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Musculoskeletal
Diagnosis
Non-Trauma
Bone Tumors and Tumor-Like Conditions
Bone-Forming Tumors
Conventional Osteosarcoma
Conventional Osteosarcoma
Behrang Amini, MD, PhD; B. J. Manaster, MD, PhD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        TERMINOLOGY

        • Abbreviations

          • Osteosarcoma (OS)

        • Synonyms

          • Osteogenic sarcoma, central OS, medullary OS, sclerosing OS, subtypes osteoblastic sarcoma, chondroblastic OS, fibroblastic OS

        • Definitions

          • Malignant, osteoid-producing, intramedullary tumor

        IMAGING

        • General Features

          • Radiographic Findings

            • CT Findings

              • MR Findings

                • Nuclear Medicine Findings

                  • Image-Guided Biopsy

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Staging, Grading, & Classification

                            • Gross Pathologic & Surgical Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Reporting Tips

                                            Selected References

                                            1. Amini B et al: Osteoid tumors of bone. Semin Ultrasound CT MR. 42(2):134-49, 2021
                                            2. Hao Y et al: Prognostic value of tumoral and peritumoral magnetic resonance parameters in osteosarcoma patients for monitoring chemotherapy response. Eur Radiol. 31(5):3518-29, 2021
                                            3. Baumhoer D et al. Osteosarcoma . In Fletcher CDM et al: World Health Organization Classification of Tumours: Tumours of Soft Tissue and Bone. IARC Press, 403-9. 2020
                                            4. Saleh MM et al: Multiparametric MRI with diffusion-weighted imaging in predicting response to chemotherapy in cases of osteosarcoma and Ewing's sarcoma. Br J Radiol. 93(1115):20200257, 2020
                                            5. Gulia A et al: Comparison of MRI and histopathology with regard to intramedullary extent of disease in bone sarcomas. Sarcoma. 2019:7385470, 2019
                                            6. Kumar R et al: Primary osteosarcoma in the elderly revisited: current concepts in diagnosis and treatment. Curr Oncol Rep. 20(2):13, 2018
                                            7. Yedururi S et al: Tumor thrombus in the large veins draining primary pelvic osteosarcoma on cross sectional imaging. Eur J Radiol. 105:49-55, 2018
                                            8. Costelloe CM et al: PET/CT of osteosarcoma and Ewing sarcoma. Semin Roentgenol. 52(4):255-68, 2017
                                            9. Byun BH et al: Prediction of response to neoadjuvant chemotherapy in osteosarcoma using dual-phase 18F-FDG PET/CT. Eur Radiol. 25(7):2015-24, 2015
                                            10. Loh AH et al: Influence of bony resection margins and surgicopathological factors on outcomes in limb-sparing surgery for extremity osteosarcoma. Pediatr Blood Cancer. 62(2):246-51, 2015
                                            11. Quartuccio N et al: Pediatric bone sarcoma: diagnostic performance of ¹⁸F-FDG PET/CT versus conventional imaging for initial staging and follow-up. AJR Am J Roentgenol. 204(1):153-60, 2015
                                            12. Reddy KI et al: Does amputation offer any survival benefit over limb salvage in osteosarcoma patients with poor chemonecrosis and close margins? Bone Joint J. 97-B(1):115-20, 2015
                                            13. Xu M et al: Marginal resection for osteosarcoma with effective neoadjuvant chemotherapy: long-term outcomes. World J Surg Oncol. 12:341, 2014
                                            14. Costelloe CM et al: Tumor necrosis in osteosarcoma: inclusion of the point of greatest metabolic activity from F-18 FDG PET/CT in the histopathologic analysis. Skeletal Radiol. 39(2):131-40, 2010
                                            15. Cheon GJ et al: Prediction model of chemotherapy response in osteosarcoma by 18F-FDG PET and MRI. J Nucl Med. 50(9):1435-40, 2009
                                            16. Costelloe CM et al: 18F-FDG PET/CT as an indicator of progression-free and overall survival in osteosarcoma. J Nucl Med. 50(3):340-7, 2009
                                            17. Dutour A et al: 18F-FDG PET SUVmax correlates with osteosarcoma histologic response to neoadjuvant chemotherapy: preclinical evaluation in an orthotopic rat model. J Nucl Med. 50(9):1533-40, 2009
                                            18. Kunze B et al: Multifocal osteosarcoma in childhood. Musculoskelet Surg. 93(1):27-31, 2009
                                            19. Mertens F et al: Translocation-related sarcomas. Semin Oncol. 36(4):312-23, 2009
                                            20. Murphey MD et al: The many faces of osteosarcoma. Radiographics. 17(5):1205-31, 1997
                                            21. Rosenberg ZS et al: Osteosarcoma: subtle, rare, and misleading plain film features. AJR Am J Roentgenol. 165(5):1209-14, 1995
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Clinical Issues

                                                  TERMINOLOGY

                                                  • Abbreviations

                                                    • Osteosarcoma (OS)

