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MRI differentiation of low-grade from high-grade appendicular chondrosarcoma

  • Musculoskeletal
  • Published:
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Abstract

Objectives

To identify magnetic resonance imaging (MRI) features which differentiate low-grade chondral lesions (atypical cartilaginous tumours/grade 1 chondrosarcoma) from high-grade chondrosarcomas (grade 2, grade 3 and dedifferentiated chondrosarcoma) of the major long bones.

Methods

We identified all patients treated for central atypical cartilaginous tumours and central chondrosarcoma of major long bones (humerus, femur, tibia) over a 13-year period. The MRI studies were assessed for the following features: bone marrow oedema, soft tissue oedema, bone expansion, cortical thickening, cortical destruction, active periostitis, soft tissue mass and tumour length. The MRI-features were compared with the histopathological tumour grading using univariate, multivariate logistic regression and receiver operating characteristic curve (ROC) analyses.

Results

One hundred and seventy-nine tumours were included in this retrospective study. There were 28 atypical cartilaginous tumours, 79 grade 1 chondrosarcomas, 36 grade 2 chondrosarcomas, 13 grade 3 chondrosarcomas and 23 dedifferentiated chondrosarcomas. Multivariate analysis demonstrated that bone expansion (P = 0.001), active periostitis (P = 0.001), soft tissue mass (P < 0.001) and tumour length (P < 0.001) were statistically significant differentiating factors between low-grade and high-grade chondral lesions with an area under the ROC curve of 0.956.

Conclusions

On MRI, bone expansion, active periostitis, soft tissue mass and tumour length can reliably differentiate high-grade chondrosarcomas from low-grade chondral lesions of the major long bones.

Key Points

• Accurate differentiation of low-grade from high-grade chondrosarcomas is essential before surgery

• MRI can reliably differentiate high-grade from low-grade chondrosarcomas of long bone

• Differentiating features are bone expansion, periostitis, soft tissue mass and tumour length

• Presence of these four MRI features demonstrated a diagnostic accuracy (AUC) of 95.6 %

• The findings may result in more accurate diagnosis before definitive surgery

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References

  1. Hogendoorn PCW, Bovee JM, Nielsen GP (2013) Chondrosarcoma (grades I-III), including primary and secondary variants and periosteal chondrosarcoma. In: Fletcher CDM, Bridge JA, Hogendoorn PCW, Mertens F (eds) World Health Organization Classification of Tumours of Soft Tissue and Bone. IARC Press, Lyon, pp 264–268

    Google Scholar 

  2. Inwards CHP (2013) In: Fletcher CDM, Bridge JA, Hogendoorn PCW, Mertens F (eds) World Health Organization Classification of Tumours of Soft Tissue and Bone. IARC Press, Lyon, pp 269–270

    Google Scholar 

  3. Grimer RJ, Carter SR, Tillman RM, Mangham DC, Abudu A, Fiorenza F (2000) Chondrosarcoma of bone. J Bone Joint Surg Am 82-A:1203–1204

    CAS  PubMed  Google Scholar 

  4. Lee FY, Mankin HJ, Fondren G et al (1999) Chondrosarcoma of bone: an assessment of outcome. J Bone Joint Surg Am 81:326–338

    CAS  PubMed  Google Scholar 

  5. Campanacci DA, Scoccianti G, Franchi A et al (2013) Surgical treatment of central grade 1 chondrosarcoma of the appendicular skeleton. J Orthop Traumatol 14:101–107

    Article  PubMed Central  PubMed  Google Scholar 

  6. Donati D, Colangeli S, Colangeli M, Di Bella C, Bertoni F (2010) Surgical treatment of grade I central chondrosarcoma. Clin Orthop Relat Res 468:581–589

    Article  PubMed Central  PubMed  Google Scholar 

  7. Hanna SA, Whittingham-Jones P, Sewell MD et al (2009) Outcome of intralesional curettage for low-grade chondrosarcoma of long bones. Eur J Surg Oncol 35:1343–1347

    Article  CAS  PubMed  Google Scholar 

  8. Verdegaal SH, Brouwers HF, van Zwet EW, Hogendoorn PC, Taminiau AH (2012) Low-grade chondrosarcoma of long bones treated with intralesional curettage followed by application of phenol, ethanol, and bone-grafting. J Bone Joint Surg Am 94:1201–1207

    Article  PubMed  Google Scholar 

  9. Skeletal Lesions Interobserver Correlation among Expert Diagnosticians (SLICED) Study Group (2007) Reliability of histopathologic and radiologic grading of cartilaginous neoplasms in long bones. J Bone Joint Surg Am 89:2113–2123

    Article  Google Scholar 

  10. Murphey MD, Walker EA, Wilson AJ, Kransdorf MJ, Temple HT, Gannon FH (2003) From the archives of the AFIP: imaging of primary chondrosarcoma: radiologic-pathologic correlation. Radiographics 23:1245–1278

