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Musculoskeletal Tumors


Aside from conventional radiography, MRI is the preferred imaging modality for the diagnosis and T-staging of malignant primary bone tumors. An overlap of imaging findings between benign and malignant masses and the diagnosis of malignancy are typically aided by advanced MRI techniques. We believe that PET/MRI may not increase the diagnostic accuracy of T-staging of bone tumors over MRI alone, but a whole-body PET/MRI approach may offer TNM staging of the whole body with high accuracy in a single session. PET/MRI may thus be used to guide the surgeon in preoperative planning of tumor resection.

The synergistic potential of hybrid PET/MR imaging in terms of acquiring anatomic, molecular, and functional data simultaneously seems advantageous not only in the diagnostic workup, treatment planning, monitoring and follow-up of patients with musculoskeletal malignancies, and may also prove helpful in the assessment of musculoskeletal infectious and inflammatory disorders. The application of more sophisticated MR imaging sequences and PET radiotracers other than FDG in the diagnostic workup and follow-up of patients with musculoskeletal disorders is an area of further research.


Case 1: Malignant Fibrous Histiocytoma Anterior Chest Wall

Case History:

51 year old male with recurrent Malignant Fibrous Histiocytoma anterior chest wall


Findings:

Axial T1 (A) T1 Sagittal(B) PET/MRI fused image © and Post-contrast axial VIBE (D) show a metabolically active enhancing soft tissue mass in the right anterior chest wall extending craniocaudally from just below the clavicle to the level of the lower margin of IIIrd rib (red arrow) abutting the anterior cortex of the right Ist, IInd and IIIrd ribs and the intercostal muscles with, however, no obvious pleural invasion. Coronal MIP images ( E) showing focal encasement and occlusion of the right subclavian vein (white arrow in E).


Case 2 : Metastatic Malignant Melanoma


Case History:

55 year old female with soft tissue swelling right thigh.


Findings:

Axial STIR (A), Axial T1 (B) and PET/MR fused ( C) at the level of upper thigh showing a T1 hyperintense heterogeneously enhancing FDG avid mass in the subcutaneous plane of the right upper thigh consistent with melanoma.

Similar intensity lesions in the brain, (A) spleen ( C) and left kidney(D): metastatic. Note: Melanoma lesions are better characterized by MR owing to their characteristic T1 hyperintensity and T2 hypointensity.


Case 3: Soft tissue Sarcoma – Left Hand


Case History:

27 year old male with soft tissue swelling left hand.


Findings:

Oblique axial T2W (A), PET/MRI fused (B) and coronal post-contrast (C) images showing an enhancing metabolically active soft tissue mass on the dorsal and palmar aspect of the left hand in the 1st webspace involving the thenar muscles, the first and second dorsal and palmar interossei muscles, also involving the flexor digitorumsuperficialis and profundus tendons of the 1st & the 2nd fingers. Coronal arterial phase image in MIP reformat (D) showing complete encasement of the radial artery and the proximal palmar arch(arrow).


Case Study Prepared by:

This short PET-MRI Scan case was compiled by Dr. Sangeeta Taneja and Dr. Amarnath Jena (Nuclear Medicine Physician at PET-Suite @ Indraprastha Apollo Hospital, Sarita Vihar).


Read More about PET-MRI Scan at House Of Diagnostics in Delhi and NCR.

The Simultaneous PET-MRI Scan is currently offered at PET-Suite at Apollo Hospital, Sarita Vihar.