of abnormal signal intensity within a bone that should contain normal fatty marrow [13] In suspected cases of pathological fractures, MRI should be used to evaluate the existence of an underlying lesion [1] Both benign and malignant tumours usually have inferior signal intensity to the normal marrow signal in T1WI [13]. CT plays a further role in the characterisation of sclerotic or mixed (lytic/sclerotic) lesions and is superior to MRI in the evaluation of osteoid osteoma [10, 35]
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