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Purpose: Undifferentiated pleomorphic sarcomas (UPSs) demonstrate therapy-induced hemosiderin deposition, granulation tissue formation, fibrosis, and calcification. We aimed to determine the treatment-assessment value of morphologic tumoral hemorrhage patterns and first- and high-order radiomic features extracted from contrast-enhanced susceptibility-weighted imaging (CE-SWI)., Materials and Methods: This retrospective institutional review board-authorized study included 33 patients with extremity UPS with magnetic resonance imaging and resection performed from February 2021 to May 2023. Volumetric tumor segmentation was obtained at baseline, postsystemic chemotherapy (PC), and postradiation therapy (PRT). The pathology-assessed treatment effect (PATE) in surgical specimens separated patients into responders (R; ≥90%, n = 16), partial responders (PR; 89%-31%, n = 10), and nonresponders (NR; ≤30%, n = 7). RECIST, WHO, and volume were assessed for all time points. CE-SWI T2* morphologic patterns and 107 radiomic features were analyzed., Results: A Complete-Ring (CR) pattern was observed in PRT in 71.4% of R ( P = 7.71 × 10 -6 ), an Incomplete-Ring pattern in 33.3% of PR ( P = .2751), and a Globular pattern in 50% of NR ( P = .1562). The first-order radiomic analysis from the CE-SWI intensity histogram outlined the values of the 10th and 90th percentiles and their skewness. R showed a 280% increase in 10th percentile voxels ( P = .061) and a 241% increase in skewness ( P = .0449) at PC. PR/NR showed a 690% increase in the 90th percentile voxels ( P = .03) at PC. Multiple high-order radiomic texture features observed at PRT discriminated better R versus PR/NR than the first-order features., Conclusion: CE-SWI morphologic patterns strongly correlate with PATE. The CR morphology pattern was the most frequent in R and had the highest statistical association predicting response at PRT, easily recognized by a radiologist not requiring postprocessing software. It can potentially outperform size-based metrics, such as RECIST. The first- and high-order radiomic analysis found several features separating R versus PR/NR.

Undifferentiated pleomorphic sarcoma (UPS) is the largest subgroup of soft tissue sarcomas. This study determined the value of perfusion-weighted imaging with dynamic-contrast-enhancement (PWI/DCE) morphologic, qualitative, and semiquantitative features for predicting UPS pathology-assessed treatment effect (PATE). This retrospective study included 33 surgically excised extremity UPS patients with pre-surgical MRI. Volumetric tumor segmentation from PWI/DCE was obtained at Baseline (BL), Post-Chemotherapy (PC), and Post-Radiation Therapy (PRT). The surgical specimens' PATE separated cases into Responders (R) (≥ 90%, 16 patients), Partial-Responders (PR) (89 - 31%, 10 patients), and Non-Responders (NR) (≤ 30%, seven patients). Seven semiquantitative kinetic parameters and maps were extracted from time-intensity curves (TICs), and 107 radiomic features were derived. Statistical analyses compared R vs. PR/NR. At PRT, 79% of R displayed a "Capsular" morphology (P = 1.49 × 10 -7 ), and 100% demonstrated a TIC-type II (P = 8.32 × 10 -7 ). 80% of PR showed "Unipolar" morphology (P = 1.03 × 10 -5 ), and 60% expressed a TIC-type V (P = 0.06). Semiquantitative wash-in rate (WiR) was able to separate R vs. PR/NR (P = 0.0078). The WiR radiomics displayed significant differences in the first_order_10 percentile (P = 0.0178) comparing R vs. PR/NR at PRT. The PWI/DCE TIC-type II curve, low WiR, and "Capsular" enhancement represent PRT patterns typically observed in successfully treated UPS and demonstrate potential for UPS treatment response assessment., (© 2024. The Author(s).)

Purpose: Limitations from commercial software applications prevent the implementation of a robust and cost-efficient high-throughput cancer imaging radiomic feature extraction and perfusion analysis workflow. This study aimed to develop and validate a cancer research computational solution using open-source software for vendor- and sequence-neutral high-throughput image processing and feature extraction., Methods: The Cancer Radiomic and Perfusion Imaging (CARPI) automated framework is a Python-based software application that is vendor- and sequence-neutral. CARPI uses contour files generated using an application of the user's choice and performs automated radiomic feature extraction and perfusion analysis. This workflow solution was validated using two clinical data sets, one consisted of 40 pelvic chondrosarcomas and 42 sacral chordomas with a total of 82 patients, and a second data set consisted of 26 patients with undifferentiated pleomorphic sarcoma (UPS) imaged at multiple points during presurgical treatment., Results: Three hundred sixteen volumetric contour files were processed using CARPI. The application automatically extracted 107 radiomic features from multiple magnetic resonance imaging sequences and seven semiquantitative perfusion parameters from time-intensity curves. Statistically significant differences ( P < .00047) were found in 18 of 107 radiomic features in chordoma versus chondrosarcoma, including six first-order and 12 high-order features. In UPS postradiation, the apparent diffusion coefficient mean increased 41% in good responders ( P = .0017), while firstorder&#95;10Percentile ( P = .0312) was statistically significant between good and partial/nonresponders., Conclusion: The CARPI processing of two clinical validation data sets confirmed the software application's ability to differentiate between different types of tumors and help predict patient response to treatment on the basis of radiomic features. Benchmark comparison with five similar open-source solutions demonstrated the advantages of CARPI in the automated perfusion feature extraction, relational database generation, and graphic report export features, although lacking a user-friendly graphical user interface and predictive model building.

Purpose: Chondrosarcomas arise from the lateral pelvis; however, midline chondrosarcomas (10%) display similar imaging features to chordoma, causing a diagnostic challenge. This study aims to determine the diagnostic accuracy of apparent diffusion coefficient (ADC)-based radiomic features and two novel diffusion indices for differentiating sacral chordomas and chondrosarcomas., Methods: A retrospective, multireader review was performed of 82 pelvic MRIs (42 chordomas and 40 chondrosarcomas) between December 2014 and September 2021, split into training (n = 69) and validation (n = 13) data sets. Lesions were segmented on a single slice from ADC maps. Eight first-order features (minimum, mean, median, and maximum ADC, standard deviation, skewness, kurtosis, and entropy) and two novel indices: restriction index (RI, proportion of lesions with restricted diffusion) and facilitation index (FI, proportion of lesions with facilitated diffusion) were estimated. One hundred seven radiomic features comparing patients with chondrosarcoma versus chordoma were sorted based on mean group differences., Results: There was good to excellent interobserver reliability for eight of the 10 ADC metrics on the training data set. Significant differences were observed ( P < .005) for RI, FI, median, mean, and skewness using the training data set. Optimal cutpoints for diagnosis of chordoma were RI > 0.015; FI < 0.25; mean ADC < 1.7 × 10 -3 mm 2 /s; and skewness >0.177. The optimal decision tree relied on FI. In a secondary analysis, significant differences ( P < .00047) in chondrosarcoma versus chordoma were found in 18 of 107 radiomic features, including six first-order and 12 high-order features., Conclusion: The novel ADC index, FI, in addition to ADC mean, skewness, and 12 high-order radiomic features, could help differentiate sacral chordomas from chondrosarcomas.

