Chemotherapy in the multimodality treatment of osteosarcoma has improved survival. Reported outcomes on adult patients are limited. Poor necrosis rates post neoadjuvant chemotherapy (NAC) is considered an adverse prognostic factor and attempts have been made to improve survival in this group.

Soft tissue tumors are defined as mesenchymal proliferations that occur in the extraskeletal, non-epithelial tissues of the body, excluding the viscera, coverings of the brain and lymphoreticular system [1]. The true frequency of soft tissue tumors is difficult to estimate because most benign lesions are not removed. A conservative estimate is that benign tumors outnumber their malignant counterparts by a ratio of at least 100:1. In the United States only 7,200 sarcomas are diagnosed annually (0.8 percent of invasive malignancies), yet they are responsible for 2 percent of all cancer deaths, reflecting their lethal nature [1]. Classification is based on the tissue from which the lesions arise (Table 16.1). The cause of most soft tissue tumors is unknown. There are documented associations between radiation therapy [2], and rare instances in which chemical burns, heat burns or trauma were associated with subsequent development of sarcoma [1]. Soft tissue tumors may arise in any location, with approximately 50 percent in the extremities (two-thirds of these in the lower extremities), 14 percent in the retroperitoneum, 15 percent in the viscera, 10 percent in the trunk and 11 percent in other sites [3]. Regarding sarcomas, males are affected more frequently than females (ratio 1.4:1), and the incidence generally increases with age. Fifteen percent arise in children and constitute the fourth most common malignancy in this age group [1]. Specific sarcomas tend to appear in certain age groups (e.g., rhabdomyosarcoma in children, synovial sarcoma in young adults and liposarcoma and malignant fibrous histiocytoma in mid- to late adult life) [1].

OBJECTIVE:The purposes of our study were to determine the temporal changes in MR signal in bone after radiofrequency ablation of osteoid osteoma and the size of the zone of marrow signal change produced by the radiofrequency technique and to compare the size of the zone with published data for radiofrequency ablation with manual-control protocols.MATERIALS AND METHODS:Radiofrequency ablation was performed in 10 patients with a clinical and radiologic diagnosis of osteoid osteoma. A cooled radiofrequency probe was inserted in the nidus. Twelve minutes of radiofrequency energy was applied from a 200-W radiofrequency generator in an impedance-control setting. MRI with multiplanar turbo spin-echo T1-weighted and STIR sequences was performed at 1, 7, and 28 days after the procedure in seven patients. The three remaining patients had follow-up imaging at 28 days only. The images were reviewed by two radiologists who categorized the imaging features and measured the marrow zone of signal alteration when visible. The size of the zone of marrow signal change produced by the radiofrequency technique was compared with published data for radiofrequency ablation with manual-control protocols.RESULTS:A 1-mm band of homogeneous altered marrow signal distributed symmetrically parallel to the entire probe tract was seen earliest, at 1 day, in the femoral neck lesion treated with the 2-cm probe. The band was low signal on the T1 sequence and high signal on the STIR sequence, and the diameter of the zone was 27 mm. By 7 days, five of the seven treated bones showed a band of marrow signal alteration. By 28 days, all 10 treated bones had a band of marrow signal alteration. The interband distance at 90 degrees to the probe measured on STIR images at 28 days was a mean of 20.9 mm (confidence interval, 16.1-25.7 mm [p < 0.05]; range +/- measurement error, 10.5-35 +/- 1.64 mm) with a 1-cm probe and 30.5 mm (measurement error, +/- 0.78 mm) on T1 images without contrast material when a 2-cm exposed-tip probe was used. Higher-output generators with impedance-control software and internally cooled radiofrequency probes with longer exposed tips produce larger zones of marrow signal change than expected with manual-control protocols.CONCLUSION:MRI allows detection of temporal marrow signal change after radiofrequency ablation. The marrow signal change with a high-energy delivery protocol is larger than manual-control protocols.

This article reviews technique and clinical applications of whole body MR imaging as a diagnostic tool in cancer staging. In particular the article reviews its role as an alternative to scintigraphy (bone scan and PET) in staging skeletal spread of disease, its role in assessing total tumour burden, its role in multiple myeloma and finally its evolving non oncologic role predominantly assessing total body composition.

