| 1. Fletcher CDM, World Health Organization, International Agency for Research on Cancer. WHO classification of tumours of soft tissue and bone. 5th ed. Lyon: IARC Press; 2020. |
Review/Other-Dx |
N/A |
To provide an international standard for oncologists and pathologists and will serve as an guide for use in the design of studies monitoring response to therapy and clinical outcome. |
No abstract available. |
4 |
| 2. National Cancer Institute. Surveillance, Epidemiology, and End Results (SEER). Cancer Stat Facts: Bone and Joint Cancer. Available at: https://seer.cancer.gov/statfacts/html/bones.html. |
Review/Other-Dx |
Data based on "per 100,00" cases. |
To provide cancer statistics regarding bone and joint cancer. |
Using statistical models for analysis, rates for new bone and joint cancer cases have been rising on average 0.4% each year over the last 10 years. Death rates have been falling on average 0.3% each year over 2006-2015. 5-year survival trends are shown below. |
4 |
| 3. Bucolo GM, Ascenti V, Barbera S, et al. Virtual Non-Contrast Spectral CT in Renal Masses: Is It Time to Discard Conventional Unenhanced Phase?. Journal of Clinical Medicine. 12(14), 2023 Jul 17. |
Observational-Dx |
40 patients |
The purpose of this study is to evaluate the reliability of attenuation values of renal masses in virtual non-contrast (VNC) images, compared to true non-contrast (TNC) images, using a dual-layer (dl) DECT scanner. |
The study cohort included 100 renal masses in 40 patients who underwent dl-DECT between June and December 2021. Attenuation values and standard deviations were assessed through the drawing of regions of interest on TNC and VNC images reconstructed from corticomedullary and nephrographic phases. A Wilcoxon signed-rank test was performed in order to assess equivalence of data and Spearman's Rho correlation coefficient to evaluate correlations between each parameter. The diagnostic accuracy of VNC was estimated through the performance of receiver operating characteristic (ROC) curve analysis. Differences between attenuation values were, respectively, 74%, 18%, 5% and 3% (TNC-VNCcort), and 74%, 15%, 9% and 2% (TNC-VNCneph). The Wilcoxon signed-rank test demonstrated the equivalence of attenuation values between the TNC and VNC images. The diagnostic performance of VNC images in the depiction of kidney simple cysts remains high compared to TNC (VNCcort-AUC: 0.896; VNCneph-AUC: 0.901, TNC-AUC: 0.903). In conclusion, quantitative analysis of attenuation values showed a strong agreement between VNC and TNC images in the evaluation of renal masses. |
3 |
| 4. Demehri S, Baffour FI, Klein JG, et al. Musculoskeletal CT Imaging: State-of-the-Art Advancements and Future Directions. Radiology 2023;308:e230344. |
Review/Other-Dx |
N/A |
In this review, the authors discuss the current state of the above computed tomography (CT) technologies, their respective advantages and disadvantages, and their projected future directions for various musculoskeletal applications. |
No results stated in the abstract. |
4 |
| 5. Liang H, Du S, Yan G, et al. Dual-energy CT of the pancreas: comparison between virtual non-contrast images and true non-contrast images in the detection of pancreatic lesion. Abdominal Radiology. 48(8):2596-2603, 2023 08. |
Observational-Dx |
106 patients |
To evaluate the image quality and diagnostic performance for pancreatic lesion between true non-contrast (TNC) and virtual non-contrast (VNC) images obtained from the dual-energy computed tomography (DECT). |
A total of 78.38% (765/976) of the attenuation measurement pairs were reproducible between TNC and aVNC images, and 71.0% (693/976) between TNC and pVNC images. In triphasic examinations, a total of 108 pancreatic lesions were found in 106 patients, and no significant difference in detection accuracy was found between TNC and VNC images (p = 0.587-0.957). Qualitatively, image quality was rated diagnostic (score = 3) in all the VNC images. Calculated CTDIvol and SSDE reduction of about 34% could be achieved by omitting the non-contrast phase. |
2 |
| 6. McCoombe K, Dobeli K, Meikle S, Llewellyn S, Kench P. Sensitivity of virtual non-contrast dual-energy CT urogram for detection of urinary calculi: a systematic review and meta-analysis. [Review]. European Radiology. 32(12):8588-8596, 2022 Dec. |
Meta-analysis |
13 studies |
The purpose of this systematic review and meta-analysis is to determine the sensitivity of dual-energy (DE) virtual non-contrast computed tomography (vNCT), generated from the excretory phase of a CT urogram, compared to true non-contrast CT (tNCT) for the detection of urinary calculi. |
Thirteen studies (1760 patients; 1740 urinary calculi) were included for sensitivity assessment. Pooled sensitivity for urinary calculi on vNCT was 78.1% (95% CI: 70.2 to 85.0%); however, heterogeneity between studies was very high (I2 = 92.0%). Sources of heterogeneity between studies were explored through subgroup analysis by categorising studies according to slice thickness (= 2 mm and < 2 mm), use of oral hydration, and use of intravenous furosemide. Pooled sensitivity for detection of urinary calculi on vNCT for studies that used oral hydration and < 2 mm slice thickness was 92.2% (95% CI: 89.5 to 94.5%). Pooled specificity was not performed as true negatives were not reported in most studies. Potential sources of bias were identified in included studies. |
Good |
| 7. Stern C, Graf DN, Bouaicha S, Wieser K, Rosskopf AB, Sutter R. Virtual non-contrast images calculated from dual-energy CT shoulder arthrography improve the detection of intraarticular loose bodies. Skeletal Radiology. 51(8):1639-1647, 2022 Aug. |
Observational-Dx |
123 patients |
This study aims to evaluate the image quality of virtual non-contrast (VNC) images calculated from dual-energy CT shoulder arthrography (DECT-A) and their ability to detect periosteal calcifications and intraarticular loose bodies. |
VNC images (129/129) were of good quality (median 4 (3–4)), and the mean effective dose of DECT-A scans was 2.21 mSv (±?1.0 mSv). CT numbers of iodine, muscle, and VNC joint fluid density were mean 1017.6 HU (±?251.6 HU), 64.6 HU (±?8.2 HU), and 85.3 HU (±?39.5 HU), respectively. Image contrast was mean 953.1 HU (±?251 HU) on DECT-A and 31.3 HU (±?32.3 HU) on VNC images. Iodine removal on VNC images was 91% on average. No difference was observed in the detection of periosteal calcifications between VNC (n?=?25) and DECT-A images (n?=?21) (p?=?0.29), while the detection of intraarticular loose bodies was superior on VNC images (14 vs. 7; p?=?0.02). Diagnostic confidence was higher on VNC images for both periosteal calcifications (median 3 (3–3) vs. 3 (3–3); p?=?0.009) and intraarticular loose bodies (median 3 (3–4) vs. 3 (3–3); p?<?0.001). |
2 |
| 8. Stern C, Marcon M, Bouaicha S, Wieser K, Rosskopf AB, Sutter R. Dual energy CT arthrography in shoulder instability: successful iodine removal with virtual non-contrast images and accurate 3D reformats of the glenoid for assessment of bone loss. Skeletal Radiology. 51(5):1027-1036, 2022 May. |
Observational-Dx |
52 patients |
To evaluate the image quality of dual energy CT (DECT) of the shoulder after arthrography and of virtual non-contrast (VNC) 3D reformats of the glenoid and to compare glenoid measurements on VNC 3D reformats and on 2D CTs. |
Calculation of VNC images and VNC 3D reformats was successful in 42/42 shoulders (100%). The effective dose was mean 1.95 mSv (± 0.9 mSv). CT values of iodine and muscle were mean 1014.6 HU (± 235.8 HU) and 64.5 HU(± 8.6 HU), respectively, and image contrast was mean 950.2 HU (± 235.5 HU). Quality of cross-sectional images, VNC images, and VNC 3D reformats was rated good (median 4 (4-5), 4 (3-4), 4 (3-5), respectively). Detection of an osseous defect was equal on 2D and 3D images (13/42, P > 0.99) with no difference for measurement of the glenoid diameter with mean 28.3 mm (± 2.8 mm) vs. 28.4 mm (± 2.9 mm) (P = 0.5), width of the glenoid defect with 3.2 mm (± 2.1 mm) vs. 3.1 mm (± 2.3 mm) (P = 0.84), surface area with 638.5 mm2 (± 127 mm2) vs. 640.8 mm2 (± 129.5 mm2) (P = 0.47), and surface area of the defect with 46.6 mm2 (± 44.3 mm2) vs. 47.2 mm2 (± 48.0 mm2) (P = 0.73), respectively. |
2 |
| 9. Verstraeten S, Ansems J, Ommen WV, Linden DV, Looijmans F, Tesselaar E. Comparison of true non-contrast and virtual non-contrast images in the characterization of renal lesions using detector-based spectral CT. British Journal of Radiology. 96(1149):20220157, 2023 Sep. |
Observational-Dx |
27 patients |
The aim of this study was to investigate the feasibility to use virtual non-contrast (VNC) images, acquired using a detector-based dual-energy CT, for the characterization of renal lesions. |