                                                  • Synonyms

                                                    • Osteogenic sarcoma, central OS, medullary OS, sclerosing OS, subtypes osteoblastic sarcoma, chondroblastic OS, fibroblastic OS

                                                  • Definitions

                                                    • Malignant, osteoid-producing, intramedullary tumor

                                                  IMAGING

                                                  • General Features

                                                    • Radiographic Findings

                                                      • CT Findings

                                                        • MR Findings

                                                          • Nuclear Medicine Findings

                                                            • Image-Guided Biopsy

                                                              • Imaging Recommendations

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    • Staging, Grading, & Classification

                                                                      • Gross Pathologic & Surgical Features

                                                                        • Microscopic Features

                                                                          CLINICAL ISSUES

                                                                          • Presentation

                                                                            • Demographics

                                                                              • Natural History & Prognosis

                                                                                • Treatment

                                                                                  DIAGNOSTIC CHECKLIST

                                                                                  • Consider

                                                                                    • Reporting Tips

                                                                                      Selected References

                                                                                      1. Amini B et al: Osteoid tumors of bone. Semin Ultrasound CT MR. 42(2):134-49, 2021
                                                                                      2. Hao Y et al: Prognostic value of tumoral and peritumoral magnetic resonance parameters in osteosarcoma patients for monitoring chemotherapy response. Eur Radiol. 31(5):3518-29, 2021
                                                                                      3. Baumhoer D et al. Osteosarcoma . In Fletcher CDM et al: World Health Organization Classification of Tumours: Tumours of Soft Tissue and Bone. IARC Press, 403-9. 2020
                                                                                      4. Saleh MM et al: Multiparametric MRI with diffusion-weighted imaging in predicting response to chemotherapy in cases of osteosarcoma and Ewing's sarcoma. Br J Radiol. 93(1115):20200257, 2020
                                                                                      5. Gulia A et al: Comparison of MRI and histopathology with regard to intramedullary extent of disease in bone sarcomas. Sarcoma. 2019:7385470, 2019
                                                                                      6. Kumar R et al: Primary osteosarcoma in the elderly revisited: current concepts in diagnosis and treatment. Curr Oncol Rep. 20(2):13, 2018
                                                                                      7. Yedururi S et al: Tumor thrombus in the large veins draining primary pelvic osteosarcoma on cross sectional imaging. Eur J Radiol. 105:49-55, 2018
                                                                                      8. Costelloe CM et al: PET/CT of osteosarcoma and Ewing sarcoma. Semin Roentgenol. 52(4):255-68, 2017
                                                                                      9. Byun BH et al: Prediction of response to neoadjuvant chemotherapy in osteosarcoma using dual-phase 18F-FDG PET/CT. Eur Radiol. 25(7):2015-24, 2015
                                                                                      10. Loh AH et al: Influence of bony resection margins and surgicopathological factors on outcomes in limb-sparing surgery for extremity osteosarcoma. Pediatr Blood Cancer. 62(2):246-51, 2015
                                                                                      11. Quartuccio N et al: Pediatric bone sarcoma: diagnostic performance of ¹⁸F-FDG PET/CT versus conventional imaging for initial staging and follow-up. AJR Am J Roentgenol. 204(1):153-60, 2015
                                                                                      12. Reddy KI et al: Does amputation offer any survival benefit over limb salvage in osteosarcoma patients with poor chemonecrosis and close margins? Bone Joint J. 97-B(1):115-20, 2015
                                                                                      13. Xu M et al: Marginal resection for osteosarcoma with effective neoadjuvant chemotherapy: long-term outcomes. World J Surg Oncol. 12:341, 2014
                                                                                      14. Costelloe CM et al: Tumor necrosis in osteosarcoma: inclusion of the point of greatest metabolic activity from F-18 FDG PET/CT in the histopathologic analysis. Skeletal Radiol. 39(2):131-40, 2010
                                                                                      15. Cheon GJ et al: Prediction model of chemotherapy response in osteosarcoma by 18F-FDG PET and MRI. J Nucl Med. 50(9):1435-40, 2009
                                                                                      16. Costelloe CM et al: 18F-FDG PET/CT as an indicator of progression-free and overall survival in osteosarcoma. J Nucl Med. 50(3):340-7, 2009
                                                                                      17. Dutour A et al: 18F-FDG PET SUVmax correlates with osteosarcoma histologic response to neoadjuvant chemotherapy: preclinical evaluation in an orthotopic rat model. J Nucl Med. 50(9):1533-40, 2009
                                                                                      18. Kunze B et al: Multifocal osteosarcoma in childhood. Musculoskelet Surg. 93(1):27-31, 2009
                                                                                      19. Mertens F et al: Translocation-related sarcomas. Semin Oncol. 36(4):312-23, 2009
                                                                                      20. Murphey MD et al: The many faces of osteosarcoma. Radiographics. 17(5):1205-31, 1997
                                                                                      21. Rosenberg ZS et al: Osteosarcoma: subtle, rare, and misleading plain film features. AJR Am J Roentgenol. 165(5):1209-14, 1995