The mechanisms by which tumors metastasize to bone are complex. Upon the successful establishment of metastatic deposits in the skeleton, detection of the disease becomes essential for therapeutic planning. The roles of CT, skeletal scintigraphy, SPECT/CT, MRI, PET/CT and PET/MRI will be reviewed. Therapeutic response criteria specifically designed to evaluate bone metastases (MD Anderson/MDA criteria) can guide image interpretation. Knowledge of therapeutic strategies such as systemic therapy with bisphosphonates or radiopharmaceuticals, radiation therapy, surgery, and percutaneous interventions such as vertebroplasty and radiofrequency ablation can help the radiologist produce reports that will provide maximum benefit to clinicians and patients., (Published by Elsevier Inc.)

According to the Revised Response Evaluation Criteria in Solid Tumors (RECIST) 1.1, the majority of bone metastases are considered to be nonmeasurable disease. Traditional response criteria rely on physical measurements. New criteria would be valuable if they incorporated newly developed imaging features in order to provide a more comprehensive assessment of oncological status. Advanced magnetic resonance imaging (MRI) sequences such as diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) with dynamic contrast-enhanced (DCE) perfusion imaging are reviewed in the context of the initial and post-therapeutic assessment of musculoskeletal tumors. Particular attention is directed to the pseudoprogression phenomenon in which a successfully treated tumor enlarges from the pretherapeutic baseline, followed by regression without a change in therapy., (Published by Elsevier Inc.)

The radiographic appearance of primary bone tumors is important for initial diagnosis and often augments histopathological analysis. The original grading system relied on the radiographic analysis of the margin of the lesions to determine tumor aggression, which often corresponds with malignant potential. The recently developed, modified Lodwick-Madewell grading system also incorporates the appearance of lesion margins on radiographs but also considers the change in margins on serial radiographs and includes a category for clinically suspected, radiographically occult, aggressive lesions. This article reviews the prior and modified grading systems, and the concepts necessary for proper interpretation of the initial appearance of bone tumors which often determines the radiologist's recommendation for biopsy or follow-up imaging., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Functional imaging can add valuable information to conventional imaging in the settings of tumor characterization and treatment response assessment. Traditional response criteria rely primarily on physical measurements, while functional imaging can potentially give a more comprehensive evaluation of oncological status. The second part of this review article discusses advanced imaging techniques such as susceptibility-weighted imaging, tumor-associated macrophage imaging, diffusion-weighted imaging, perfusion-weighted imaging, Dixon imaging, whole-body magnetic resonance imaging, whole-body low-dose dual energy computed tomography with virtual noncalcium technique, and ultrasound elastography., (Published by Elsevier Inc.)

The responsible use of gadolinium-based contrast agents (GBCAs) requires a balance between safety and clinical utility. While nephrogenic systemic fibrosis (NSF) has been associated with most linear GBCAs few, if any, new cases have been verified since the successful implementation of screening programs to detect renal impairment and prevent susceptible patients from receiving these higher-risk agents. The likelihood of developing nephrogenic systemic fibrosis has been shown to be negligible with macrocyclic agents, prompting the American College of Radiology and other regulatory agencies to suggest that no screening is necessary when they are used. There is no solid evidence of negative clinical effect from the retention of macrocyclic agents in the brain while there is evidence that they wash out of the brain over time. GBCAs have many important clinical uses that can help prevent morbidity or death. This article reviews the risks and benefits of GBCA administration., (Copyright © 2019. Published by Elsevier Inc.)

The Publisher regrets that this article is an accidental duplication of an article that has already been published in [Seminars in Ultrasound, CT, and MRI, 41/2 (2020) 170–182], https://dx.doi.org/10.1053/j.sult.2019.12.005. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal, (Copyright © 2020 Elsevier Inc. All rights reserved.)

Purpose: To determine the diagnostic efficacy of gadolinium-based contrast agents for the detection of recurrent soft-tissue sarcoma compared with non-contrast-enhanced conventional MRI sequences., Materials and Methods: A retrospective study of patients with soft-tissue sarcomas who were imaged from January 2009 to December 2014 was performed. MRI studies from 69 patients (mean age, 61 years ± 15 [standard deviation], 45 men) with recurrent soft-tissue sarcoma and 63 age-, sex-, and tumor-matched controls with positive findings (nonrecurrence) were presented to six musculoskeletal radiologists at a tertiary cancer center in three image groupings. Group 1 consisted of precontrast T1-weighted and fat-suppressed T2-weighted images (no contrast agent). Group 2 consisted of precontrast and postcontrast fat-saturated T1-weighted images. Group 3 consisted of precontrast and fat-saturated postcontrast T1- and fat-suppressed T2-weighted images. Images within these three groups contained either recurrent soft-tissue sarcomas or positive postoperative findings (nonsarcoma). The presentation order of the first two image sets was reversed for half the readers. The readers were asked to classify presence of tumor on a five-point scale. The average score from the readers was used as consensus score for each case, and a case was considered positive if the average score was less than 3. Receiver operating characteristic (ROC) analysis was performed using the average score for each image set., Results: Assessment of the group 3 image set resulted in higher sensitivity (74%, 95% confidence interval [CI]: 62%, 83%) than the group 2 image set (64%, 95% CI: 51%, 75%), which was also more sensitive than the assessment of the group 1 images set (49%, 95% CI: 37%, 61%), with P = .02 for both. There was no significant difference in specificity between the three groups. The area under the ROC curve (AUC) for the assessment of group 1 was 0.78 (95% CI: 0.70, 0.86), which was significantly lower than that of group 2, 0.92 (95% CI: 0.87, 0.96) and group 3, 0.93 (95% CI: 0.88, 0.97), with P values of .0006 and < .0001, respectively. There was no difference between the AUCs of groups 2 and 3 ( P = .58)., Conclusion: Gadolinium-based contrast agents improved diagnostic performance in detection of recurrent soft-tissue sarcoma. Addition of fat-saturated T2-weighted images provided modest improvement in sensitivity. Keywords: Efficacy Studies, MR-Contrast Agent, Oncology, Soft Tissues/Skin© RSNA, 2020., Competing Interests: Disclosures of Conflicts of Interest: B.A. disclosed no relevant relationships. W.A.M. disclosed no relevant relationships. T.M.H. Activities related to the present article: Received administrative support from Anderson Cancer Center (home institution). Activities not related to the present article: received an honorarium for speaking at Emory University; received minimal (less than $10) royalties from the University of Alabama Press; invited to give a lecture at Emory University and expenses were paid by Emory University. Other relationships: disclosed no relevant relationships. R.K. disclosed no relevant relationships. K.W.M. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: consultant for CodaMetrix; employed with MD Anderson Cancer Center; has received Trusted Advisor Travel expenses reimbursements from Philips Healthcare. Other relationships: disclosed no relevant relationships. J.E.M disclosed no relevant relationships. B.M.M. disclosed no relevant relationships. W.W. disclosed no relevant relationships. C.M.C. disclosed no relevant relationships., (2020 by the Radiological Society of North America, Inc.)

