1. Orthopaedic Oncology Radiology Review Tae Won Kim, MD PCOM Tumor Review 4.23.16

2. Goals X-ray Bone Scan CT Scan MRI PET Scan

3. Staging Studies 10 yo male presents with following x-ray. Measures 10cm cranio- caudal. Biopsy reveals osteosarcoma. What is the patients AJCC and MSTS stage if: 1.+Lung nodules 2.No lung nodules

4. Describe the xray

5. Enneking 4 Questions Where is the lesion? Central: lies on exact central axis of bone Eccentric: one side of central axis yet within cortices Cortical: center of lesion within substance of cortex Parosteal: center of lesion in soft tissue external to bone Joint: center of lesion within joint

8. What is the lesion doing to the bone? Type of destruction: types I-III I.Geographic: single large hole, punched out between intact and destroyed II.Moth-eaten: irregular poorly define margin III.Permeative: numerous elongated slotted holes parallel to long axis

11. What is the bone doing to the lesion? – Periosteal reaction – “Codman’s triangle” – “Onion skinning” – “Buttressing”

14. Are there any clues (ie. Matrix) on the x-ray that could provide information about the lesion? -Lytic -Blastic -Ground glass -Flocculent, popcorn, punctate -Cloud or smoke-like -Fat -Solid

17. Bone Scan

18. Active Material Technetium-99-MDP methylene diphosphonate

19. Interpret Bone Scan

20. CT Scan

23. MRI T1 vs T2 Fat suppressed Pre vs post-contrast

24. Why do we use contrast? Bright post contrast = vascular Dark post contrast = avascular

25. Basics Dark T1, Dark T2

26. Bright T1, Dark T2, Dark fat suppressed Lipoma

27. Dark T1, Bright T2, No enhancement post- contrast T2 Cysts

28. Dark T1, Bright T2, Enhance post-contrast T2 SARCOMA!

29. Dark T1, Bright T2, Rim-enhancing T2 Abscess/Cyst or Sarcoma

30. MRI Well Circumscribed Soft Tissue masses – think Malignancy Ill-define Soft tissue masses – think Benign

31. PET Scan

32. PET-CT Scan

33. FDG (Fluorodeoxyglucose)

34. Images

36. 50 y/o with Foot Pain

39. Giant Cell Tumor of Bone

41. Osteosarcoma