Sixteen patients had cystic lesions, five had angiomyolipoma (AML), and six had suspected renal cell carcinomas (RCC). Attenuation values in VNC and TNC images were strongly correlated (? = 0.7, mean difference -6.0 ± 13 HU). The largest differences were found for unenhanced high-attenuation lesions. Radiologists classified 86% of the lesions correctly using VNC images. |
2 |
| 10. Lodwick GS. A probabilistic approach to the diagnosis of bone tumors. Radiol Clin North Am. 1965;3(3):487-497. |
Review/Other-Dx |
N/A |
To present a basic method of evaluating radiographs of bone tumors and also a prior probability matrix. |
No results stated in abstract. |
4 |
| 11. Madewell JE, Ragsdale BD, Sweet DE. Radiologic and pathologic analysis of solitary bone lesions. Part I: internal margins. Radiol Clin North Am. 19(4):715-48, 1981 Dec. |
Review/Other-Dx |
N/A |
To describe the anatomic site and extent of lesions as well as the interface between tumor and normal bone. |
No results stated in abstract. |
4 |
| 12. Ragsdale BD, Madewell JE, Sweet DE. Radiologic and pathologic analysis of solitary bone lesions. Part II: periosteal reactions. Radiol Clin North Am. 19(4):749-83, 1981 Dec. |
Review/Other-Dx |
N/A |
To describe preriosteal responses and their importance in predicting the biologic behavior of bone neoplasms. |
No results stated in the abstract. |
4 |
| 13. Sweet DE, Madewell JE, Ragsdale BD. Radiologic and pathologic analysis of solitary bone lesions. Part III: matrix patterns. Radiol Clin North Am. 19(4):785-814, 1981 Dec. |
Review/Other-Dx |
N/A |
To describe the radiographic patterns of increased density and their significance in predicting bone tumor matrices. |
No results stated in abstract. |
4 |
| 14. Oudenhoven LF, Dhondt E, Kahn S, et al. Accuracy of radiography in grading and tissue-specific diagnosis--a study of 200 consecutive bone tumors of the hand. Skeletal Radiol. 35(2):78-87, 2006 Feb. |
Observational-Dx |
200 patients with bony tumors of the hand |
To determine the usefulness of radiography and magnetic resonance imaging in differentiating benign from malignant bony tumors of the hand and in making a tissue-specific diagnosis. |
By the combining of "certainly" and "probably" benign (grades I and II) and "certainly" and "probably" malignant (grades IV and V), a correct grading was obtained in 165 (82.5%) of the cases (154 of the 173 benign and 11 of the 27 malignant tumors). A correct tissue-specific diagnosis was included in the three proposed differentials in 87.5%. MRI confirmed a correct diagnosis made on radiography in 72% and improved the grading capability by correctly upgrading malignant tumors and downgrading benign tumors in, respectively, 8% and 12%. The capability to obtain a tissue-specific diagnosis improved with change of an incorrect diagnosis on radiography to a correct one on MRI in 12 cases (24%). |
3 |
| 15. Caracciolo JT, Temple HT, Letson GD, Kransdorf MJ. A Modified Lodwick-Madewell Grading System for the Evaluation of Lytic Bone Lesions. AJR Am J Roentgenol. 207(1):150-6, 2016 Jul. |
Observational-Dx |
183 bone lesions |
To apply a Modified Lodwick-Madewell Grading System as an alternative means to categorize lytic bone tumors into those with low, moderate, and high risks of malignancy. |
Of the 183 tumors, 81 were classified as grade I, 54 as grade II, and 48 as grade III. When correlating grade with pathology, we found that 76 of 81 (94%) grade I lesions were benign and 39 of 48 grade III lesions (81%) were malignant. A nearly equal number of grade II lesions proved to be benign (29/54; 54%) and malignant (28/54; 53%). |
3 |
| 16. Crim J, Schmidt R, Layfield L, Hanrahan C, Manaster BJ. Can imaging criteria distinguish enchondroma from grade 1 chondrosarcoma?. Eur J Radiol. 84(11):2222-30, 2015 Nov. |
Observational-Dx |
53 patients |
To minimize systematic bias and optimize agreement on imaging criteria in order to better define the accuracy of imaging criteria in the diagnosis of grade 1 chondrosarcoma. |
The correct diagnosis of enchondroma was made on radiographs in 43 (67.2%) of readings, and on MRI in 37/64 (57.8%). The correct diagnosis of chondrosarcoma was made on radiographs in 5/24 (20.8%) of readings, and on MRI in 14/24 (57.8%). A diagnosis of borderline lesion was made in 19/64 (29.7%) of enchondromas on radiographs and 18/64 (28.1%) on MRI. The false positive rate of radiographs for chondrosarcoma was 2/64 (3.1%) and the false positive rate of MRI was 9/64 (14.1%). There was substantial interobserver variability. Cortical thickening and bone expansion were rare but specific signs of chondrosarcoma. |
2 |
| 17. Geirnaerdt MJ, Hermans J, Bloem JL, et al. Usefulness of radiography in differentiating enchondroma from central grade 1 chondrosarcoma. AJR. 1997; 169(4):1097-1104. |
Observational-Dx |
78 patients |
To evaluate clinical symptoms and radiographic features that allow radiologists to differentiate between enchondroma and central grade 1 chondrosarcoma. |
No statistically significant correlation was found between clinical symptoms and the benign or malignant nature of the neoplasms. Grade 1 chondrosarcomas were more likely to be found in the axial skeleton and in flat bones. Also, chondrosarcomas were significantly larger than enchondromas (P<.001). Ill-defined margins and lobulated contours were the only morphologic features seen on radiographs that allowed significant discrimination (P=.004 and .009, respectively). An optimal combination of four radiographic features still left 72 of the 78 lesions with a 10%-90% probability of malignancy, indicative of poor discriminating power. Kappa values generally showed poor to fair agreement. |
3 |
| 18. Frank JA, Ling A, Patronas NJ, et al. Detection of malignant bone tumors: MR imaging vs scintigraphy. AJR. 1990; 155(5):1043-1048. |
Observational-Dx |
106 patients |
To determine the relative sensitivities of MRI and scintigraphy for detecting primary malignant bone tumors and bone metastases. |
A retrospective analysis showed that in 30 (28%) of 106 patients, MRI performed over a limited region of interest revealed a focal abnormality consistent with tumor that was not observed on scintigraphy. Only one patient had an abnormality on scintigraphy, caused by a metastasis that was not found on MRI. In 73 (69%) of the 106 patients, the results of MRI and scintigraphy were equivalent; in 41 cases results of both techniques were normal. A McNemar analysis of the discordant cases showed MRI to be more sensitive than scintigraphy was (P<.001). |
2 |
| 19. Niitsu M, Takeda T. Solitary hot spots in the ribs on bone scan: value of thin-section reformatted computed tomography to exclude radiography-negative fractures. J Comput Assist Tomogr 2003;27:469-74. |
Observational-Dx |
47 patients |
To classify solitary, scintigraphy-positive and radiography-negative rib lesions and to clarify the features of rib fractures by using thin-section reformatted helical computed tomography (CT). |
The final diagnosis included 17 cases of fractures where CT findings were fracture line, focal sclerosis, and callus formation. Fourteen ribs demonstrated intramedullary, focal osteosclerosis, and 8 ribs did not demonstrate any abnormalities. Four metastatic lesions appeared as intramedullary mixture of osteolysis and osteosclerosis, or bone destruction. Four intramedullary lesions with cystic appearance remained unchanged. |
3 |
| 20. Azar A, Garner HW, Rhodes NG, Yarlagadda B, Wessell DE. CT Attenuation Values Do Not Reliably Distinguish Benign Sclerotic Lesions From Osteoblastic Metastases in Patients Undergoing Bone Biopsy. AJR. American Journal of Roentgenology. 216(4):1022-1030, 2021 04. |
Observational-Dx |
280 patients |
The purpose of this article is to determine if computed tomography (CT) attenuation thresholds allow the distinguishing of benign sclerotic bone lesions from osteoblastic metastases in patients undergoing bone biopsy. |
A total of 280 patients met inclusion criteria. Of those, 162 had malignant biopsy results and 118 had benign biopsy results. Of the 162 malignant lesions, 81 had received prior treatment. Maximum and mean attenuation were not significantly different between benign and malignant lesions for either reader (all p > .05). For reader 1, to distinguish benign from malignant lesions, a maximum attenuation threshold of more than 1060 HU resulted in sensitivity of 23.7%, specificity of 87.0%, and accuracy of 60.6%. A mean attenuation threshold of greater than 885 HU resulted in sensitivity of 19.5%, specificity of 90.7%, and accuracy 60.7%. ROC curve analysis showed AUCs for mean and maximum attenuation thresholds of 51.8% and 54.6%, respectively. Subgroup analyses of benign versus malignant and treated versus untreated lesions had similar results. Similar findings were obtained for reader 2. The two readers' ICC was 0.946 for maximum attenuation and 0.918 for mean attenuation. |
2 |
| 21. Elangovan SM, Sebro R. Accuracy of CT Attenuation Measurement for Differentiating Treated Osteoblastic Metastases From Enostoses. AJR. American Journal of Roentgenology. 210(3):615-620, 2018 Mar. |
