Osteosarcoma: Review of the Various Types with Emphasis on Recent Advancements in Imaging

Michael G. Fox; Brian M. Trotta

doi:10.1055/s-0033-1342969

Seminars in Musculoskeletal Radiology, Table of Contents

Semin Musculoskelet Radiol 2013; 17(02): 123-136
DOI: 10.1055/s-0033-1342969

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Osteosarcoma: Review of the Various Types with Emphasis on Recent Advancements in Imaging

Michael G. Fox

¹Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia

,

Brian M. Trotta

¹Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia

› Author Affiliations

Abstract

Osteosarcoma is the classic malignant osteoid-forming bone tumor. The typical clinical presentation, histology, imaging findings, treatment, and prognosis for each subtype of osteosarcoma is provided. Particular emphasis is placed on more current magnetic resonance imaging and nuclear medicine imaging techniques that may soon improve the ability to determine the most appropriate therapy and ultimately improve patient survival.

Keywords

osteosarcoma - central osteosarcoma - surface osteosarcoma - MRI - PET

Full Text

References

References
1 Klein MJ, Siegal GP. Osteosarcoma: anatomic and histologic variants. Am J Clin Pathol 2006; 125 (4) 555-581
2 Wootton-Gorges SL. MR imaging of primary bone tumors and tumor-like conditions in children. Magn Reson Imaging Clin N Am 2009; 17 (3) 469-487 , vi
3 Anbari KK, Ierardi-Curto LA, Silber JS , et al. Two primary osteosarcomas in a patient with Rothmund-Thomson syndrome. Clin Orthop Relat Res 2000; (378) 213-223
4 Suresh S, Saifuddin A. Radiological appearances of appendicular osteosarcoma: a comprehensive pictorial review. Clin Radiol 2007; 62 (4) 314-323
5 Pahade J, Sekhar A, Shetty SK. Imaging of malignant skeletal tumors. Cancer Treat Res 2008; 143: 367-422
6 Murphey MD, Robbin MR, McRae GA, Flemming DJ, Temple HT, Kransdorf MJ. The many faces of osteosarcoma. Radiographics 1997; 17 (5) 1205-1231
7 Pringle JAS. Osteosarcoma: the experiences of a specialist unit. Curr Diagn Pathol 1996; 3 (3) 127-136
8 Kim MS, Lee SY, Cho WH , et al. Initial tumor size predicts histologic response and survival in localized osteosarcoma patients. J Surg Oncol 2008; 97 (5) 456-461
9 Greene FLPD, Fleming ID, Fritz A, Balch CM, Haller DG, Morrow M. AJCC Cancer Staging Manual. 6th ed. New York, NY: Springer-Verlag; 2002
10 Spina V, Montanari N, Romagnoli R. Malignant tumors of the osteogenic matrix. Eur J Radiol 1998; 27 (Suppl. 01) S98-S109
11 Kaste SC, Liu T, Billups CA, Daw NC, Pratt CB, Meyer WH. Tumor size as a predictor of outcome in pediatric non-metastatic osteosarcoma of the extremity. Pediatr Blood Cancer 2004; 43 (7) 723-728
12 Lee JA, Kim MS, Kim DH , et al. Relative tumor burden predicts metastasis-free survival in pediatric osteosarcoma. Pediatr Blood Cancer 2008; 50 (2) 195-200
13 Wang CS, Yin QH, Liao JS , et al. Primary diaphyseal osteosarcoma in long bones: imaging features and tumor characteristics. Eur J Radiol 2012; 81 (11) 3397-3403
14 Eftekhari F. Imaging assessment of osteosarcoma in childhood and adolescence: diagnosis, staging, and evaluating response to chemotherapy. Cancer Treat Res 2009; 152: 33-62
15 Cho WH, Song WS, Jeon DG , et al. Differential presentations, clinical courses, and survivals of osteosarcomas of the proximal humerus over other extremity locations. Ann Surg Oncol 2010; 17 (3) 702-708
16 Lee SY, Cho WH, Song WS, Park JH. Different radiological findings with the same pathologic diagnosis due to different age in primary osteosarcoma. Acta Radiol 2006; 47 (8) 841-844
17 Rajiah P, Ilaslan H, Sundaram M. Imaging of sarcomas of pelvic bones. Semin Ultrasound CT MR 2011; 32 (5) 433-441
18 Erlemann R, Sciuk J, Bosse A , et al. Response of osteosarcoma and Ewing sarcoma to preoperative chemotherapy: assessment with dynamic and static MR imaging and skeletal scintigraphy. Radiology 1990; 175 (3) 791-796