Bertolotti’s syndrome is characterised by anomalous enlargement of the transverse process(es) of the most caudal lumbar vertebra which may articulate or fuse with the sacrum or ilium and cause isolated L4/5 disc disease. We analysed the elective MR scans of the lumbosacral spine of 769 consecutive patients with low back pain taken between July 2003 and November 2004. Of these 568 showed disc degeneration. Bertolotti’s syndrome was present in 35 patients with a mean age of 32.7 years (15 to 60). This was a younger age than that of patients with multiple disc degeneration, single-level disease and isolated disc degeneration at the L4/5 level (p ≤ 0.05). The overall incidence of Bertolotti’s syndrome in our study was 4.6% (35 of 769). It was present in 11.4% (20 patients) of the under-30 age group. Our findings suggest that Bertolotti’s syndrome must form part of a list of differential diagnoses in the investigation of low back pain in young people.

We describe the use of whole-body turbo STIR MRI (WBMRI) in the assessment of inflammatory myopathies. The distribution of muscle inflammation was analysed in each of 12 cases undergoing WBMRI, and compared with the clinical presentation and biopsy findings. We concluded that WBMRI may facilitate the characterization of inflammatory myopathies. In allowing identification of the pattern of muscle inflammation, the technique may be useful as a diagnostic discriminator and may help identify sites of inflammation suitable for muscle biopsy.

This study was undertaken to qualitatively and quantitatively compare fast MRI of hips with and without parallel imaging using SENSE (sensitivity encoding). 27 patients underwent MRI of the hips with coronal T1 turbo spin echo (TSE) (repetition time (TR) 500 ms, effective echo time (TEeff) 15 ms, Turbo Factor 4), coronal IR-TSE (TR 2000 ms, TEeff 30 ms, inversion time (TI) 160 ms, Turbo Factor 20) and axial T2 TSE (TR 3000 ms, TEeff 80 ms, Turbo Factor 20) weighted images acquired with and without SENSE with a reduction factor of 2. Conventional imaging was performed in 8 min and 36 s. Images acquired with SENSE were acquired in 5 min and 31 s without a discernible reduction in image quality or a significant quantitative reduction in image signal to noise ratio, contrast to noise ratio or edge enhancement.

PURPOSE To determine whether the secondary cleft sign demonstrated in the symphysis pubis at magnetic resonance (MR) imaging is a marker of injury in athletes presenting with groin pain. MATERIALS AND METHODS Ethics review board approval was not required for studies involving retrospective image or case record review; informed consent for review was not required. Eighteen male athletes (mean age, 24 years; age range, 19-32 years) were included for study. All patients underwent radiography and MR imaging (coronal fast spin-echo T1-weighted, transverse fast spin-echo T2-weighted, and coronal turbo short inversion time inversion-recovery [STIR] imaging) of the pelvis. Subsequent image-guided nonionic contrast material injection was followed by a 0.5% bupivacaine hydrochloride (1 mL) and methyprednisolone acetate (20 mg) injection into the central cleft of the symphysis pubis. Comparison was made between imaging findings at symphyseal cleft injection and appearances at preprocedure MR imaging, with specific reference to the presence of a secondary cleft. The sensitivity and specificity of MR imaging in demonstrating the secondary cleft sign were compared with those of the reference standard, imaging at symphyseal cleft injection. MR images from a reference group of 70 asymptomatic athletes who underwent STIR imaging of the pelvis were analyzed for evidence of a secondary cleft. RESULTS Osteitis pubis was diagnosed in six patients on the basis of radiography and/or MR imaging. A secondary cleft was identified in 12 of 18 patients at MR imaging, was best visualized at coronal STIR imaging, and was confirmed in each patient during contrast material injection into the central physiologic symphyseal cleft. In no patient was a secondary cleft identified at symphyseal cleft injection and not identified at MR imaging (sensitivity and specificity, 100%). In each patient, the side of the secondary cleft corresponded to the side of symptoms that responded to local anesthetic and steroid injection. Four of the six patients with osteitis pubis had evidence of a secondary cleft. In one patient, a secondary cleft was not identified at MR imaging or symphyseal cleft injection, but adductor avulsion was identified at MR imaging. No evidence of a secondary cleft sign at MR imaging was identified in the reference group. CONCLUSION The secondary cleft sign demonstrated at MR imaging is a marker of groin injury in athletes presenting with groin pain.