Observational-Dx |
165 patients |
The objective of our study was to assess whether the maximum and mean computed tomography (CT) attenuations are accurate for differentiating between enostoses and treated sclerotic metastases. |
The maximum CT attenuation of enostoses (1212.0 HU) was higher from that of untreated (754.7 HU) (p = 9.7 × 10-16) and that of treated (891.7 HU) (p = 9.9 × 10-10) sclerotic metastases. The maximum CT attenuation of treated sclerotic metastases (891.7 HU) was higher than that of untreated sclerotic metastases (754.7 HU) (p = 0.003). Enostoses had higher mean CT attenuation (1123.0 HU) than untreated (602.0 HU) (p < 2.2 × 10-16) and treated (731.7 HU) (p = 9.6 × 10-15) sclerotic metastases. A threshold mean CT attenuation of 885 HU had an accuracy of 91.7% and 81.7% to differentiate enostoses from untreated and treated metastases, respectively, whereas a threshold maximum CT attenuation of 1060.0 HU had an accuracy of 81.3% and 72.5% to differentiate enostoses from untreated and treated metastases. |
3 |
| 22. Ulano A, Bredella MA, Burke P, et al. Distinguishing Untreated Osteoblastic Metastases From Enostoses Using CT Attenuation Measurements. AJR. American Journal of Roentgenology. 207(2):362-8, 2016 Aug. |
Observational-Dx |
62 patients |
The purpose of this study was to determine whether computed tomography (CT) attenuation thresholds can be used to distinguish untreated osteoblastic metastases from enostoses. |
The mean and maximum CT attenuation values of enostoses were 1190 ± 239 HU and 1323 ± 234 HU, respectively, and those of osteoblastic metastases were 654 ± 176 HU and 787 ± 194 HU, respectively. Using a cutoff of 885 HU for mean attenuation, the AUC was 0.982, sensitivity was 95%, and specificity was 96%. Using a cutoff of 1060 HU for maximum CT attenuation, the AUC was 0.976, sensitivity was 95%, and specificity was 96%. The mean attenuation intraclass correlation coefficient was 0.987 for enostoses and 0.81 for metastases. The maximum attenuation intraclass correlation coefficient was 0.814 for enostoses and 0.980 for metastases. |
3 |
| 23. Murphey MD, Suhardja A, Senchak L, Walker E, Fanburg-Smith J, Kransdorf MJ. Imaging of unusual complications of non-ossifying fibroma. Skeletal Radiol 2016;45:1158. |
Review/Other-Dx |
8 patients |
To describe the radiologic appearance of unusual complications of nonossifying fibroma including stress fracture, diffuse infarction, aneurysmal bone cyst and malignant transformation that may simulatemore aggressive disease. |
Patients included 5 males and 3 females (average age 14 years; age range 8–20 years).Common locations included the distal femur (50%), fibula (25%) and tibia (25%). Lesions were centered in the metaphysis in all cases. Radiographs and CTshowed a predominantly lytic lesion with a narrow zone of transition in 88 % of cases with one case revealing prominent sclerosis. Nonaggressive periosteal reaction was seen in 62 % of cases. A soft tissue mass was seen in only one case by MR. Fluid levels and relatively rapid enlargementwere also seen in one case onMR imaging. Prominent surrounding marrow and/or periosteal cuff of edema was seen in 71%of cases onMR imaging. The signal intensity of the nonossifying fibroma was low to intermediate intensity with heterogeneity in 86 % of cases on both T1 and T2- weighted MR images. One case showed diffuse high signal on T2-weighted MR and rim enhancement suggesting infection. Diffuse heterogeneous enhancement was seen in the other 2 cases following contrast administration both in the lesion and the adjacent edema. |
4 |
| 24. Gruenewald LD, Koch V, Gruber-Rouh T, et al. MR angiography facilitates the differentiation of aneurysmal from unicameral bone cysts. Br J Radiol 2023;96:20220849. |
Observational-Dx |
36 patients |
The objective of this work was to evaluate the incremental value of MR angiography over plain radiographs and MRI for the differentiation of aneurysmal bone cysts (ABCs) from unicameral bone cysts (UBCs). |
Of 16 imaging features, only abnormal vascularization in MR angiography provided sufficient diagnostic accuracy for the identification of ABCs. Other imaging features such as fluid-fluid levels and internal septations were insufficient for the differentiation of UBCs from ABCs. Availability of MR angiography images significantly increased diagnostic accuracy (94.4 vs 75.0% and 83.3 vs 69.4%, respectively, p < 0.05) and diagnostic confidence (4.5 vs 3.7, p < 0.05) of reading radiologists. |
2 |
| 25. Josip E, Kremser C, Haider B, Thaler M, Dammerer D, Henninger B. MRI analysis of simple and aneurysmal bone cysts in the proximal humerus: what actually matters in clinical routine. Skeletal Radiology. 51(4):819-827, 2022 Apr. |
Observational-Dx |
26 patients |
To evaluate magnetic resonance imaging (MRI) characteristics of simple and aneurysmal bone cysts (SBC/ABC) of the proximal humerus and the intermittent difficulty in the imaging differentiation between the two in daily clinical routine. |
Eighteen patients had the image-based diagnosis of an SBC, yet the histology confirmed only 12, the residual 6 were identified as an ABC, despite the imaging criteria corresponding unambiguously to the former. One of the main reasons was the unicameral morphology of lesions, found in 9/14 (64.3%) cases of all ABCs, i.e., in 19/26 cases in total. Therefore, the sensitivity of the radiological diagnosis was moderate (57.14%), yet specificity very high (100%). In total, 69.2% (18/26) presented with a pathological fracture at admission, which correlated strongly with both circumferential (MCC = 0.65, p = 0.01) and septal (MCC = 0.42, p = 0.06) enhancement patterns. Circumferential enhancement was also found to correlate strongly with the histological diagnosis, being recognized in all cases of ABC (MCC = 0.44, p = 0.06). |
2 |
| 26. McDermott MB, Kyriakos M, McEnery K. Painless osteoid osteoma of the rib in an adult. A case report and a review of the literature. Cancer 1996;77:1442-9. |
Review/Other-Dx |
1 patient |
To review a case report for an asymptomatic rib lesion was discovered by means of a bone scan obtained during the clinical evaluation of an adult man with biopsy proven prostate adenocarcinoma. Clinically and radiologically considered to be a metastatic focus, on resection it proved to be an osteoid osteoma (OO). |
OO in patients older than age 50 years is rare (1% - 2% of cases). Only 18 cases of painless OO were found. Of these, 8 (44%) occurred in the phalanges, and 3 (17%) in the cranial-facial bones, both uncommon sites for OO; only 7 (39%) arose in the long bones, the most common site for conventional OO. A disproportionate number of these patients (44%) were younger than age five years, a rarity for OO. Fourteen reported examples of costal OO were found, all of which were associated with pain. The possible mechanisms involved in the production of pain, including analysis of the effect of its site of origin and the presence of nerve fibers, is reviewed. |
4 |
| 27. Sharma P, Mukherjee A, Karunanithi S, et al. 99mTc-Methylene diphosphonate SPECT/CT as the one-stop imaging modality for the diagnosis of osteoid osteoma. Nucl Med Commun. 35(8):876-83, 2014 Aug. |
Observational-Dx |
31 patients |
To evaluate the utility of Tc-methylene diphosphonate (Tc-MDP) single-photon emission tomography (SPECT)/computed tomography (CT) for the diagnosis of osteoid osteoma and compare the same with three-phase planar bone scintigraphy (BS) and CT alone. |
There were nine equivocal lesions on planar BS and five equivocal lesions on CT, but none on SPECT/CT. The sensitivity, specificity, and accuracy of SPECT/CT were all 100%; those of CT were 77.8, 92.3, and 83.8% and those of planar BS were 100, 38.4, and 74.1%, respectively. On comparison, the area under the curve of SPECT/CT was significantly larger than that of planar BS (1.00 vs. 0.761; P=0.005) and CT (1.00 vs. 0.872; P=0.044). However, no significant difference was seen between planar BS and CT (0.761 vs. 0.872; P=0.236). |
3 |
| 28. Gondim Teixeira PA, Lecocq S, Louis M, et al. Wide area detector CT perfusion: can it differentiate osteoid osteomas from other lytic bone lesions?. Diagn Interv Imaging. 95(6):587-94, 2014 Jun. |
Review/Other-Dx |
56 patients |
To compare the enhancement dynamics of osteoid osteomas with other benign and malignant lytic bone lesions using CT perfusion. |
Enhancement curve morphology of the osteoid osteomas was significantly different from its mimickers. All osteoid osteomas had an early enhancement with a delay between nidus and arterial peak below 30 seconds. Eighty percent of the mimickers demonstrated a slow and progressive enhancement. The perfusion parameters of the other lytic bone lesions were similar to those of the osteoid osteomas in 46.1% of the patients. |
4 |
| 29. Sundaram M, McLeod RA. MR imaging of tumor and tumorlike lesions of bone and soft tissue. AJR. 1990; 155(4):817-824. |
