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

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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.

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Acknowledgements

This manuscript was presented as a scientific paper at the 2018 Society for Pediatric Radiology (SPR) Meeting in Nashville, TN. The authors would like to acknowledge Mr. Warren Corber, research assistant, for his contribution in the randomization and anonymization of our patient cohort and data recording.

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Authors and Affiliations

  1. Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada

    Alaa N. Alsharief, Afsaneh Amirabadi, Andrea S. Doria & Mary-Louise C. Greer

  2. Department of Medical Imaging, University of Toronto, Toronto, ON, Canada

    Alaa N. Alsharief, Andrea S. Doria & Mary-Louise C. Greer

  3. Department of Medical Imaging, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada

    Claudia Martinez-Rios

  4. University of Ottawa, Ottawa, ON, Canada

    Claudia Martinez-Rios

  5. Department of Orthopedic Surgery, The Hospital for Sick Children, Toronto, ON, Canada

    Sevan Hopyan

  6. Department of Surgery, University of Toronto, Toronto, ON, Canada

    Sevan Hopyan

Authors
  1. Alaa N. Alsharief
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  2. Claudia Martinez-Rios
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  3. Sevan Hopyan
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  4. Afsaneh Amirabadi
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  5. Andrea S. Doria
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  6. Mary-Louise C. Greer
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Corresponding author

Correspondence to Mary-Louise C. Greer.

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Alsharief, A.N., Martinez-Rios, C., Hopyan, S. et al. Usefulness of diffusion-weighted MRI in the initial assessment of osseous sarcomas in children and adolescents. Pediatr Radiol 49, 1201–1208 (2019). https://doi.org/10.1007/s00247-019-04436-y

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  • DOI: https://doi.org/10.1007/s00247-019-04436-y

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