    Article  PubMed  Google Scholar 

  11. Hudson TM, Chew FS, Manaster BJ (1982) Radionuclide bone scanning of medullary chondrosarcoma. AJR Am J Roentgenol 139:1071–1076

    Article  CAS  PubMed  Google Scholar 

  12. Yoo HJ, Hong SH, Choi JY et al (2009) Differentiating high-grade from low-grade chondrosarcoma with MR imaging. Eur Radiol 19:3008–3014

    Article  PubMed  Google Scholar 

  13. De Beuckeleer LH, De Schepper AM, Ramon F (1996) Magnetic resonance imaging of cartilaginous tumors: is it useful or necessary? Skeletal Radiol 25:137–141

    Article  PubMed  Google Scholar 

  14. Geirnaerdt MJ, Bloem JL, Eulderink F, Hogendoorn PC, Taminiau AH (1993) Cartilaginous tumors: correlation of gadolinium-enhanced MR imaging and histopathologic findings. Radiology 186:813–817

    CAS  PubMed  Google Scholar 

  15. De Beuckeleer LH, De Schepper AM, Ramon F, Somville J (1995) Magnetic resonance imaging of cartilaginous tumors: a retrospective study of 79 patients. Eur J Radiol 21:34–40

    Article  PubMed  Google Scholar 

  16. Janzen L, Logan PM, O'Connell JX, Connell DG, Munk PL (1997) Intramedullary chondroid tumors of bone: correlation of abnormal peritumoral marrow and soft-tissue MRI signal with tumor type. Skeletal Radiol 26:100–106

    Article  CAS  PubMed  Google Scholar 

  17. Varma DG, Ayala AG, Carrasco CH, Guo SQ, Kumar R, Edeiken J (1992) Chondrosarcoma: MR imaging with pathologic correlation. Radiographics 12:687–704

    Article  CAS  PubMed  Google Scholar 

  18. Evans HL, Ayala AG, Romsdahl MM (1977) Prognostic factors in chondrosarcoma of bone: a clinicopathologic analysis with emphasis on histologic grading. Cancer 40:818–831

    Article  CAS  PubMed  Google Scholar 

  19. Dahlin DC, Beabout JW (1971) Dedifferentiation of low-grade chondrosarcomas. Cancer 28:461–466

    Article  CAS  PubMed  Google Scholar 

  20. Enneking WF (1986) A system of staging musculoskeletal neoplasms. Clin Orthop Relat Res 204:9–24

    PubMed  Google Scholar 

  21. Douis H, Saifuddin A (2012) The imaging of cartilaginous bone tumours. I. Benign lesions. Skeletal Radiol 41:1195–1212

    Article  CAS  PubMed  Google Scholar 

  22. Eefting D, Schrage YM, Geirnaerdt MJ et al (2009) Assessment of interobserver variability and histologic parameters to improve reliability in classification and grading of central cartilaginous tumors. Am J Surg Pathol 33:50–57

    Article  PubMed  Google Scholar 

  23. Geirnaerdt MJ, Hermans J, Bloem JL et al (1997) Usefulness of radiography in differentiating enchondroma from central grade 1 chondrosarcoma. AJR Am J Roentgenol 169:1097–1104

    Article  CAS  PubMed  Google Scholar 

  24. Geirnaerdt MJ, Hogendoorn PC, Bloem JL, Taminiau AH, van der Woude HJ (2000) Cartilaginous tumors: fast contrast-enhanced MR imaging. Radiology 214:539–546

    Article  CAS  PubMed  Google Scholar 

  25. Weiner SD (2004) Enchondroma and chondrosarcoma of bone: clinical, radiologic, and histologic differentiation. Instr Course Lect 53:645–649

    PubMed  Google Scholar 

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Akcnowledgment

The images of the patients in Figs. 1 and 3 have been previously published by us in the following article: The imaging of cartilaginous bone tumours. II. Chondrosarcoma. Douis H, Saifuddin A. Skeletal Radiol. 2013 May;42(5):611-26

We have to emphasize however that the images are not exactly the same and that we either used a different slice position or a different MRI-sequence. Therefore, these exact images have not been previously published. We have nevertheless obtained permission from the publisher Springer to reprint the images.

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Authors and Affiliations

  1. Department of Radiology, The Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK

    Hassan Douis, Leanne Singh & Asif Saifuddin

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  1. Hassan Douis
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  2. Leanne Singh
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  3. Asif Saifuddin
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Correspondence to Hassan Douis.

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Douis, H., Singh, L. & Saifuddin, A. MRI differentiation of low-grade from high-grade appendicular chondrosarcoma. Eur Radiol 24, 232–240 (2014). https://doi.org/10.1007/s00330-013-3003-y

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  • DOI: https://doi.org/10.1007/s00330-013-3003-y

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