Advanced Imaging of Musculoskeletal Tumors (MST) for Orthopaedic Surgeon

8/13/2019 Advanced Imaging of Musculoskeletal Tumors (MST) for Orthopaedic Surgeon

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Advanced Imaging ofMusculoskeletal Tumors (MST)

for Orthopaedic Surgeon

Paulus Rahardjo


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Paulus Rahardjo

Consultant Radiologist in MusculoskeletalImaging

Teaching Staff of Radiology Dept. School of

Medicine. Airlangga University - Surabaya

Membership:

ASIAN MUSCULOSKELETAL SOCIETY (AMS)-

(Executive committee)

Indonesian Musculoskeletal Tumor Society(Member-Founder)

Musculoskeletal Pathology Team Dr. Soetomo

Hospital-Surabaya (Secretary)

SPINE Team. Dr. Soetomo Hospital- Surabaya


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The objectives of radiologic

evaluation detection of suspected lesion: +/-,soft tissue or bone tumor

establishment of a diagnosis orformulation of an appropriate

differential diagnosis, and

radiologic staging of the lesion

post treatment evaluation


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MRI

CT Scan

Ultrasound

Plain

Radiograph

Scintigraphy


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Radiograph remains the most

reliable predictor of thehistologic nature of a given

lesion

Despite all of the imaging advances: CT,

MRI, Scintigraphy .

Sundaram M, McDonald DJ (1989) The Solitary tumor or tumor like lesion of bone. Topics Magn Reson

Imaging 1(4):17-29


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Tripple diagnosisMultidisciplinary

approach

FNA

Clinical Info Imaging


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Informations needed to formulate diangosis

or differential diagnosis

Growth Rate/ Activity

+

Periosteal reaction

AgeLocation

Matrix calcification


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Growth Rate/ Activity:

Lodwick et al. Radiology 134:577-583,1980

Geographic, moth-eaten, permeative


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Permeative Moth-eaten Geographic


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Periosteal reaction

Uninterupted Interupted Interupted


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Prof. Enneking:

Tell me the age Ill tell you the pathology


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Location

What bone?

Epi/Met/Dia?

Cortex/Med/par-ost/para-ost?

Multiple/single?


13/58Brown tumor - Hyperparathyroidism


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LocationDiagnosis


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Calcification

Chondroblastic vs.

Osteoblastic


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Role of CT scan

Examine the presentor absence of nidus

Demonstrating lesion

in flat bones Confirming anycortical break inlesion with thin cortex

Help characterizedtype of matrixcalcification

Guide to Biopsy


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28/12/2013 Neoplasma Tulang/PRahardjo 17


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28/12/2013 Neoplasma Tulang/PRahardjo 18


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1

2

3


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Staging:

MRI of

Bone tumor


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Soft tissue sarcoma with blood vessel encasement &extra-compartmental infiltration


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Bone

Marrow

Imaging


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Cortical thickening with normal

marrow signal

NORMAL


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MRI: 44 yrs M, malignant

degeneration of osteochondroma?
http://e/metastase_th_l_s/se011.jpg


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http://e/metastase_th_l_s/se011.jpg


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Multiple sites


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Soft Tissue Tumors

And Tumor-like Lesions


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RELATION OF AGE TO INCIDENCE OF SARCOMA

SOFT TISSUE MALIGNANT TUMORS


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Soft tissue

tumors

Plain Film

MRI

Lipoma Probablehemangioma/

IM lipomaDoppler US

Other

Arteriography/ MR

angio

Biopsy


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Plain Radiography

To exclude a palpablelesion caused by an

underlying skeletaldeformity:

* Exuberant callus

* Bony exostosis

* Bone tumor withsoft tissue mass.


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Plain Radiography

Soft tissue calsification

characteristic of a specific

diagnosis:* Phleboliths

* Synovial

osteochondromatosis.

* Myositis ossificans.


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CT scan has been replaced

by MRI


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Soft tissue mass on the chest wall


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Spesific Diagnosis

in MRI

Lipomatous lesions

Angiomatous lesions Tumorlike lesions

Peripheral nerve lesions

Fibrous lesions

Synovial lesions


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Lipoma


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Hemangioma


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Sign of Malignant lesion

Larger

Deeper

More heterogenous Bone & neurovascular

involvement

I filt ti t dj t


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Infiltration to adjacent

compartment


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Neurofibroma


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Variable signal intensity


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Ultrasound + Doppler

Doppler and high resolution

ultrasonography challenges the role

of MRI. It has a few advantages compare to

MRI; low cost, real time scanning

and more available examination.


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Spesific Diagnosis(Soft tissue masses with pathognomonic

imaging appearance)

Angiomatous lesions

Lipomatous lesions Neurogenic tumors

cystic masses


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Phleboliths of hemangioma

Hemangioma


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Lipoma

HypoechoicHomogenous

Well defined margin

Oval

Long axis parallel to skin

Compressible

Neurogenic tumors


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Neurogenic tumors


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Big Bursitis


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Huge

Bakers Cyst


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A case study:

Triple


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ClinicalFindings

Radiology Pathology

TripleDiagnosis


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Terima KasihYou

Advanced Imaging of Musculoskeletal Tumors (MST) for Orthopaedic Surgeon

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