Main description:

During the last decade the therapeutic approach to musculoskeletal tumors has changed dramatically, from ablative surgery with ampu tation ofthe limb to reconstructive surgery with transplantation of bone and vessels combined with radio-and chemotherapy. This has changed the demands on radiologists and pathologists to a considerable degree. At the same time there has been a manifold increase in the diagnostic possibilities offered by modern radiology, with several new modalities affording a potential for morphologic depiction and tissue character ization that was unattainable a decade ago. Today, the definitive diagnostic work-up and treatment of patients with musculoskeletal tumors is most often done in tumor centers, by groups that ideally should be composed of an orthopedic surgeon, radiotherapist, oncologist, radiologist, pathologist and cytologist. It is necessary for all the members of this team to be well versed in the surgi cal and other treatment principles, in the pathologic concepts, and in the radiologic interpretation of musculoskeletal tumors. Moreover, it is important that the modern diagnostic approach to musculoskeletal tumors is well known also at the referring center, be it a private practi tioner's office or a large hospital. This will avoid unnecessary biopsies, and repetition of radiologic and other diagnostic procedures that have already been performed at the referring center.

Contents:

1 General Pathologic Principles of Muscoloskeletal Neoplasia.- Growth Patterns.- Pathways of Growth.- Surgical Staging System.- Histologic Grade.- Anatomic Extent and Surgical Compartments.- Surgical Stage.- References.- 2 Surgical Principles.- Biopsy.- Definitive Surgery.- References.- 3 Radiologic Evaluation: General Remarks.- Local Behavior of the Tumor.- Radiologic Diagnosis.- Local Extent.- The Radiologic Assessment as the Basis for Clinical Management.- Reference.- 4 Diagnostic Imaging Modalities: Technical Comments.- Conventional Radiography and Tomography.- Arthrography.- Angiography (by Irvin F. Hawkins, Jr.).- Choice of Catheters.- Examination of the Upper Extremity.- Examination of the Retroperitoneum and Pelvis.- Examination of the Lower Extremity.- Analgesia.- Digital Subtraction Angiography (DSA).- Carbon Dioxide Angiography.- Xeroradiography.- Ultrasonography.- Scintigraphy.- Computed Tomography (CT).- Patient Position and Choice of Sections.- Contrast Medium Infusion.- Technique for Image Evaluation.- Magnetic Resonance Imaging (MRI).- Field Strength.- Coil Design.- Pulse Sequences.- Imaging Plane and Slice Thickness.- Calculation of Relaxation Times.- NMR Spectroscopy.- References.- 5 Local Behavior of the Tumor: Growth Pattern and Growth Rate.- Bone Tumors.- Bone Destruction as Seen in the Plain Film Examination.- Classification according to Lodwick.- Bone Reaction as Seen in the Plain Film Examination.- Endosteal and Periosteal Reactions.- Endosteal Reaction.- Periosteal Reaction.- A Simplified Classification of Local Behavior.- The Value of Other Modalities for Assessment of Local Behavior.- Soft Tissue Tumors.- References.- 6 Radiologic Diagnosis.- Age of the Patient and Pertinent Clinical Information.- Singularity or Multiplicity of the Tumor.- Localization in the Body and in the Bone.- Size and Shape of the Tumor.- Specific Radiologic Patterns of the Tumor Matrix.- Plain Film Radiography.- Ultrasound.- Angiography.- Scintigraphy.- Computed Tomography.- Magnetic Resonance Imaging.- Tissue Characterization: T1 and T2 Values.- Nuclear Magnetic Resonance Spectroscopy.- The Diagnosis.- References.- 7 Local Extent of the Tumor.- Bone Tumors.- Intraosseous Extent.- Cortical Breakthrough.- Soft Tissue Component.- Joint Involvement.- Soft Tissue Tumors and Bone Tumors with Soft Tissue Extension.- Definition of Involved Compartment(s).- Involvement of the Neurovascular Bundle.- Involvement of Adjacent Bone.- References.- 8 Radiologic Appearance of the Response to Treatment.- Surgery.- Radiation Therapy.- Chemotherapy.- References.- 9 Imaging Protocols.- The Relative Values of the Different Imaging Modalities.- Proposed Protocols.- Bone Tumors.- Soft Tissue Tumors and Bone Tumors with Soft Tissue Extension.- Reference.- 10 Case Examples.