Review/Other-Dx |
N/A |
A review to examine the role of MRI in the diagnosis and staging of tumors and tumor like lesions of bone and soft tissue. |
For tumors of bone, the plain radiograph is not only the least expensive diagnostic test but is the most reliable predictor of the histologic nature of a given lesion. MRI is the examination of choice for staging bone tumors. CT is preferred to MRI only when the characteristics of the lesion are inadequately defined on plain radiographs, as may occur in flat bones. Although MRI is of limited value in predicting the histology of bone tumors, it is a useful tool for distinguishing round-cell tumors and metastases from stress fractures and medullary infarcts in symptomatic patients with normal radiographs. For depiction of soft-tissue masses, MRI is unrivaled. Biopsy of bone and soft-tissue tumors should follow and not precede MRI. MRI reliably shows change in tumor volume after radiation or chemotherapy and is less reliable in predicting the amount of tumor necrosis. |
4 |
| 30. Assoun J, Richardi G, Railhac JJ, et al. Osteoid osteoma: MR imaging versus CT. Radiology. 1994;191(1):217-223. |
Experimental-Dx |
19 patients |
To compare the performance of CT and MRI in diagnosis of osteoid osteoma. |
CT was more accurate than MRI in detection of the osteoid osteoma nidus in 63% of cases. MRI was better than CT in showing intramedullary and soft-tissue changes in all cases. This may produce a misleading aggressive appearance on MRIs. There was a statistically significant correlation between presence or absence of marrow or soft-tissue changes and treatment with anti-inflammatory medications (P<.05). |
3 |
| 31. Crenn V, Vezole L, Bouhamama A, et al. Percutaneous Core Needle Biopsy Can Efficiently and Safely Diagnose Most Primary Bone Tumors. Diagnostics. 11(9), 2021 Aug 27. |
Observational-Dx |
196 patients |
This study evaluates the diagnostic yield of the preferred use of percutaneous core needle biopsy (PCNB) in a referral center, its accuracy, and its complication rate. |
The data relating to the biopsy and the histological analysis were extracted from the database of a bone tumor reference center where PCNB of bone tumors was discussed as a first-line option. 196 bone tumors were biopsied percutaneously between 2016 and 2020. They were located in the axial skeleton in 21.4% (42) of cases, in the lower limb in 58.7% (115), and in the upper limb in 19.9% (39) cases. We obtained a diagnosis yield of 84.7% and a diagnosis accuracy of 91.7%. The overall complication rate of the percutaneous biopsies observed was 1.0% (n = 2), consisting of two hematomas. PCNB performed in a referral center is a safe, precise procedure, with a very low complication rate, and which avoids the need for first-line open surgical biopsy. The consultation between pathologist, radiologist, and clinician in an expert reference center makes this technique an effective choice as a first-line diagnosis tool. |
3 |
| 32. Efthymiadis A, Tsikopoulos K, Uddin F, et al. Which is the optimal minimally invasive treatment for osteoid osteoma of the hip? A systematic review and proportional meta-analysis. Journal of Orthopaedic Science. 27(2):456-462, 2022 Mar. |
Meta-analysis |
29 studies |
In this meta-analysis, we sought to investigate positive and negative outcomes relating to minimally invasive surgery (MIS), which has superseded open resection and conservative measures over the last decades. |
Sixteen case-series were identified. Success rates for computed-tomography (CT)-guided radiofrequency ablation (RFA), CT-guided percutaneous resection drilling and arthroscopic resection were 98.2% (95% CI 95.8–99.5), p = 0.47; 91.5% (95% CI 81.1–97.9), p = 0.06; and 98% (95% CI 89.3–99.7), p = 0.95, respectively. Both RFA and percutaneous drilling resection were associated with two iatrogenic femoral fractures. Arthroscopic removal was not associated with any complications. Definitive diagnosis was established at least six months after symptom onset in up to 43% of patients. |
Good |
| 33. Liu PT, Chivers FS, Roberts CC, Schultz CJ, Beauchamp CP. Imaging of osteoid osteoma with dynamic gadolinium-enhanced MR imaging. Radiology. 2003;227(3):691-700. |
Observational-Dx |
11 patients |
To compare dynamic gadolinium-enhanced T1-weighted MRI with nonenhanced T1-weighted and T2-weighted MRI and thin-section CT for the demonstration of osteoid osteomas. |
Compared with CT, dynamic gadolinium-enhanced MRI demonstrated the osteoid osteoma equally well in 8/11 patients and with better conspicuity in 3/11 patients, although this difference was not statistically significant (P=.69). The dynamic gadolinium-enhanced MRIs demonstrated the osteoid osteomas significantly better than the nonenhanced T1-weighted (P<.001) and T2-weighted (P<.001) MRIs. On the dynamic gadolinium-enhanced MRIs, 9 (82%) of 11 patients had peak enhancement of the osteoid osteoma in the arterial phase with early partial washout, compared with slower, progressive enhancement of the adjacent marrow. This resulted in greatest lesion to marrow contrast material enhancement in the arterial phase. One osteoid osteoma had peak enhancement in the venous phase, and one showed progressive enhancement through all phases to 150 seconds. |
2 |
| 34. Davies M, Cassar-Pullicino VN, Davies AM, McCall IW, Tyrrell PN. The diagnostic accuracy of MR imaging in osteoid osteoma. Skeletal Radiol. 2002; 31(10):559-569. |
Review/Other-Dx |
43 patients |
To analyze the MRI appearances of a large series of osteoid osteomas, to assess the ability of MRI to detect the tumor, and to identify potential reasons for misdiagnosis. |
The potential for a missed diagnosis was 35% based solely on the MR investigations. This included 6 tumors which were not seen and 9 which were poorly visualized. The major determinants of the diagnostic accuracy of MRI were the MR technique, skeletal location, and preliminary radiographic appearances. There was a wide spectrum of MR signal appearances of the lesion. The tumor was identified in 65% of sequences performed in the axial plane. The nidus was present in only one slice of the optimal sequence in 27 patients. Reactive bone changes were present in 33 and soft tissue changes in 37 patients. |
4 |
| 35. Ahmed S, Jubouri S, Mulligan M. Incidental long bone cartilage lesions: is any further imaging workup needed?. Skeletal Radiol. 50(6):1189-1196, 2021 Jun. |
Observational-Dx |
73 patients |
To determine the rate of chondrosarcoma in incidentally discovered painless long bone cartilage lesions and to determine if any further imaging is needed. |
Only 1/73 (1.4%) patients with an initial incidentally discovered painless lesion was later diagnosed, with new symptoms, as atypical cartilage tumor. Average age was 59.4 years. Bones involved were the femur (n = 33), humerus (n = 30), tibia (n = 7), fibula (n = 2), and ulna (n = 1). Average enchondroma size was 3.9 cm (range 1.4-11.5). Average follow-up was 47 months (range 2-196 months). Eleven long bone chondrosarcomas were identified. All chondrosarcoma patients had pain and aggressive imaging findings. |
4 |
| 36. Akoh CC, Craig E, Troester AM, Miller BJ. Radiographic Enchondroma Surveillance: Assessing Clinical Outcomes and Costs Effectiveness. Iowa Orthopaedic Journal. 39(1):185-193, 2019. |
Observational-Dx |
55 patients |
The purposes of our study are: 1) to determine the number and proportion of low-grade cartilaginous tumors that demonstrate growth or require treatment and 2) to optimize the efficacy and cost-effectiveness of surveillance strategies for detecting biologically active lesions. |
For stable enchondromas, 35 out of 52 lesions (67.3%) presented in the lower extremities compared to three out of three (100%) growing cartilaginous tumors. Three out of 55 (5.45%) long bone cartilaginous lesions exhibited growth at a median of 23 (range 21-25 months) follow-up. There was no apparent difference in median presenting age for stable versus growing lesions (58.5 versus 55.0 years old, p =0.5673) or median lesion size at presentation (4.1 cm versus 3.6 cm, p = 0.2923). None of these lesions presented with pain attributable to the lesion. One out of seven biopsied cartilaginous lesions (four stable and three growing) had a histology diagnosis of grade 1 chondrosarcoma. There was no significant difference in the median number of total clinical visits for stable (four) and growing (five) enchondromas (p = 0.0807). The median pre-referral costs per patient were: plain radiographs ($383.00), CT scans ($0.00), and MRI imaging ($3,969.00). The median post-referral costs for plain radiographs and MRI per patient were $1,326.00 and $4,668.00, respectively. The annual median costs for plain radiographs and MRI were $609.23 and $2,240.64, respectively. |
3 |