OBJECTIVE. The objective of this video article is to discuss the use of the scapular osteocutaneous free flap in reconstructive procedures. We attempt to discuss normal and variant vascular anatomy, image acquisition via CT angiography, and image interpretation as well as computer-assisted design and manufacturing. CONCLUSION. The scapular osteocutaneous free flap is commonly used for maxillary and mandibular reconstructive surgery. The complex vasculature supplying the scapular region allows flap versatility. There are anatomic variations in the origin of the circumflex scapular and angular arteries. Our method of performing and reporting CT angiography for patients scheduled to undergo scapular osteocutaneous free flap procedures provides a reliable and reproducible means of communicating important elements of vasculature to surgeons. This in turn can facilitate the manufacturing of custom scapular cutting guides and improve surgical outcomes.

Objective: The objective of this video article is to provide an introduction to the use of fibular free flaps. Normal and variant vascular anatomy of the fibular free flap is discussed, as are imaging acquisition and CT angiography interpretation, computer-assisted design and manufacturing, and the limitations of the fibular free flap., Conclusion: The fibular free flap is commonly used for head and neck reconstructive surgery. Variation exists between individuals regarding the origin of the peroneal artery and the perforating arteries. Our method of performing CT angiography and reporting its findings for patients undergoing a fibular free flap procedure provides a reproducible means of identifying important elements of the vasculature and effectively communicating their locations to surgeons. Accurate communication can maximize the success of the flap harvesting and the preoperative manufacture of custom fibular cutting guides.

Objective : The existing literature of 18 F-FDG PET/CT in Ewing sarcoma investigates mixed populations of patients with both soft tissue and bone primary tumors. The aim of our study was to evaluate whether the maximum standardized uptake value (SUVmax) obtained with 18F-FDG PET/CT before and after induction chemotherapy can be used as an indicator of survival in patients with Ewing sarcoma originating exclusively in the skeleton. Materials and Methods: A retrospective database search from 2004-2011 identified 28 patients who underwent 18 F-FDG PET/CT before (SUV1, n= 28) and after (SUV2, n=23) induction chemotherapy. Mean follow up was 3.3 years and median follow up for survivors was 6.3 years (range: 2.6-9.8 years). Multivariate and univariate Cox proportional hazard model was used to assess for correlation of SUV1, SUV2, and the change in SUVmax with overall survival (OS) and progression-free survival (PFS). Results: Mean SUVmax was 10.74 before (SUV1) and after 4.11 (SUV2) induction chemotherapy. High SUV1 (HR = 1.05, 95% CI: 1.0-1.1, P = 0.01) and SUV2 (HR =1.2, 95% CI: 1.0-1.4, P = 0.01) were associated with worse OS. A cut off point of 11.6 was identified for SUV1. SUV1 higher than 11.6 had significantly worse OS (HR = 5.71, 95% CI: 1.85 - 17.61, P = 0.003) and PFS (HR = 3.16, 95% CI: 1.13 - 8.79, P = 0.03, P < 0.05 is significant). Conclusion: 18F-FDG PET/CT can be used as a prognostic indicator for survival in primary Ewing sarcoma of bone., Competing Interests: Competing Interests: Our third co-author is a consultant for Sage Health Management Solutions.

Objective: This video article will review the relevant vascular anatomy of the anterolateral thigh flap, describe the CT angiography (CTA) image acquisition, and describe how to report the locations of the perforating arteries along with characteristics that may be important to the surgeon., Conclusion: Our method of performing and reporting CTA for patients scheduled to undergo anterolateral thigh flap reconstruction provides a reproducible method of identifying perforating vessels and communicating their location to surgeons.

Purpose: Osteoclast-mediated bone resorption through src kinase releases growth factors, sustaining bone metastases. This trial determined the recommended phase II dose (RP2D) and clinical efficacy of the src kinase inhibitor dasatinib combined with zoledronic acid in bone predominant, HER2-negative breast cancer metastases., Experimental Design: A 3+3 lead in phase I design confirmed the RP2D allowing activation of the single-arm, phase II trial. Zoledronic acid was administered intravenously on day 1, and dasatinib was given orally once daily for 28 days each cycle as twice daily administration caused dose-limiting toxicity (DLT). Response was assessed every three cycles. N-telopeptide (NTx) was serially measured., Results: A total of 25 patients were enrolled. No DLTs were noted at the RP2D of dasatinib = 100 mg/d. Common adverse events were grade 1-2: rash (9/25, 36%), fatigue (9/25, 36%), pain (9/25, 36%), nausea (6/25, 20%). The objective response rate in bone was 5/22 (23%), all partial responses (PR). The clinical benefit rate [PRs + stable disease (SD) ≥ 6 months] in bone was 8/22 (36%). Median time to treatment failure was 2.70 months [95% confidence interval (CI), 1.84-5.72] in the general cohort, 3.65 months (95% CI, 1.97-7.33) in patients with hormone receptor (HR)-positive breast cancer and 0.70 months (95% CI, 0.30-NA) in those with HR-negative disease. Factors associated with response in bone included lower tumor grade, HR-positive status, and pretreatment high NTx levels., Conclusions: Combination therapy was well tolerated and produced responses in bone in patients with HR-positive tumors. Clin Cancer Res; 22(23); 5706-12. ©2016 AACR., (©2016 American Association for Cancer Research.)