19 Zwaga T, Bovée JV, Kroon HM. Osteosarcoma of the femur with skip, lymph node, and lung metastases. Radiographics 2008; 28 (1) 277-283
20 Wenaden AE, Szyszko TA, Saifuddin A. Imaging of periosteal reactions associated with focal lesions of bone. Clin Radiol 2005; 60 (4) 439-456
21 Kaste SC, Pratt CB, Cain AM, Jones-Wallace DJ, Rao BN. Metastases detected at the time of diagnosis of primary pediatric extremity osteosarcoma at diagnosis: imaging features. Cancer 1999; 86 (8) 1602-1608
22 Burak Z, Moretti JL, Ersoy O , et al. 99mTc-MIBI imaging as a predictor of therapy response in osteosarcoma compared with multidrug resistance-associated protein and P-glycoprotein expression. J Nucl Med 2003; 44 (9) 1394-1401
23 McCarville MB, Barton EH, Cameron JR , et al. The cause and clinical significance of central tumor photopenia on thallium scintigraphy of pediatric osteosarcoma of the extremity. AJR Am J Roentgenol 2007; 188 (2) 572-578
24 Bajpai J, Kumar R, Sreenivas V , et al. Prediction of chemotherapy response by PET-CT in osteosarcoma: correlation with histologic necrosis. J Pediatr Hematol Oncol 2011; 33 (7) e271-e278
25 Hamada K, Tomita Y, Inoue A , et al. Evaluation of chemotherapy response in osteosarcoma with FDG-PET. Ann Nucl Med 2009; 23 (1) 89-95
26 Gaston LL, Di Bella C, Slavin J, Hicks RJ, Choong PF. 18F-FDG PET response to neoadjuvant chemotherapy for Ewing sarcoma and osteosarcoma are different. Skeletal Radiol 2011; 40 (8) 1007-1015
27 Ye Z, Zhu J, Tian M , et al. Response of osteogenic sarcoma to neoadjuvant therapy: evaluated by 18F-FDG-PET. Ann Nucl Med 2008; 22 (6) 475-480
28 Costelloe CM, Macapinlac HA, Madewell JE , et al. 18F-FDG PET/CT as an indicator of progression-free and overall survival in osteosarcoma. J Nucl Med 2009; 50 (3) 340-347
29 Franzius C, Sciuk J, Daldrup-Link HE, Jürgens H, Schober O. FDG-PET for detection of osseous metastases from malignant primary bone tumours: comparison with bone scintigraphy. Eur J Nucl Med 2000; 27 (9) 1305-1311
30 Franzius C, Daldrup-Link HE, Sciuk J , et al. FDG-PET for detection of pulmonary metastases from malignant primary bone tumors: comparison with spiral CT. Ann Oncol 2001; 12 (4) 479-486
31 Brisse H, Ollivier L, Edeline V , et al. Imaging of malignant tumours of the long bones in children: monitoring response to neoadjuvant chemotherapy and preoperative assessment. Pediatr Radiol 2004; 34 (8) 595-605
32 Onikul E, Fletcher BD, Parham DM, Chen G. Accuracy of MR imaging for estimating intraosseous extent of osteosarcoma. AJR Am J Roentgenol 1996; 167 (5) 1211-1215
33 Gillespy III T, Manfrini M, Ruggieri P, Spanier SS, Pettersson H, Springfield DS. Staging of intraosseous extent of osteosarcoma: correlation of preoperative CT and MR imaging with pathologic macroslides. Radiology 1988; 167 (3) 765-767
34 Hoffer FA, Nikanorov AY, Reddick WE , et al. Accuracy of MR imaging for detecting epiphyseal extension of osteosarcoma. Pediatr Radiol 2000; 30 (5) 289-298
35 Saifuddin A. The accuracy of imaging in the local staging of appendicular osteosarcoma. Skeletal Radiol 2002; 31 (4) 191-201
36 Schima W, Amann G, Stiglbauer R , et al. Preoperative staging of osteosarcoma: efficacy of MR imaging in detecting joint involvement. AJR Am J Roentgenol 1994; 163 (5) 1171-1175
37 Sajadi KR, Heck RK, Neel MD , et al. The incidence and prognosis of osteosarcoma skip metastases. Clin Orthop Relat Res 2004; (426) 92-96
38 Kager L, Zoubek A, Kastner U , et al; Cooperative Osteosarcoma Study Group. Skip metastases in osteosarcoma: experience of the Cooperative Osteosarcoma Study Group. J Clin Oncol 2006; 24 (10) 1535-1541
39 van der Woude HJ, Bloem JL, Verstraete KL, Taminiau AH, Nooy MA, Hogendoorn PC. Osteosarcoma and Ewing's sarcoma after neoadjuvant chemotherapy: value of dynamic MR imaging in detecting viable tumor before surgery. AJR Am J Roentgenol 1995; 165 (3) 593-598