BACKGROUND:Osteoid osteoma is a painful benign bone tumour. Previously the standard therapy was surgical excision. Image guided radiofrequency ablation can be clinically applied to ablate the tumour in a minimally invasive manner.AIMS:We present a case of an 18-year-old boy who presented with features of chronic left hip arthropathy secondary to intra-articular osteoid osteoma, subsequently successfully treated by percutaneous CT guided radiofrequency ablation.RESULTS:The CT guided radiofrequency ablation was technically successful as a day case procedure without complication. The patient returned to normal function within one week. No recurrence occurred in the three-year follow-up period.CONCLUSION:Radiofrequency ablation is a safe, minimally invasive and effective technique for treatment of osteoid osteoma.

BACKGROUND: Bone involvement in myeloma is conventionally assessed by radiographic skeletal survey (plain x-rays of spine, skull, chest, pelvis and long bones). However this may not pick up bony involvement in all patients who may then present with serious complications of myeloma bone disease such as spinal cord compression. Whole body MRI may be better than skeletal survey at evaluating myeloma bone involvement.

Purpose: To describe magnetic resonance imaging (MRI) findings in patients with suspected Parsonage Turner syndrome and to emphasize the value of an additional whole body MR scan to improve specificity of this diagnosis. Material and Methods: Three patients with proven Parsonage Turner syndrome referred for conventional MRI of the shoulder girdle and additional whole body turboSTIR MRI were included for study. Results: In each case, imaging revealed edema in the muscles of the shoulder girdle. Whole body turboSTIR MRI scan confirmed localized unilateral changes in each case improving specificity and confidence in the diagnosis of Parsonage Turner syndrome in each case. Conclusion: Whole body turboSTIR MR imaging is a useful diagnostic tool in the evaluation of patients with suspected Parsonage Turner syndrome. Inclusion of the brain, neck, brachial plexus, and extremity musculature at whole body imaging allows differentiation from polymyositis and elimination of additional causes of shoulder girdle pain and weakness including gross lesions in the brain, neck, and brachial plexus by a single non‐invasive study.

We propose this ratio as a useful radiological index of PCL attenuation in the presence of normal morphological appearance on MRI scan.

These results suggest that there is a direct correlation between clinical symptoms and meniscal derangement in severe osteoarthritis. Isolated articular defects and bone marrow oedema did not correlate well with location of pain. A greater understanding of the origin of pain in the degenerate knee may assist in the choice of management options for these patients.

Osteopathia striata is an asymptomatic autosomal dominant or sporadically inherited disorder that causes dense striations at sites of endochondral bone formation, with a predilection for the metaphyses of long bones. Melorheostosis is a mixed sclerosing dysplasia with disturbance of both endochondral and intramembranous ossification, in which disordered intramembranous ossification dominates. It presents typical radiological changes of cortical hyperostosis distributed along a sclerotome with variable associated cutaneous and clinical features. Overlap syndromes including one or more of these diseases are described. We report a 44-year-old man with both melorheostosis and osteopathia striata who presented with pain secondary to superimposed osteosarcoma. In reporting this case we discuss the relationship between sclerosing dysplasia and either coexisting or complicating sarcoma.

Widespread use of MRI now allows the routine identification of previously unevaluated traumatic bone marrow oedema and haemorrhage. Similar marrow oedema is identified in patients with tumours, hyperaemia and medullary congestion. Patterns and extent of traumatic bone marrow oedema and haemorrhage are dictated by mechanism. Diffusion techniques may allow precise evaluation of severity of injury. Illustrative examples and discussion are presented. Eustace, S. (2001). Clinical Radiology56, 4-12.

MR Imaging has altered radically the detection, characterization, and the staging of bone tumors. This article reviews MR imaging techniques and appearances of benign and malignant bone tumors that are encountered in the cervical spine.