Background: Plasmablastic lymphoma (PBL) is an aggressive variant of diffuse large B-cell lymphoma. We sought to assess the treatment outcomes after combined-modality therapy for early-stage PBL., Materials and Methods: We retrospectively reviewed the outcomes of 10 consecutive patients diagnosed with stage I-II PBL from February 2001 to December 2013 at a single institution. The baseline clinical characteristics, treatment modalities, overall outcomes, and treatment-related toxicity were assessed., Results: The median age at diagnosis was 50.5 years. All patients had extranodal disease; 2 were positive for human immunodeficiency virus. Seven patients received hyper-CVAD (cyclophosphamide, vincristine, doxorubicin, dexamethasone)-based chemotherapy, 2 received CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone), and 1 received dose-adjusted EPOCH (etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin). Radiotherapy (RT) was administered after a complete response to chemotherapy in 7 patients and a partial response in 1 patient. At a median follow-up period of 42 months, the estimated 2-year progression-free and overall survival rates were 90% and 100%, respectively., Conclusion: PBL can be successfully treated with aggressive chemotherapy followed by RT. The treatment was well tolerated and can result in long-term survival for patients with limited-stage disease., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objective: Numerous primary bone tumors are encountered on (18)F-FDG PET/CT, and many are FDG avid. The degree of FDG uptake in bone tumors does not necessarily reflect malignant potential. In conjunction with radiographs, evaluation of morphologic characteristics on the CT portion of PET/CT scans is important for characterization of the lesions. FDG PET/CT has been found to be useful for staging and has also been found to reflect prognosis in some primary bone malignancies. The purpose of this article is to familiarize the reader with topics regarding FDG PET/CT and both malignant and benign primary bone tumors., Conclusion: FDG uptake alone is not adequate for characterizing primary bone tumors, and morphologic evaluation is an important factor in the interpretation of PET/CT scans. After diagnosis, FDG avidity and morphologic features can play an important role in staging and determining response to therapy. On completion of this article, readers should have an improved ability to evaluate the FDG uptake and CT morphologic features of malignant and benign primary bone tumors. Readers should also have a better understanding of the potential role of FDG PET/CT in the management of patients with osteosarcoma and Ewing sarcoma.

Objective: To assess the diagnostic performance of (18)F-FDG PET-CT in differentiating soft tissue sarcomas (STSs) from benign fluid collections (BFs)., Materials and Methods: Four readers independently reviewed 100 lesions on (18)F-FDG PET-CT and subjectively classified each lesion as an STS or BF and scored the spatial pattern of (18)F-FDG avidity (SP) of each on a 4-point ordered scale (thin, moderate, thick, solid)., Results: Subjective assessment by readers allowed sensitive (91%-98%) differentiation of STSs from BFs, with lower specificity (59%-91%). The STSs had significantly higher SUVmax (median 10.7, range: 2.0-33.7) than BFs (median 2.8, range: 1.1-12.3). Reader agreement in assessment of SP had average κ = 0.61 (range 0.46-0.70). Classification of thick or solid SP as STS yielded an inter-reader averaged sensitivity and specificity of 69% and 98%, respectively. The presence of thick or solid SP resulted in 14.1-fold increase in partial odds of STS. Each unit increase in SUVmax resulted in 1.35-fold increase in partial odds of STS. The receiver operating characteristic (ROC) curves and 95% intervals for SUVmax alone and SUVmax + SP overlapped. The average subjective assessments for the four readers and estimated performance of using SP alone were both contained within the 95% intervals of the two ROC curves., Conclusions: (18)F-FDG PET-CT is a sensitive modality for differentiating STSs from BFs. SUVmax and SP are significantly associated with STS. Classification schemes based upon SUVmax alone or augmented with SP can be useful for distinguishing STS from BF.

Objective. The default window setting on PET/CT workstations is soft tissue. This study investigates whether bone windowing and hybrid FDG PET/CT can help differentiate between malignant and benign primary bone tumors. Materials and methods. A database review included 98 patients with malignant (n=64) or benign primary bone (n=34) tumors. The reference standard was biopsy for malignancies and biopsy or >1 year imaging follow-up of benign tumors. Three radiologists and/or nuclear medicine physicians blinded to diagnosis and other imaging viewed the lesions on CT with bone windows (CT-BW) without and then with PET (PET/CT-BW), and separate PET-only images for malignancy or benignity. Three weeks later the tumors were viewed on CT with soft tissue windows (CT-STW) without and then with PET (PET/CT-STW). Results. Mean sensitivity and specificity for identifying malignancies included: CT-BW: 96%, 90%; CT-STW: 90%, 90%; PET/CT-BW: 95%, 85%, PET/CT-STW: 95%, 86% and PET-only: 96%, 75%, respectively. CT-BW demonstrated higher specificity than PET-only and PET/CT-BW (p=0.0005 and p=0.0103, respectively) and trended toward higher sensitivity than CT-STW (p=0.0759). Malignant primary bone tumors were more avid than benign lesions overall (p<0.0001) but the avidity of benign aggressive lesions (giant cell tumors and Langerhans Cell Histiocytosis) trended higher than the malignancies (p=0.08). Conclusion. Bone windows provided high specificity for distinguishing between malignant and benign primary bone tumors and are recommended when viewing FDG PET/CT.