| 37. Sharma P, Dhull VS, Reddy RM, et al. Hybrid SPECT-CT for characterizing isolated vertebral lesions observed by bone scintigraphy: comparison with planar scintigraphy, SPECT, and CT. Diagn Interv Radiol. 2013;19(1):33-40. |
Observational-Dx |
99 patients with 108 isolated vertebral lesions |
To assess the role of single photon emission computed tomography-computed tomography (SPECT-CT) for characterizing isolated vertebral lesions observed by bone scintigraphy compared to planar scintigraphy, SPECT, and CT, and to evaluate the impact of SPECT-CT on patient management. |
Among the 108 lesions, 49 were indeterminate on planar scintigraphy, 16 on SPECT, and one each on SPECT-CT and CT. SPECT-CT was superior to both planar scintigraphy (P < 0.001) and SPECT alone (P = 0.014), but not to CT (P = 0.302). CT was superior to planar scintigraphy (P < 0.001) but only slightly superior to SPECT (P = 0.063). SPECT-CT correctly characterized 96% of the indeterminate lesions observed by planar scintigraphy. SPECT-CT had an impact on the clinical management of 60.6% patients compared to planar scintigraphy and 18.1% compared to SPECT. |
3 |
| 38. Bui KL, Ilaslan H, Bauer TW, Lietman SA, Joyce MJ, Sundaram M. Cortical scalloping and cortical penetration by small eccentric chondroid lesions in the long tubular bones: not a sign of malignancy?. Skeletal Radiol. 38(8):791-6, 2009 Aug. |
Review/Other-Dx |
122 patients |
To evaluate by cross-sectional imaging the prevalence and degree of cortical scalloping by small eccentric chondromas correlated with histologic diagnosis and patient history. |
The chondromas ranged in size from 1.6 to 3.8 cm (mean 2.3 cm). Two lesions were located in the proximal femoral diaphysis, two in the distal femoral diaphysis, six in the distal femoral metaphysis, and one in the proximal tibial epimetaphysis. The lesions were curetted due to diagnostic uncertainty, continued pain, marked radiologic cortical penetration, or due to patient insistence on biopsy. All 11 lesions were benign, nine histologically, and two by stability over 4 and 7 years. The prevalence of cortical scalloping among eccentric chondromas was 100%. Cortical scalloping or occupancy ranged from 50 to 100% (mean 75%). |
4 |
| 39. Collins MS, Koyama T, Swee RG, Inwards CY. Clear cell chondrosarcoma: radiographic, computed tomographic, and magnetic resonance findings in 34 patients with pathologic correlation. Skeletal Radiol. 32(12):687-94, 2003 Dec. |
Review/Other-Dx |
72 patients |
To describe the radiographic features of clear cell chondrosarcoma, including the CT and MRI findings, and to correlate them with the histopathologic findings. |
Clear cell chondrosarcoma typically presents radiographically as a geographic lytic lesion located in the epimetaphyseal region of long bones. Most commonly lesions are found in the proximal femur, followed by the proximal humerus. Lesions within the proximal humerus may exhibit more aggressive features. Lesions in the axial skeleton are typically expansile and destructive, often with soft tissue extension and lack of mineralization. MRI may show the presence or absence of bone marrow edema. |
4 |
| 40. Murphey MD, wan Jaovisidha S, Temple HT, Gannon FH, Jelinek JS, Malawer MM. Telangiectatic osteosarcoma: radiologic-pathologic comparison. Radiology. 2003; 229(2):545-553. |
Review/Other-Dx |
40 patients |
To describe the imaging characteristics of a large series of telangiectatic osteosarcomas with pathologic findings for comparison. |
Lesions frequently affected the femur, tibia, and humerus. Radiographs showed geographic bone lysis, a wide zone of transition, and matrix mineralization. CT demonstrated low attenuation, MR demonstrated high signal intensity on T2-weighted images, and both demonstrated hemorrhage, which simulated the appearance of aneurysmal bone cyst. Viable sarcomatous tissue surrounding hemorrhagic and/or necrotic regions was best seen at contrast material-enhanced CT and MRI, with thick peripheral, septal, and nodular enhancement in all cases. Subtle matrix mineralization in this viable tissue was best seen at CT. An associated soft-tissue mass was also seen in 19/25 cases (76%) at CT and in 24/27 cases (89%) at MRI. |
4 |
| 41. Panicek DM, Gatsonis C, Rosenthal DI, et al. CT and MR imaging in the local staging of primary malignant musculoskeletal neoplasms: Report of the Radiology Diagnostic Oncology Group. Radiology. 1997;202(1):237-246. |
Experimental-Dx |
316 patients |
To assess the relative accuracies of CT and MRI in the local staging of primary malignant bone and soft-tissue tumors. The CT images were obtained with and without contrast. No contrast was used in the MR images. |
There was no statistically significant difference between CT and MRI in determining tumor involvement of muscle, bone, joints, or neurovascular structures. The combined interpretation of CT and MRI did not statistically significantly improve accuracy. Inter-reader variability was similar for both modalities. |
2 |
| 42. Yuan Y, Zhang Y, Lang N, Li J, Yuan H. Differentiating malignant vertebral tumours from non-malignancies with CT spectral imaging: a preliminary study. Eur Radiol. 2015;25(10):2945-2950. |
Observational-Dx |
37 patients |
To investigate the value of dual-energy spectral computed tomography (DESCT) for differentiating malignant vertebral tumours from non-malignancies during venous phase. |
The iodine density, lesion-to-muscle ratio, and lesion-to-artery ratio of the iodine density measurement for malignant vertebral tumours were significantly different from the respective values for non-malignancies (all p < 0.05). Using 0.52 as the threshold value for the lesion-to-artery iodine density ratio, one could obtain sensitivity of 85% and specificity of 100% for differentiating malignant vertebral tumours from non-malignancies, significantly higher than the qualitative diagnosis. |
3 |
| 43. Aoki J, Watanabe H, Shinozaki T, et al. FDG PET of primary benign and malignant bone tumors: standardized uptake value in 52 lesions. Radiology. 2001; 219(3):774-777. |
Observational-Dx |
52 primary bone lesions |
To evaluate the SUV of FDG-PET in the differentiation of benign from malignant bone lesions. |
There was a statistically significant difference in SUV between benign (2.18 +/- 1.52 [SD]) and malignant (4.34 +/- 3.19) lesions in total (P=.002). However, giant cell tumors (n = 5; SUV, 4.64 +/- 1.05) showed significantly higher SUV than chondrosarcomas (n = 7; SUV, 2.23 +/- 0.74) (P=.036, adjusted for multiple comparisons) and had no statistically significant difference in SUV compared with osteosarcomas (n = 6; SUV, 3.07 +/- 0.96) (P=.171). There was no statistically significant difference in SUV between fibrous dysplasias (n = 6; SUV, 2.05 +/- 0.98) and osteosarcoma (P=.127) or chondrosarcomas (P=.667). Although the number of cases was small, three chondroblastomas, one sarcoidosis, and one Langerhans cell histiocytosis showed levels of FDG accumulation as high as that of osteosarcomas. |
3 |
| 44. Bredella MA, Essary B, Torriani M, Ouellette HA, Palmer WE. Use of FDG-PET in differentiating benign from malignant compression fractures. Skeletal Radiology. 37(5):405-13, 2008 May. |
Observational-Dx |
33 patients with 43 compression fractures |
To evaluate the use of FDG-PET in differentiating benign from malignant compression fractures. |
There were 14 malignant and 29 benign compression fractures, including 5 acute benign fractures. On FDG-PET, 5 benign fractures were falsely classified as malignant (false-positive). Three of these patients underwent prior treatment with bone marrow-stimulating agents. There were two false-negative results. Sensitivity, specificity, PPV, NPV, and accuracy of FDG-PET in differentiating benign from malignant compression fractures were 86%, 83%, 84%, 71%, and 92% respectively. The difference between SUV values of benign and malignant fractures was statistically significant (1.9 +/- 0.97 for benign and 3.9 +/- 1.52 for malignant fractures, P<0.001). SUV of benign acute and chronic fractures were not statistically significant. |
3 |
| 45. Dehdashti F, Siegel BA, Griffeth LK, et al. Benign versus malignant intraosseous lesions: discrimination by means of PET with 2-[F-18]fluoro-2-deoxy-D-glucose. Radiology. 1996; 200(1):243-247. |
Observational-Dx |
20 patients |
To assess the ability of FDG-PET to allow differentiation of benign from malignant intraosseous lesions. |
SUV assessment of FDG accumulation within osseous lesions was superior to subjective visual analysis for discriminating benign from malignant lesions. With use of a 2.0 cutoff value for SUV, 14 of 15 malignant lesions were categorized correctly vs 12 of 15 correctly categorized by means of subjective image evaluation; four of five benign lesions were categorized correctly with both techniques. |
2 |
| 46. Liu F, Zhang Q, Zhu D, et al. Performance of Positron Emission Tomography and Positron Emission Tomography/Computed Tomography Using Fluorine-18-Fluorodeoxyglucose for the Diagnosis, Staging, and Recurrence Assessment of Bone Sarcoma: A Systematic Review and Meta-Analysis. Medicine (Baltimore). 94(36):e1462, 2015 Sep. |
