MR Imaging of Pediatric Musculoskeletal Tumors:: Recent Advances and Clinical Applications

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Key points

  • Diffusion-weighted imaging reflects the tissue cellularity of musculoskeletal tumors, and a low apparent diffusion coefficient value (<1.1) is seen in more cellular and more aggressive tumors, but does not reliably differentiate malignant from benign tumors.

  • Pharmacokinetic value changes in dynamic contrast-enhanced MR imaging after treatment that reflects decreased vessel permeability (Ktrans, Kep) and tumor blood volume (Ve and Vp) reflect and correlate with therapeutic response.

  • High choline

Pediatric musculoskeletal tumors

Childhood sarcomas, including rhabdomyosarcoma (RMS) and other soft tissue sarcomas, Ewing sarcoma (EWS), and osteosarcoma, comprise approximately 10% of childhood malignancies. Pediatric sarcomas are generally treated with a multimodal therapeutic approach that includes some combination of systemic chemotherapy, surgical resection, and/or radiotherapy. Survival for localized pediatric sarcomas improved dramatically after the introduction of dose-intensive multiagent chemotherapy regimens, but

Role of conventional MR imaging techniques

MR imaging is a primary imaging modality in pediatric musculoskeletal tumors. In pediatric bone and soft tissue tumors, MR imaging starts with large field-of-view studies to include joint to joint using short-tau inversion recovery (STIR) and T1WI sequences and provides information for local staging of the primary tumor (T) and nodal staging (N). According to the American Joint Committee on Cancer staging system, malignant bone tumors are defined as T1 (tumor size ≤8 cm), T2 (tumor size >8 cm),

Diffusion-Weighted Imaging

DW imaging exploits the degree of water diffusion (Brownian motion) around the cells,39 represented by a quantitative variable, the apparent diffusion coefficient (ADC) value (×10−3 mm2/s). As opposed to the free environment, water diffusion is restricted in tissues because of several barriers, including cell membranes, organelles, other proteins, and so forth. Thus, restricted diffusion is observed in highly organized, fibrotic, fatty, proteinaceous, cellular tissues or tumors, whereas

Summary

To conclude, many novel MR imaging approaches are now available to exploit tumor cellularity, perfusion, oxygenation, and heterogeneity in the realm of pediatric musculoskeletal tumor imaging. More scientific work with greater interdisciplinary collaboration between physicists, computer specialists, and physicians is needed to optimally use these different techniques. Finally, their incremental value over conventional imaging in providing more functional and physiologic information can help

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  • Cited by (5)

    Dr H.K. Kim serves as consultant with Medpace. Dr A. Chhabra serves as consultant with ICON Medical and receives royalties from Jaypee and Wolters. Drs M-J. Lee, J.G. Pressey, and C.L. Dumoulin have nothing to disclose.

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