Purpose: The purpose of the study was to evaluate the conspicuity of bone metastases on each of the numerous sequences produced by fast Dixon-based multisequence whole-body (WB) magnetic resonance imaging (MRI) scanning in order to determine the most clinically useful sequences overall and per anatomic region., Materials and Methods: Twenty-seven breast cancer patients with bone metastases were prospectively studied with fast Dixon-based WB MRI including head/neck, chest, abdominal, pelvic, thigh, calf/feet and either cervical, thoracic and lumbar or cervical/thoracic and thoracic/lumbar regions. Sequences included coronal T2, axial T1 without and with intravenous gadolinium (+C), sagittal T1 spine+C, each associated fat-only (FO) and fat-saturated (FS) sequence, axial diffusion-weighted imaging (DWI) and short tau inversion recovery (STIR). Blinded reviewers evaluated lesion conspicuity, a surrogate of clinical utility, on a five-point scale per anatomic region. Sequences were compared using analysis of variance, differences were detected with Tukey's honestly significant difference test, and the four sequences with highest mean conspicuity were compared to the remainder overall and per anatomic region., Results: Overall, a significant lesion conspicuity difference was found (P<.0001), and lesion conspicuity was significantly higher on FS T1+C, FO T1+C, T1+C sagittal and FS T1+C axial sequences (P<.0001). Per-region results were the same in the head/neck. Other sequences overlapped with these and included the following: chest/abdomen - FO T2, DWI; pelvis - DWI, FO T2; thigh - FS T2, FO T2, FO T1+C; calf/feet - FS T2, DWI, FO T2, STIR., Conclusion: Overall, bone lesions were most conspicuous on FS T1+C sagittal, FO T1+C sagittal, T1+C sagittal and FS T1+C axial fast Dixon WB MRI sequences., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Background: In our previous study, new MD Anderson (MDA) bone tumor response criteria (based on computed tomography [CT], plain radiography [XR], and skeletal scintigraphy [SS]) predicted progression-free survival (PFS) better than did World Health Organization (WHO) bone tumor response criteria (plain radiography [XR] and SS) among patients with breast cancer and bone-only metastases. In this pilot study, we tested whether MDA criteria could reveal bone metastasis response earlier than WHO criteria in patients with newly diagnosed breast cancer with osseous and measurable nonosseous metastases., Methods: We prospectively analyzed bone metastasis response using each imaging modality and set of bone response criteria to distinguish progressive disease (PD) from non-PD and their association with PFS and overall survival (OS). We also compared the response of osseous metastases assessed by both criteria with the response of nonosseous measurable lesions., Results: The median follow-up period was 26.7 months (range, 6.1-53.3 months) in 29 patients. PFS rates differed at 6 months based on the classification of PD or non-PD using either set of criteria (MDA, P = .002; WHO, P = .014), but these rates, as well as OS, did not differ at 3 months. Response in osseous metastases by either set of criteria did not correlate with the response in nonosseous metastases., Conclusion: MDA and WHO criteria predicted PFS of patients with osseous metastases at 6 months but not at an earlier time point. We plan a well-powered study to determine the role of MDA criteria in predicting bone tumor response by incorporating 18-fluorodeoxyglucose ((18)F) positron emission tomography (FDG-PET)/CT to see if findings using this modality are earlier than those with WHO criteria., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Objective: The purpose of this article is to review the normal and abnormal radiographic appearances of cardiac pacemaker and implantable cardioverter defibrillator systems., Conclusion: Chest radiographs showing pacemakers and implantable cardioverter defibrillators contain identifying and clinically relevant information, such as MRI compatibility and possible malfunction. Accurate and timely reporting of these features provides important information that can improve patient care.

Objective: Our purposes were to explore the epidemiology of metastases to skeletal muscle and their detection on fused positron emission tomography and computed tomography., Materials and Methods: We evaluated the epidemiology of skeletal muscle metastases in the literature and among cases from our hospital and studied the prevalence and appearance of skeletal muscle metastases among 433 patients undergoing fused positron emission tomography and computed tomography for non-small-cell lung cancer., Results: We found 264 cases of skeletal muscle metastases in 151 articles. Mean age was 57.8 years with 67% men. At our hospital we studied 70 cases. Mean patient age was 55.7 years with 63% men. The most common source was lung cancer, and the most common site of involvement was the muscles of the trunk. Among our lung cancer patients undergoing fused positron emission tomography and computed tomography, we found 7 (1.6%) with skeletal muscle metastases. In only one of these seven patients was the metastasis first discovered by another imaging modality. In one patient discovery of the metastasis at fused positron emission tomography and computed tomography changed management., Conclusion: Skeletal muscle metastases are not rare. They may be more apparent at fused positron emission tomography and computed tomography than at other staging examinations, particularly contrast-enhanced CT scanning. Radiologists need to be alert to their presence when interpreting staging examinations in cancer patients.

Background: Numerous imaging modalities may be used to detect bone metastases (BM) in women with breast cancer., Methods: Systematic evidence review, including quality appraisal, of studies reporting on comparative imaging accuracy for detection of BM from breast cancer., Results: Eligible studies (N = 16) included breast cancer subjects who had imaging evaluation for suspected BM or for staging/restaging in suspected local or distant relapse. Median prevalence of BM was 34.0% (range 10.0%-66.7%). There was substantial heterogeneity in the quality of reference standards and in the prevalence of BM, which could account for some of the differences in reported comparative accuracy. Most frequently, bone scan (BS) was compared with newer imaging modalities in subjects selected to both tests; therefore, results could be affected by selection bias. There was some evidence that positron emission tomography (PET), and limited evidence that PET/computed tomography (CT), CT, and magnetic resonance imaging (MRI), may provide small increments in accuracy relative to BS as add-on tests; there was little evidence regarding single photon emission computed tomography or whole-body MRI., Conclusions: There is some evidence of enhanced incremental accuracy for some of the above-mentioned tests where used as add-on in subjects selected to more than one imaging modality, with little evidence to support their application as a replacement to BS in first-line imaging of BM. PET/CT appears to have high accuracy and is recommended for further evaluation.

Purpose: To evaluate the feasibility of fast Dixon whole-body (WB) magnetic resonance imaging (MRI) for detecting bone and liver metastasis in clinical patients and to compare its performance with skeletal scintigraphy (SS) for detecting bone metastases using reference imaging with >1 year follow-up as the gold standard., Materials and Methods: Twenty-nine patients with bone metastases prospectively underwent WB MRI and SS. WB MRI included coronal T2, axial T1 with and without intravenous gadolinium (including triphasic liver sequences), and axial diffusion-weighted imaging, plus spinal sagittal postcontrast T1-weighted images. The skeleton was divided into 16 segments. Reviewers blinded to other images identified up to five lesions per segment and rated them using a five-point confidence scale for metastatic disease. Sensitivities and specificities were compared using the McNemar test., Results: The sensitivity of WB MRI and SS in detecting bone metastases was 70.8% and 59.6% (P = 0.003), respectively; specificity was 89.1% and 98.7% (P < 0.0001). WB MRI detected all livers with metastases (n = 8). One focal nodular hyperplasia was classified as a metastasis on WB MRI., Conclusion: Fast Dixon WB MRI is feasible in clinical patients, highly specific, and more sensitive than SS in detecting bone metastases, and can detect metastases of the liver., (Copyright © 2011 Wiley Periodicals, Inc.)