Meta-analysis |
35 studies |
To investigate the performance of fluorine-18-fluorodeoxyglucose (F-FDG) positron emission tomography (PET) and PET/computed tomography (CT) in the diagnosis, staging, restaging, and recurrence surveillance of bone sarcoma by systematically reviewing and meta-analyzing the published literature. |
The pooled sensitivity and specificity of PET/CT to differentiate primary bone sarcomas from benign lesions were 96% (95% confidence interval [CI], 93-98) and 79% (95% CI, 63-90), respectively. For detecting recurrence, the pooled results on an examination-based level were sensitivity 92% (95% CI, 85-97), specificity 93% (95% CI, 88-96), positive likelihood ratio (PLR) 10.26 (95% CI, 5.99-17.60), and negative likelihood ratio (NLR) 0.11 (95% CI, 0.05-0.22). For detecting distant metastasis, the pooled results on a lesion-based level were sensitivity 90% (95% CI, 86-93), specificity 85% (95% CI, 81-87), PLR 5.16 (95% CI, 2.37-11.25), and NLR 0.15 (95% CI, 0.11-0.20). |
Good |
| 47. Shin DS, Shon OJ, Han DS, Choi JH, Chun KA, Cho IH. The clinical efficacy of (18)F-FDG-PET/CT in benign and malignant musculoskeletal tumors. Ann Nucl Med. 22(7):603-9, 2008 Aug. |
Observational-Dx |
91 patients |
To analyze the clinical efficacy of FDG-PET/CT in a relatively large group of patients with musculoskeletal tumors. |
Final diagnosis revealed 19 benign soft tissue tumors (mean SUV(max) 4.7), 27 benign bone tumors (5.1), 25 malignant soft tissue tumors (8.8), and 20 malignant bone tumors (10.8). There was a significant difference in SUV(max) between benign and malignant musculoskeletal tumors in total (P<0.002), soft tissue tumors (P<0.05), and bone tumors (P<0.02). Sensitivity, specificity, and diagnostic accuracy were 80%, 65.2%, and 73% in total with cutoff SUV(max) 3.8, 80%, 68.4%, and 75% in the soft tissue tumors with cutoff SUV(max) 3.8, and 80%, 63%, and 70% in the bone tumors with cutoff SUV(max) 3.7. |
3 |
| 48. Treglia G, Salsano M, Stefanelli A, Mattoli MV, Giordano A, Bonomo L. Diagnostic accuracy of 18F-FDG-PET and PET/CT in patients with Ewing sarcoma family tumours: a systematic review and a meta-analysis. [Review]. Skeletal Radiol. 41(3):249-56, 2012 Mar. |
Meta-analysis |
13 studies comprising a total of 342 patients |
To systematically review and meta-analyse literature data on the diagnostic performance of fluorine-18-fluorodeoxyglucose (FDG) positron emission tomography (PET) and positron emission tomography/computed tomography (PET/CT) in patients with Ewing sarcoma family tumours (ESFT). |
We found 13 studies comprising a total of 342 patients with ESFT. The main findings of the studies included are presented. The meta-analysis of five selected studies provided these results about FDG-PET and PET/CT in ESFT: pooled sensitivity: 96% (95% confidence interval [CI] 91-99%); pooled specificity: 92% (95% CI 87-96%); area under the ROC curve: 0.97. |
Good |
| 49. Wang CK, Li CW, Hsieh TJ, Chien SH, Liu GC, Tsai KB. Characterization of bone and soft-tissue tumors with in vivo 1H MR spectroscopy: initial results. Radiology. 232(2):599-605, 2004 Aug. |
Observational-Dx |
36 consecutive patients |
To determine if in vivo detection of choline by using hydrogen 1 MRS with dynamic contrast material-enhanced MRI can help differentiate between benign and malignant musculoskeletal tumors. |
Choline was detected in 18/19 patients with malignant tumors and in 3/17 patients with benign lesions. The 3 benign lesions included one perineurioma, one giant cell tumor, and one abscess. Choline was not detected in 14 patients with benign lesions nor in one patient with a densely ossifying low-grade parosteal osteosarcoma. In vivo hydrogen 1MRS characterized bone and soft-tissue tumors, resulting in a sensitivity of 95%, specificity of 82%, and accuracy of 89% (P<.001). |
2 |
| 50. Shin DS, Shon OJ, Byun SJ, Choi JH, Chun KA, Cho IH. Differentiation between malignant and benign pathologic fractures with F-18-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography. Skeletal Radiol. 37(5):415-21, 2008 May. |
Observational-Dx |
34 patients |
To evaluate the efficacy of FDG-PET/CT in differentiating malignant from benign pathologic fractures. |
There were 19 malignant and 15 benign fractures. In the malignant fractures, PET/CT demonstrated high (mean SUVmax 12.0, range 4.3 to 45.7). FDG uptake in bone marrow in most cases (17/19). In benign fractures, there was low FDG uptake (mean SUVmax 2.9, range 0.6 to 5.5) within cortical bone or adjacent soft tissue around the fracture, rarely in the marrow. There were significant differences in the pattern of intramedullary FDG uptake (P<0.001) and in the mean SUVmax (P<0.01) between malignant and benign fractures. The sensitivity, specificity and diagnostic accuracy of FDG-PET/CT were 89.5%, 86.7% and 88.2%, respectively, with a cut-off SUVmax set at 4.7. The time interval between fracture and PET/CT did not significantly influence FDG uptake at the fracture site. |
3 |
| 51. Feldman F, Van Heertum R, Saxena C, Parisien M. 18FDG-PET applications for cartilage neoplasms. Skeletal Radiol. 34(7):367-74, 2005 Jul. |
Observational-Dx |
29 patients |
To assess the value of FDG-PET in defining aggressive cartilage neoplasms, particularly those with problematic or borderline histologic, imaging and clinical characteristics. |
In 26 operated cases the overall sensitivity of whole-body FDG-PET in separating benign and malignant lesions was 90.9% (10/11), specificity 100% (18/18) and accuracy 96.6%. |
3 |
| 52. Younis MH, Abu-Hijleh HA, Aldahamsheh OO, Abualruz A, Thalib L. Meta-Analysis of the Diagnostic Accuracy of Primary Bone and Soft Tissue Sarcomas by 18F-FDG-PET. Medical Principles & Practice. 29(5):465-472, 2020. |
Meta-analysis |
21 studies |
The goal of this meta-analysis was to assess the use of FDG-PET in the diagnosis of primary bone and soft tissue sarcomas. |
Of the 1,258 papers screened, 21 studies satisfied the inclusion criteria. The pooled sensitivity and specificity of FDG-PET combined with CT for the detection of sarcomas were 89.2 and 76.3%, respectively. These diagnostic accuracy measures were higher when combined with CT than those of PDG-PET alone. Diagnostic accuracy for bone and soft tissue lesions were comparable but slightly better for soft tissue tumors. Pooling only the high-quality studies with low risk of bias yielded a sensitivity of 88.5% and specificity reduced to 65.6%. There was no evidence for publication bias, but significant heterogeneity among the studies was apparent. This study also showed that FDG-PET can efficiently differentiate between benign and malignant tumors, with a mean standard uptake value of maximally 2.52 units in benign and 6.81 units in malignant tumors (89.2% sensitivity and 75.1% specificity). |
Good |
| 53. Liu F, Zhang Q, Zhou D, Dong J. Effectiveness of 18F-FDG PET/CT in the diagnosis and staging of osteosarcoma: a meta-analysis of 26 studies. BMC Cancer. 19(1):323, 2019 Apr 05. |
Meta-analysis |
26 studies |
To investigate the effectiveness of 18F-FDG PET and PET/CT in the diagnosis, staging, recurrence and metastasis formation observations of osteosarcoma through systematic review followed by meta-analysis. |
All data from these articles, utilized in the quantitative analyses, showed after meta-analysis that when utilizing 18F-FDG PET or PET/CT it was better with a success rate of 90-100% for detecting primary lesions and distant metastases of patients with osteosarcoma. Similar results were also obtained for detecting lung and bone metastases in a subgroup analysis. |
Good |
| 54. Feydy A, Anract P, Tomeno B, Chevrot A, Drape JL. Assessment of vascular invasion by musculoskeletal tumors of the limbs: use of contrast-enhanced MR angiography. Radiology. 238(2):611-21, 2006 Feb. |
Observational-Dx |
30 patients |
To prospectively evaluate the accuracy of contrast material-enhanced MR angiography in the evaluation of vascular invasion by bone and soft-tissue tumors, with surgery serving as the reference standard. |
Among the 31 cases, 20 were classified as negative and 11 were classified as positive at surgery. All but 3 cases with a gap between the tumor and the vessels on MRI were classified as free and without adhesions at surgery. All cases with arterial stenoses at MR angiography had tumoral adhesion or tumoral encasement at surgery. MRI had a sensitivity of 64%, a specificity of 95%, a PPV of 88% a NPV of 83%, and an accuracy of 84% in the detection of vascular invasion on the basis of findings of partial or total encasement. MR angiography had a sensitivity of 82%, a specificity of 85%, a PPV of 75%, a NPV of 90%, and an accuracy of 84% in the detection of vascular invasion on the basis of the findings of a stenosis. |
2 |
