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Pediatr Radiol. 2019 Aug;49(9):1201-1208. doi: 10.1007/s00247-019-04436-y. Epub 2019 Jun 15.

Usefulness of diffusion-weighted MRI in the initial assessment of osseous sarcomas in children and adolescents.

Author information

1
Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada.
2
Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.
3
Department of Medical Imaging, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.
4
University of Ottawa, Ottawa, ON, Canada.
5
Department of Orthopedic Surgery, The Hospital for Sick Children, Toronto, ON, Canada.
6
Department of Surgery, University of Toronto, Toronto, ON, Canada.
7
Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada. mary-louise.greer@sickkids.ca.
8
Department of Medical Imaging, University of Toronto, Toronto, ON, Canada. mary-louise.greer@sickkids.ca.

Abstract

BACKGROUND:

Concern regarding gadolinium deposition in the brain after repeated administration of intravenous gadolinium-based contrast agents has prompted evaluation of imaging alternatives.

OBJECTIVE:

The study purpose was to determine if magnetic resonance imaging (MRI) using conventional sequences with diffusion-weighted imaging (DWI) instead of gadolinium-based contrast-enhanced MRI is valid for local staging and guiding biopsies in osseous sarcomas.

MATERIALS AND METHODS:

Initial pretreatment MRI with DWI and gadolinium-based contrast-enhanced images in patients ≤ 18 years with histopathologically proven osseous sarcomas were included. Two radiologists blinded to collated demographic and clinical data, independently reviewed conventional/DWI and conventional/gadolinium-based contrast-enhanced MRI then conventional sequences alone, recording tumor size, skip lesions, necrosis, neurovascular invasion, enlarged lymph nodes and diffusion restriction. Discrepancies were resolved by a third reader. A single reader measured apparent diffusion coefficient (ADC) values in non-necrotic tumors, then correlated minimum ADC values -- with and without normalization to skeletal muscle -- with relative enhancement.

RESULTS:

Twenty-one patients (mean age: 11.3±4.2 years, 15 [71%] females) had 14 osteosarcomas and 7 Ewing sarcomas, 50% centered in the femur. Conventional/DWI versus conventional/gadolinium-based contrast-enhanced MRI showed agreement for tumor size estimation with significant associations for necrosis (P=0.021), neurovascular involvement (P<0.001) and enlarged lymph nodes (P=0.005). Diagnostic accuracy of conventional/DWI is comparable to conventional/gadolinium-based contrast-enhanced MRI and superior to conventional sequences alone. Comparison between minimum ADC values and relative enhancement showed no correlation (P>0.05).

CONCLUSION:

Significant associations of key imaging features in the initial assessment of osseous sarcomas support DWI as an alternative to gadolinium-based contrast-enhanced MRI. The lack of association between ADC values and relative enhancement suggests that they measure independent constructs, DWI dependent upon tumor cellularity and perfusion.

KEYWORDS:

Children; Diffusion-weighted imaging; Ewing sarcoma; Gadolinium; Magnetic resonance imaging; Osteosarcoma

PMID:
31203404
DOI:
10.1007/s00247-019-04436-y

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