Objective: Inversion recovery has been used to correct the loss of CSF and tissue contrast at 3 T versus 1.5 T but has not been formally investigated in the spine after IV administration of gadolinium-based contrast agent. The purpose of this study is to compare two sequences for gadolinium-enhanced spine imaging at 3 T--fat-saturated T1-weighted FLAIR and fat-saturated T1-weighted fast spin-echo (FSE)--for evaluation of extradural lesions and CSF-cord contrast., Materials and Methods: After IV administration of gadolinium-based contrast agent, fat-saturated T1-weighted FSE and FLAIR sequences were obtained in 156 MRI scans of 143 patients at 3 T. Three experienced radiologists compared these sequences for conspicuity differences in bone lesions, disk lesions, other epidural lesions, and cord-CSF contrast. A 7-point visual rating scale was used, with lower numbers indicating increased conspicuity on gadolinium-enhanced fat-saturated T1-weighted FLAIR and higher numbers indicating increased conspicuity on gadolinium-enhanced fat-saturated T1-weighted FSE., Results: A slight increase in the conspicuity of gadolinium-enhancing bone lesions (mean score, 3.6; p < 0.0001), disk lesions (mean score, 3.5; p < 0.0001), and epidural lesions (mean score, 3.4; p < 0.0001) was seen on fat-saturated T1-weighted FLAIR compared with fat-saturated T1-weighted FSE. A higher degree of contrast between the spinal cord and CSF was seen on fat-saturated T1-weighted FLAIR, by a large margin (mean score, 1.8; p < 0.0001). All enhancing lesions seen on fat-saturated T1-weighted FSE images were also seen on fat-saturated T1-weighted FLAIR images., Conclusion: Decreased CSF-cord contrast at 3 T, as seen on T1-weighted FSE, can be regained by using T1-weighted FLAIR. Fat-saturated T1-weighted FLAIR may increase conspicuity of gadolinium-enhancing extradural lesions compared with fat-saturated T1-weighted FSE.

Objective: The purpose of this study was to determine, first, the accuracy with which radiologists reading posteroanterior chest radiographs differentiate whether a central venous line is in the superior vena cava or the azygos vein and, second, the circumstances in which radiologists may omit the lateral view to determine the position of a central venous line., Materials and Methods: Twenty-four radiologists evaluated 60 posteroanterior chest radiographs to determine the position of a central venous line in the superior vena cava or azygos vein. Investigators evaluated the appearance of the central venous lines to refine rules for determining central venous line position on a frontal radiograph and omitting the lateral view., Results: The accuracy of posteroanterior radiography for determining central venous line position was 90% at one study location and 85.5% at the other. No central venous line in the azygos vein extended more than 10.9 mm caudal to the cephalic edge of the right main bronchus. No central venous line in the superior vena cava had a down-the-barrel or curved appearance at the caudal edge., Conclusion: For central venous lines extending at least 15 mm caudal to the cephalic edge of the right main bronchus and having no down-the-barrel or curved caudal appearance, categorization was nearly 100% accurate. Therefore, if desired to save radiation exposure and cost, it may be feasible to omit lateral views in radiography of patients with central venous lines extending at least 15 mm caudal to the cephalic edge of the right main bronchus in whom the caudal edge does not have a down-the-barrel or curved appearance.

Objective: To evaluate the effect of half-dose intravenous gadolinium contrast on the enhancement of bone and soft tissue tumors., Materials and Methods: This study is HIPAA compliant and informed consent was waived by the institutional review board. An institutional database search was performed over a 1-year period for patients with full- and half-dose MR examinations performed for musculoskeletal oncologic indications. Examination pairs that were identical with regard to field strength and presence or absence of fat saturation were included, resulting in 29 paired examinations. When multiple, the lesion that was best delineated and enhanced well on the first examination in the pair was chosen, yielding 17 bone and 12 soft tissue. Five musculoskeletal radiologists blinded to dosages were asked to assess for a difference in enhancement when comparing the lesion on both examinations and to rate the degree of difference on a three-point scale. They were also asked to identify the examination on which the lesion enhanced less (tallied as low dose). Results were analyzed with the exact binomial test., Results: The readers perceived an enhancement difference in 41% (59/145) of studies (p = 0.03) and the majority were rated as "mild" (66%, 39/59). The readers did not accurately identify the low-dose examinations (54% correctly identified, 32/59, p = 0.60)., Conclusions: Half-dose gadolinium enhancement of lesions could not be accurately distinguished from full-dose enhancement upon review of the same lesion imaged at both concentrations.

Purpose: Fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) may reveal distant metastases more accurately than conventional imaging (CT, skeletal scintigraphy, chest radiography). We hypothesized that patients diagnosed with stage III noninflammatory breast cancer (non-IBC) and IBC by conventional imaging with PET/CT have a better prognosis than patients diagnosed without PET/CT., Patients and Methods: We retrospectively identified 935 patients with stage III breast cancer in 2000-2009. We compared the relapse-free survival (RFS) and overall survival (OS) times of patients diagnosed by conventional imaging with those of patients diagnosed by conventional imaging plus PET/CT. Univariate and multivariate Cox proportional hazards regression models were used to assess associations between survival and PET/CT., Results: RFS and OS times were not significantly different between patients imaged with PET/CT and those imaged without PET/CT. However, the RFS time in IBC patients was significantly different between patients imaged with PET/CT and those imaged without PET/CT on both univariate (hazard ratio [HR], 0.43; p = .014) and multivariate (HR, 0.33; p = .004) analysis. There was a trend for a longer OS duration in IBC patients imaged with PET/CT., Conclusion: Among IBC patients, adding PET/CT to staging based on conventional imaging might detect patients with metastases that were not detected by conventional imaging. The use of conventional imaging with PET/CT for staging in non-IBC patients is not justified on the basis of these retrospective data. The use of conventional imaging plus PET/CT in staging IBC needs to be studied prospectively to determine whether it will improve prognosis.

Purpose: Evidence from studies with small numbers of patients indicates that (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) accurately detects distant metastases in the staging of primary breast cancer. We compared the sensitivity and specificity of PET/CT and conventional imaging (CT, ultrasonography, radiography, and skeletal scintigraphy) for the detection of distant metastases in patients with primary breast cancer., Patients and Methods: We performed a retrospective review that identified 225 patients with primary breast cancer seen from January 2000 to September 2009 for whom PET/CT data were available for review. Imaging findings were compared with findings on biopsy, subsequent imaging, or clinical follow-up. Sensitivity and specificity in the detection of distant metastases were calculated for PET/CT and conventional imaging. Fisher's exact tests were used to test the differences in sensitivity and specificity between PET/CT and conventional imaging., Results: The mean patient age at diagnosis was 53.4 years (range, 23-84 years). The sensitivity and specificity in the detection of distant metastases were 97.4% and 91.2%, respectively, for PET/CT and 85.9% and 67.3%, respectively, for conventional imaging. The sensitivity and specificity of PET/CT were significantly higher than those of conventional imaging (p = .009 and p < .001, respectively). Eleven cases of distant metastases detected by PET/CT were clinically occult and not evident on conventional imaging., Conclusion: PET/CT has higher sensitivity and specificity than conventional imaging in the detection of distant metastases of breast cancer. A prospective study is needed to determine whether PET/CT could replace conventional imaging to detect distant metastases in patients with primary breast cancer.