| 55. Seeger LL, Widoff BE, Bassett LW, Rosen G, Eckardt JJ. Preoperative evaluation of osteosarcoma: value of gadopentetate dimeglumine-enhanced MR imaging. AJR. 1991; 157(2):347-351. |
Review/Other-Dx |
21 patients |
To determine if gadopentetate dimeglumine-enhanced MRIs could assist in the preoperative evaluation of osteosarcoma. |
In some instances, use of gadopentetate dimeglumine obscured differentiation of tumor from normal marrow or tumor infiltration into perineurovascular fat, and tumor extension through pseudocapsule could not be differentiated from peritumoral edema after contrast administration. Contrast enhancement did assist in differentiation of intra-articular tumor from effusion; however, synovial invasion could be identified on unenhanced T1-weighted images by loss of synovial fat and cortical disruption. These results indicate that gadopentetate dimeglumine does not assist in defining tumor margins of osteosarcoma. |
4 |
| 56. Swan JS, Grist TM, Sproat IA, Heiner JP, Wiersma SR, Heisey DM. Musculoskeletal neoplasms: preoperative evaluation with MR angiography. Radiology. 1995; 194(2):519-524. |
Observational-Dx |
23 patients |
To assess the ability of MR angiography to depict vascularity of musculoskeletal neoplasms. |
Of named vessels, 92% in proximity to tumor were noted by blinded readers. The PC technique provided supplemental data in 47% of cases, usually related to better delineation of in-plane feeder vessels and areas with pulsatile blood flow. Of the 28 branch feeder vessels, 23 were noted on both conventional arteriograms and MR angiograms in a nonblinded review, but 16 were difficult to distinguish as feeders because of lack of associated tumor blush. |
2 |
| 57. Geirnaerdt MJ, Hogendoorn PC, Bloem JL, Taminiau AH, van der Woude HJ. Cartilaginous tumors: fast contrast-enhanced MR imaging. Radiology. 2000; 214(2):539-546. |
Observational-Dx |
37 patients |
To differentiate between benign and malignant cartilaginous tumors with fast contrast material-enhanced MRI. |
Start of enhancement and the combination of start and progression of enhancement correlated significantly (P<.001) with benign and malignant tumors. Early enhancement was seen in chondrosarcoma, not seen in enchondroma, and seen in osteochondroma only when growth plates were unfused. The sensitivity was 89%, specificity 84%, PPV 84%, and NPV 89%. Differentiation of malignancy from benignity on the basis of early and exponential enhancement was possible with a sensitivity of 61%, specificity 95%, PPV 92%, and NPV 72%. |
3 |
| 58. Deckers C, Steyvers MJ, Hannink G, Schreuder HWB, de Rooy JWJ, Van Der Geest ICM. Can MRI differentiate between atypical cartilaginous tumors and high-grade chondrosarcoma? A systematic review. Acta Orthopaedica. 91(4):471-478, 2020 08. |
Review/Other-Dx |
14 studies |
This systematic review provides an overview of MRI criteria used to differentiate between atypical cartilaginous tumors (ACT) and high-grade chondrosarcoma (HGCS). |
Our search identified 2,132 unique records, of which 14 studies were included. 239 ACT and 140 HGCS were identified. The quality assessment showed great variability in consensus criteria used for both pathologic and radiologic diagnosis. Due to substantial heterogeneity we refrained from pooling the results in a meta-analysis and reported non-statistical syntheses. Loss of entrapped fatty marrow, cortical breakthrough, and extraosseous soft tissue expansion appeared to be present more often in HGCS compared with ACT. |
4 |
| 59. Arevalo-Perez J, Peck KK, Lyo JK, Holodny AI, Lis E, Karimi S. Differentiating benign from malignant vertebral fractures using T1 -weighted dynamic contrast-enhanced MRI. J Magn Reson Imaging. 2015;42(4):1039-1047. |
Review/Other-Dx |
21 patients |
To differentiate pathologic from benign vertebral fractures, which can be challenging. |
Pathologic fractures had significantly higher (P < 0.01) perfusion parameters (Vp , K(trans) , wash-in slope, peak enhancement, and AUC) compared with benign fractures. We also found significant differences (P < 0.001) in all parameters between chronic and acute fractures. Vp and K(trans) were able to differentiate between pathologic and acute fractures (P < 0.01). No significant differences were found with peak enhancement (P = 0.21) and AUC (P = 0.4) between pathologic and acute fractures. |
4 |
| 60. Verstraete KL, De Deene Y, Roels H, Dierick A, Uyttendaele D, Kunnen M. Benign and malignant musculoskeletal lesions: dynamic contrast-enhanced MR imaging--parametric "first-pass" images depict tissue vascularization and perfusion. Radiology. 1994; 192(3):835-843. |
Observational-Dx |
100 patients |
To assess the diagnostic value of parametric MRIs that display the first pass of gadopentetate dimeglumine. |
A significant difference (P<.001) was found between the first pass slope values of benign (mean, 36.2% per second) and malignant (mean, 67.4% per second) lesions. First pass images depicted tissue vascularization and perfusion rather than benignity or malignancy, because there is an overlap in the slope values of highly vascular benign lesions and malignant lesions. |
3 |
| 61. Campbell RS, Grainger AJ, Mangham DC, Beggs I, Teh J, Davies AM. Intraosseous lipoma: report of 35 new cases and a review of the literature. Skeletal Radiol. 2003; 32(4):209-222. |
Review/Other-Dx |
35 cases of intraosseous lipoma; 110 cases |
To identify the common imaging features of intraosseous lipomas on radiographs, MRI and CT, and review their histological features. |
The mean age at presentation is 43 years. Sex distribution is nearly equal. Lipomas occur most frequently in the lower limb (71% overall), particularly in the os calcis (32%). Other common sites include the metaphyses of long bones, where lesions are typically eccentric. Lipomas are usually well defined, but marginal sclerosis is commoner in lesions of the os calcis (61%) than at other sites (38%). Calcification is also more frequent in the os calcis (62%), and almost invariably centrally located. Calcification at other sites is less common (30%), and is more variable in appearance. Bone expansion is less common (30%), and usually minimal. Fat necrosis and cyst formation identified on MRI is common (67%), and more frequent in the os calcis. |
4 |
| 62. Si MJ, Wang CS, Ding XY, et al. Differentiation of primary chordoma, giant cell tumor and schwannoma of the sacrum by CT and MRI. Eur J Radiol. 82(12):2309-15, 2013 Dec. |
Review/Other-Dx |
22 SCs, 19 SGCTs and 8 GSSs were reviewed |
To evaluate criteria to differentiate sacral chordoma (SC), sacral giant cell tumor (SGCT) and giant sacral schwannoma (GSS) with CT and MRI. |
The mean ages of SC, SGCT and GSS were 55.1 +/- 10.7, 34.3 +/- 10.7 and 42.4 +/- 15.7 years old. SCs (77.3%) were predominantly located in the midline of lower sacrum, while most SGCTs (73.7%) and GSSs (87.5%) were eccentrically located in upper sacrum. There were significant differences in age, location, eccentricity, morphology of bone residues, intratumoral bleeding and septations. Multiple small cysts were mainly observed in SGCTs (73.7%) with large central cysts in GSSs (87.5%). SGCTs expanded mainly inside sacrum while SCs and GSSs often extended into pelvic cavity (P = 0.0022). Involvement of sacroiliac joints and muscles were also different. Ascending extension within sacral canal was only displayed in SCs. The preservation of intervertebral discs showed difference between large and small tumors (P = 0.0002), regardless of tumor type (P = 0.095). No significant difference was displayed in gender (P = 0.234) or tumor size (P = 0.0832) among three groups. |
4 |
| 63. Hogeboom WR, Hoekstra HJ, Mooyaart EL, et al. MRI or CT in the preoperative diagnosis of bone tumours. Eur J Surg Oncol. 1992; 18(1):67-72. |
Observational-Dx |
25 patients |
To determine the value of MRI and CT in the diagnosis of bone tumors. |
MRI is superior to CT as it permits multidirectional exposures. Moreover, the tumor can be readily distinguished from the neurovascular structures without injection of contrast medium. MRI gives better contrast than CT, making it possible to study the relationship to the soft tissues, bone marrow and joints more accurately. On the other hand, CT gives a better picture of the destruction of cortical bone. The exact tumor length cannot be measured with MRI or CT and neither permits an exact, reliable diagnosis. Owing to the relatively slow exposure technique in combination with respiratory movements, depiction of the thoracic wall is less satisfactory with MRI than with CT. If both techniques are available, MRI is preferred. |
3 |
| 64. Bloem JL, Taminiau AH, Eulderink F, Hermans J, Pauwels EK. Radiologic staging of primary bone sarcoma: MR imaging, scintigraphy, angiography, and CT correlated with pathologic examination. Radiology. 1988; 169(3):805-810. |
Observational-Dx |
56 patients |