A literature review was performed of studies reporting sensitivity and specificity of [18F]fluorodeoxyglucose (FDG) PET from January 1, 2000 to January 1, 2010. PET was found to have higher sensitivity for the detection of osseous metastases when compared to CT, skeletal scintigraphy, whole body MRI and combined conventional imaging modalities. A potential exception is when comparing PET with bone scan in the setting of blastic metastases. PET may be a better indicator of active bony metastases. The efficacy of PET can be increased with fused anatomic imaging., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Response criteria represent the standard by which the efficacy of therapeutic agents is determined in cancer trials. The most widely used criteria are based on the anatomic measurement of solid tumors. Because bone metastases are typically located in irregularly shaped bones and are difficult to measure with rulers, they have been previously considered unmeasurable disease. New developments in cancer response criteria have increased awareness of the importance of the response of bone metastases to therapy. The recently updated Response Evaluation Criteria in Solid Tumors (RECIST 1.1) now consider bone metastases with soft tissue masses > 10 mm to be measurable disease. Response criteria specific to bone metastases have been developed at The University of Texas MD Anderson Cancer Center (MDA criteria) and can be used to assess therapeutic response in numerous types of bone metastases. Functional imaging criteria, such as the recently developed Positron Emission Tomography Response Criteria in Solid Tumors (PERCIST) allow response to be measured in the absence of anatomic change through assessment of metabolic activity. As monitoring tumor response of bone metastases becomes more important in the management of cancer, so does the demand on radiologists and nuclear medicine physicians for accurate interpretation of the behavior of these lesions. This article reviews anatomic, bone, and metabolic response criteria, providing illustrations for the interpretation of therapy-induced change in bone metastases.

Background and Objectives: When the conventional lateral popliteal sciatic nerve (SN) block is performed, the needle angle required to localize and the level of the SN bifurcation are highly variable. The aim of our magnetic resonance imaging (MRI) study was to determine the most common range of needle-insertion angles and the relationship between skin-to-femur distance and angle. We also evaluated the variability of the SN bifurcation level and the relationship between patient height and nerve bifurcation level., Methods: Using 289 thigh MRIs to simulate a lateral approach in the supine position, we measured and analyzed with simple linear regressions the level of SN bifurcation, the skin-to-femur and SN-to-femur distances, and the angle at which the needle must be directed posteriorly to intersect the SN at 9 cm proximal to the lateral joint line., Results: The mean insertion angle was 30 (SD, 8) degrees. In 95% of cases, angles ranged from 15 to 45 degrees, and the larger the thigh, the smaller the angle. The SN divided at a mean distance of 7.5 (SD, 1.6) cm (range, 1.5-12.8 cm) proximal to the lateral joint line. In 93% of cases, the bifurcation level was 10 cm or less., Conclusions: Our simulated lateral popliteal SN block on MRIs shows a 15- to 45-degree range of needle-insertion angles. As the skin-to-femur distance was greater than 4.5 cm, the angles were progressively smaller than 30 degrees. Although this was an MRI study, it does provide some evidence that indicates the conventional clinically recommended 25- to 30-degree-angle ranges may need to be reevaluated. Needle insertion of 10 cm or greater proximal to the popliteal crease may increase the chance of placement at or proximal to the SN bifurcation.

Background: We compared the utility of a new response classification (MDA; based on computed tomography (CT), magnetic resonance imaging (MRI), plain radiography (XR), and skeletal scintigraphy (SS)) and the World Health Organisation response classification (WHO; based on XR and SS) in stratifying breast cancer patients with bone-only metastases with respect to progression-free survival (PFS), overall survival (OS), and clinical response., Methods: We retrospectively reviewed 41 patients with bone-only metastatic breast cancer and assigned responses according to the MDA and WHO criteria. We analysed whether the MDA or WHO response classifications correlated with PFS and OS., Results: With the MDA criteria, there were significant differences in PFS between patients classified as responders and those classified as nonresponders (P=0.025), but with the WHO criteria, there were not. Neither criteria distinguished responders from nonresponders in terms of OS. MDA response criteria correlated better than WHO response criteria with clinical response assessment., Conclusions: The MDA classification is superior to the WHO classification in differentiating between responders and nonresponders among breast cancer patients with bone-only metastases. Application of the MDA classification may allow bone lesions to be considered measurable disease. Prospective study is needed to test the MDA classification among patients with bone metastasis.

Objective: To determine if the location of the point of maximum standardized uptake value (SUVmax) being included in or not included in the histopathologic slab section corresponded to tumor necrosis or survival., Materials and Methods: Twenty-nine osteosarcoma patients underwent post-chemotherapy [fluorine-18]-fluoro-2-deoxy-D: -glucose (FDG) positron-emission tomography-computed tomography (PET/CT) prior to resection. PET/CT images were correlated with slab-section location as determined by photographs or knowledge of specimen processing. The location of the point of SUVmax was then assigned as being 'in' or 'out' of the slab section. Cox's proportional hazard regression was used to evaluate relationships between the location and value of SUVmax and survival. Logistic regression was employed to evaluate tumor necrosis., Results: No correlation was found between the SUVmax location and survival or tumor necrosis. High SUVmax correlated to poor survival., Conclusion: High SUVmax value correlated to poor survival. Minimal viable tumor (> 10%) following chemotherapy is a known indicator of poor survival. No correlation was found between the location of SUVmax and survival or tumor necrosis. Therefore, the SUVmax value either does not correspond to a sufficient number of tumor cells to influence tumor necrosis measurement or it was included in the out-of-slab samples that were directed to viable-appearing areas of the gross specimen. Since high SUVmax has been previously found to correspond to poor tumor necrosis, and tumor necrosis is simply an estimate of the amount of viable tumor, SUVmax likely represents many viable tumor cells. Therefore, when not in the slab section, SUVmax was likely included in the tumor necrosis measurement through directed sampling, validating our current method of osteosarcoma specimen analysis.

Identification of pitfalls is essential to the correct interpretation of (18)F-FDG PET/CT. The educational objectives of this self-assessment module are for the participant to exercise, self-assess, and improve his or her knowledge of FDG PET/CT of the musculoskeletal system.

Objective: Thorough evaluation of the musculoskeletal system on PET/CT requires a fund of specialized knowledge and the use of musculoskeletal-oriented viewing techniques. The study of musculoskeletal pitfalls introduces many subspecialty-specific topics and provides instruction in the methods necessary for optimal evaluation of the musculoskeletal system when interpreting PET/CT., Conclusion: This article reviews musculoskeletal pitfalls in PET/CT. On completion, reviewers should have an improved ability to evaluate the musculoskeletal system on PET/CT.

Bone is the most common site of distant metastases from breast carcinoma. The presence of bone metastases affects a patient's prognosis, quality of life, and the planning of their treatment. We discuss recent innovations in bone imaging and present algorithms, based on the strengths and weaknesses of each technique, to facilitate the most successful and cost-effective choice of imaging studies for the detection of osseous metastases. Skeletal scintigraphy (bone scan) is very sensitive in the detection of osseous metastases and is recommended as the first imaging study in patients who are asymptomatic. Radiographs are recommended for the assessment of abnormal radionuclide uptake or the risk of pathological fracture and as initial imaging studies in patients with bone pain. MRI or PET-CT can be considered for cases of abnormal radionuclide uptake that are not addressed by radiography. Osseous metastases can lead to emergent situations, such as spinal-cord compression or impending fracture of a weight-bearing bone, and imaging guidelines are essential for early detection and initiation of appropriate therapy. The imaging method used in non-emergent situations, such as assessment of the ribs, sternum, pelvis, hips, and joints, should be guided by the strengths and limitations of each technique.

Purpose: To develop and demonstrate the feasibility of multisequence and multiplanar MRI for whole-body cancer detection., Materials and Methods: Two fast Dixon-based sequences and a diffusion-weighted sequence were used on a commercially available 1.5 T scanner for whole-body cancer detection. The study enrolled 19 breast cancer patients with known metastases and in multistations acquired whole-body axial diffusion-weighted, coronal T2-weighted, axial/sagittal pre- and postcontrast T1-weighted, as well as triphasic abdomen images. Three radiologists subjectively scored Dixon images of each series for overall image quality and fat suppression uniformity on a 4-point scale (1 = poor, 2 = fair, 3 = good, and 4 = excellent)., Results: Eighteen of the 19 patients completed the whole-body MRI successfully. The mean acquisition time and overall patient table time were 46 +/- 3 and 69 +/- 5 minutes, respectively. The average radiologists' scores for overall image quality and fat suppression uniformity were both 3.4 +/- 0.5. The image quality was consistent between patients and all completed whole-body examinations were diagnostically adequate., Conclusion: Whole-body MRI offering essentially all the most optimal tumor-imaging sequences in a typical 1-hour time slot can potentially become an appealing "one-stop-shop" for whole-body cancer imaging.

Unlabelled: The aim of our study was to retrospectively evaluate whether maximum standardized uptake value (SUV(max)), total lesion glycolysis (TLG), or change therein using (18)F-FDG PET/CT performed before and after initial chemotherapy were indicators of patient outcome., Methods: Thirty-one consecutive patients who underwent (18)F-FDG PET/CT before and after chemotherapy, followed by tumor resection, were retrospectively reviewed. Univariate Cox regression was used to analyze for relationships between covariates of interest (SUV(max) before and after chemotherapy, change in SUV(max), TLG before and after chemotherapy, change in TLG, and tumor necrosis) and progression-free and overall survival. Logistic regression was used to evaluate tumor necrosis., Results: High SUV(max) before and after chemotherapy (P = 0.008 and P = 0.009, respectively) was associated with worse progression-free survival. The cut point for SUV(max) before chemotherapy was greater than 15 g/mL* (P = 0.015), and after chemotherapy it was greater than 5 g/mL* (P = 0.006), as measured at our institution and using lean body mass. Increase in TLG after chemotherapy was associated with worse progression-free survival (P = 0.016). High SUV(max) after chemotherapy was associated with poor overall survival (P = 0.035). The cut point was above the median of 3.3 g/mL* (P = 0.043). High TLG before chemotherapy was associated with poor overall survival (P = 0.021). Good overall and progression-free survival was associated with a tumor necrosis greater than 90% (P = 0.018 and 0.08, respectively). A tumor necrosis greater than 90% was most strongly associated with a decrease in SUV(max) (P = 0.015)., Conclusion: (18)F-FDG PET/CT can be used as a prognostic indicator for progression-free survival, overall survival, and tumor necrosis in osteosarcoma.

Objective: The purpose of this study is to report the radiographic changes seen in chronic sclerosing osteitis of the diaphysis of tubular bones during progression or healing, with CT and MRI correlation. Chronic sclerosing osteitis is an inflammatory condition of bone that can be considered a pediatric subset of the synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) spectrum of disease. Previous descriptions of long-bone involvement focus predominately on metaphyseal lesions. Eleven diaphyseal lesions in seven patients (age range, 13 months-14.5 years) were followed., Conclusion: The marked degree of cortical hyperostosis, medullary narrowing, and cortical lucencies seen in eight of 11 lesions is helpful for recognition of diaphyseal chronic sclerosing osteitis. Early identification of the disorder can prevent unnecessary repeat invasive procedures.

Background: Despite technical advances, nonunion or delayed union remains an important clinical problem when segmental allografts are used to repair diaphyseal defects after bone tumor resection. Using an ovine rib model, the authors studied whether the addition of a vascularized periosteum or bone flap improved healing compared with a segmental allograft alone., Methods: A 4-cm segment of rib was resected from four consecutive ribs of 15 sheep. Three different reconstructions were compared within the same sheep: allograft alone, allograft and vascularized periosteum, and allograft and vascularized bone. One defect was not reconstructed and served as a control. Five sheep were humanely killed at each of the following time points: 9, 12, and 15 weeks. The host-allograft junctions were analyzed using plain radiographs, micro-computed tomography, and histologic examination., Results: Micro-computed tomographic analysis showed significant improvement with each reconstruction technique over time. Plain radiographs and histologic analyses demonstrated earlier bridging of the host-allograft junction when either vascularized periosteum or vascularized bone was used compared with allograft alone., Conclusion: Use of vascularized periosteum or bone may facilitate healing of the host-allograft junction after intercalary allograft reconstruction.

Hematopoietic stem cell transplantation (HSCT) is the only curative therapy for autosomal recessive infantile malignant osteopetrosis, an otherwise fatal disease. HSCT has also been utilized in patients with the less severe autosomal recessive intermediate form in an attempt to correct hematologic abnormalities and halt cranial nerve deficits caused by progressive cranial foraminal stenosis. Successful engraftment is accompanied by rapid normalization of radiographic signs of osteopetrosis.