A prospective study to determine the appropriate application of diagnostic procedures in local staging of primary bone sarcoma by comparing results of CT, MRI, Tc-99m-methylene diphosphonate scintigraphy, and angiography with resected specimens. |
MRI was significantly superior to CT and scintigraphy in defining intraosseous tumor length and was as accurate as CT in demonstrating cortical bone and joint involvement. It was also superior to CT in demonstrating involvement of muscle compartments. MRI was also the best modality in exhibiting the relationship between tumor and major neurovascular bundles; however, these differences were not significant. |
3 |
| 65. Lange MB, Nielsen ML, Andersen JD, Lilholt HJ, Vyberg M, Petersen LJ. Diagnostic accuracy of imaging methods for the diagnosis of skeletal malignancies: A retrospective analysis against a pathology-proven reference. Eur J Radiol. 85(1):61-67, 2016 Jan. |
Observational-Dx |
409 biopsies from 395 patients. |
To examine the diagnostic accuracy of imaging modalities in skeletal tumours versus pathology reports. |
Sensitivity and specificity were significantly different among the five modalities (p<0.0001). The sensitivity of MRI and PET/CT was better than CT, but CT had a better specificity than PET/CT. In general, these methods outperformed BS and X-ray. The sensitivity for osteolytic lesions varied significantly between modalities (p<0.0001), with MRI and PET/CT being more sensitive than CT. Differences in sensitivity were also observed in mixed lesions (p=0.0002) but not in osteosclerotic lesions. In spine lesions, MRI showed the best sensitivity followed by PET/CT and CT (p<0.0005 vs. MRI). There was no significant differences among non-spine lesions. |
3 |
| 66. Douis H, Davies AM, Jeys L, Sian P. Chemical shift MRI can aid in the diagnosis of indeterminate skeletal lesions of the spine. Eur Radiol. 2016;26(4):932-940. |
Observational-Dx |
55 patients |
To evaluate the role of chemical shift MRI in the characterisation of indeterminate skeletal lesions of the spine as benign or malignant. |
There were 45 benign lesions and 12 malignant lesions. Chemical shift imaging correctly diagnosed 33 of 45 lesions as benign and 11 of 12 lesions as malignant. In contrast, there were 12 false positive cases and 1 false negative case based on chemical shift MRI. This yielded a sensitivity of 91.7 %, a specificity of 73.3 %, a negative predictive value of 97.1 %, a positive predictive value of 47.8 % and a diagnostic accuracy of 82.5 %. |
3 |
| 67. Liu LP, Cui LB, Zhang XX, et al. Diagnostic Performance of Diffusion-weighted Magnetic Resonance Imaging in Bone Malignancy: Evidence From a Meta-Analysis. [Review]. Medicine (Baltimore). 94(45):e1998, 2015 Nov. |
Meta-analysis |
32 studies with 1507 patients. |
To investigate whether whole-body DW-MRI is a viable means in differentiating bone malignancy. |
The pooled sensitivity, specificity, and AUC were 0.95 (95% CI, 0.90-0.97), 0.92 (95% CI, 0.88-0.95), and 0.98 on a per-patient basis, and they were 0.91 (95% CI, 0.87-0.94), 0.94 (95% CI, 0.90-0.96), and 0.97 on a per-lesion basis. In subgroup analysis, there is no statistical significance found in the sensitivity and specificity of using DWI only and DWI combined with other morphological or functional imaging sequence in both basis (P > 0.05). A b value of 750 to 1000 s/mm enables higher AUC and DOR for whole-body imaging purpose when compared with other values in both basis either (P < 0.01). The ROC space did not show a curvilinear trend of points and a threshold effect was not observed. According to the Deek's plots, there was no publication bias on both basis. |
Good |
| 68. Thawait SK, Marcus MA, Morrison WB, Klufas RA, Eng J, Carrino JA. Research synthesis: what is the diagnostic performance of magnetic resonance imaging to discriminate benign from malignant vertebral compression fractures? Systematic review and meta-analysis. Spine (Phila Pa 1976). 2012;37(12):E736-744. |
Meta-analysis |
31 studies with 1685 subjects |
To perform a systematic review and meta-analysis to summarize and combine the published data on MRI for discriminating malignant from benign VCFs. |
A total of 31 studies with 1685 subjects met the selection criteria. All the studies focused on describing specific features rather than overall diagnostic performance. Signal intensity ratio on opposed phase (chemical shift) imaging 0.8 or more (OR = 164), apparent diffusion coefficient on echo planar diffusion-weighted images 1.5 x 10(-3) mm2/s or less with b value 500 s/mm2 (OR = 130), presence of other noncharacteristic vertebral lesions (OR = 55), presence of paraspinal mass (OR = 33), involvement of posterior element (OR = 28), involvement of pedicle (OR = 24), complete replacement of normal bone marrow in VCF (OR = 19), presence of epidural mass (OR = 13), and diffuse convexity of posterior vertebral border (OR = 10) were associated with malignant VCFs, whereas coexisting healed benign VCF (OR = 0.006), presence of "fluid sign" (OR = 0.08), presence of focal posterior vertebral border convexity/retropulsion (OR = 0.08), and band-like shape of abnormal signal (OR = 0.07) were associated with benign VCFs |
Good |
| 69. Fayad LM, Wang X, Salibi N, et al. A feasibility study of quantitative molecular characterization of musculoskeletal lesions by proton MR spectroscopy at 3 T. AJR. 2010; 195(1):W69-75. |
Observational-Dx |
33 patients |
To establish the feasibility and potential value of measuring the concentration of choline-containing compounds by proton MRS in musculoskeletal lesions at 3T. |
Spectral quality was excellent in 26 cases, adequate in 4 cases, and nondiagnostic in 4 cases. For malignant lesions (3 sarcomas), the choline concentrations were 1.5, 2.9, and 3.8 mmol/kg, respectively. For 5 benign lesions (two neurofibromas, two schwannomas, and one enchondroma), the choline concentrations were 0.11, 0.28, 0.13, 0.8, and 1.2 mmol/kg, respectively. For 7 benign lesions (two hematomas, two bone cysts, one lipoma, one giant cell tumor, and one pigmented villonodular synovitis), the spectra showed negligible choline content. For 3 post-treatment fibrosis cases, the choline concentration range was 0.2-0.4 mmol/kg. For the remaining 12 post-treatment fibrosis cases, the spectra showed negligible choline content. Average choline concentrations were different for malignant and benign lesions (2.7 vs 0.5 mmol/kg; P=0.01). |
3 |
| 70. Wang LJ, Wu HB, Wang M, et al. Utility of F-18 FDG PET/CT on the evaluation of primary bone lymphoma. Eur J Radiol. 84(11):2275-9, 2015 Nov. |
Observational-Dx |
19 |
to assess the role of F-18 FDG PET/CT in the diagnosis and therapeutic effect evaluation of primary bone lymphoma (PBL) . |
F-18 FDG PET/CT was positive in 94.7% (18/19) of patients. Uptake of FDG in lesions was intense with SUVmax of 15.14 +/- 11.82. Multiple involved lesions were found in 47.4% (9/19) patients, while 52.6% presented with a single involved lesion. Based on the lesions, PET detected 98.9% (87/88) lesions. Among them, 71.6% (63/88) lesions were found to be located in axial skeleton and 28.4% (25/88) in the extremity skeleton. FDG PET/CT also found the lesions infiltrate to the surrounding soft tissue in 84.2% (16/19) patients. On the syn-modality CT, the bone destruction was noted in 43.2% (38/88) of the lesions, of which 50.0% lesions presented as slight change in bone density and 50.0% as severe change. The diagnostic sensitivity of PET was much higher than that of CT (98.9% vs. 43.2%, P=0.000). PET/CT was performed for evaluation of treatment response in 13 patients. In 12 patients with complete response(CR), PET/CT found the 25 lesions were F-18 FDG fully resoluted after treatment, however, bone destruction was still presented in 72.0% (18/25) lesions. |
3 |
| 71. National Academies of Sciences, Engineering, and Medicine; Division of Behavioral and Social Sciences and Education; Committee on National Statistics; Committee on Measuring Sex, Gender Identity, and Sexual Orientation. Measuring Sex, Gender Identity, and Sexual Orientation. In: Becker T, Chin M, Bates N, eds. Measuring Sex, Gender Identity, and Sexual Orientation. Washington (DC): National Academies Press (US) Copyright 2022 by the National Academy of Sciences. All rights reserved.; 2022. |
Review/Other-Dx |
N/A |
Sex and gender are often conflated under the assumptions that they are mutually determined and do not differ from each other; however, the growing visibility of transgender and intersex populations, as well as efforts to improve the measurement of sex and gender across many scientific fields, has demonstrated the need to reconsider how sex, gender, and the relationship between them are conceptualized. |
No abstract available. |
4 |
| 72. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. |
Review/Other-Dx |
N/A |
To provide evidence-based guidelines on exposure of patients to ionizing radiation. |
No abstract available. |
4 |