40 Torricelli P, Montanari N, Spina V , et al. Dynamic contrast enhanced magnetic resonance imaging subtraction in evaluating osteosarcoma response to chemotherapy. Radiol Med (Torino) 2001; 101 (3) 145-151
41 Guo J, Reddick WE, Glass JO , et al. Dynamic contrast-enhanced magnetic resonance imaging as a prognostic factor in predicting event-free and overall survival in pediatric patients with osteosarcoma. Cancer 2012; 118 (15) 3776-3785
42 Yakushiji T, Oka K, Sato H , et al. Characterization of chondroblastic osteosarcoma: gadolinium-enhanced versus diffusion-weighted MR imaging. J Magn Reson Imaging 2009; 29 (4) 895-900
43 Geirnaerdt MJ, Bloem JL, van der Woude HJ, Taminiau AH, Nooy MA, Hogendoorn PC. Chondroblastic osteosarcoma: characterisation by gadolinium-enhanced MR imaging correlated with histopathology. Skeletal Radiol 1998; 27 (3) 145-153
44 Yen CH, Chang CY, Teng MM , et al. Different and identical features of chondroblastic osteosarcoma and chondrosarcoma: highlights on radiography and magnetic resonance imaging. J Chin Med Assoc 2009; 72 (2) 76-82
45 Nagata S, Nishimura H, Uchida M, Hayabuchi N, Zenmyou M, Harada H. Giant cell-rich osteosarcoma of the distal femur: radiographic and magnetic resonance imaging findings. Radiat Med 2006; 24 (3) 228-232
46 Bertoni F, Bacchini P, Donati D, Martini A, Picci P, Campanacci M. Osteoblastoma-like osteosarcoma. The Rizzoli Institute experience. Mod Pathol 1993; 6 (6) 707-716
47 Rosenberg ZS, Lev S, Schmahmann S, Steiner GC, Beltran J, Present D. Osteosarcoma: subtle, rare, and misleading plain film features. AJR Am J Roentgenol 1995; 165 (5) 1209-1214
48 Tani T, Okada K, Shoji K, Hashimoto M, Sageshima M. Osteoblastoma-like osteosarcoma. Skeletal Radiol 2000; 29 (11) 656-659
49 Kallel R, Ayadi L, Toumi N , et al. Small cell osteosarcoma: a case report. Pathologica 2009; 101 (2) 101-104
50 Mulligan ME, Lewis Jr DR, Resnik CS, Kumar D, Levine AM. Small cell osteosarcoma of the ulna: a case report and review of the literature. J Hand Surg Am 1999; 24 (2) 417-420
51 Murphey MD, wan Jaovisidha S, Temple HT, Gannon FH, Jelinek JS, Malawer MM. Telangiectatic osteosarcoma: radiologic-pathologic comparison. Radiology 2003; 229 (2) 545-553
52 Weiss A, Khoury JD, Hoffer FA , et al. Telangiectatic osteosarcoma: the St. Jude Children's Research Hospital's experience. Cancer 2007; 109 (8) 1627-1637
53 Kenan S, Ginat DT, Steiner GC. Dedifferentiated high-grade osteosarcoma originating from low-grade central osteosarcoma of the fibula. Skeletal Radiol 2007; 36 (4) 347-351
54 Andresen KJ, Sundaram M, Unni KK, Sim FH. Imaging features of low-grade central osteosarcoma of the long bones and pelvis. Skeletal Radiol 2004; 33 (7) 373-379
55 Lee HJ, Kim IO, Kim WS, Cheon JE, Kim KW, Yeon KM. Metachronous multifocal osteosarcoma: a case report and literature review. Clin Imaging 2002; 26 (1) 63-68
56 Currall VA, Dixon JH. Synchronous multifocal osteosarcoma: case report and literature review. Sarcoma 2006; 2006: 53901
57 Nakayama E, Sugiura K, Kobayashi I, Oobu K, Ishibashi H, Kanda S. The association between the computed tomography findings, histologic features, and outcome of osteosarcoma of the jaw. J Oral Maxillofac Surg 2005; 63 (3) 311-318
58 Fu HH, Zhuang QW, He J, Wang LZ, He Y. Giant cell-rich osteosarcoma or giant cell reparative granuloma of the mandible?. J Craniofac Surg 2011; 22 (3) 1136-1139
59 Murphey MD, Jelinek JS, Temple HT, Flemming DJ, Gannon FH. Imaging of periosteal osteosarcoma: radiologic-pathologic comparison. Radiology 2004; 233 (1) 129-138
60 Vanel D, Picci P, De Paolis M, Mercuri M. Radiological study of 12 high-grade surface osteosarcomas. Skeletal Radiol 2001; 30 (12) 667-671
61 Dönmez FY, Tüzün U, Başaran C, Tunaci M, Bilgiç B, Acunaş G. MRI findings in parosteal osteosarcoma: correlation with histopathology. Diagn Interv Radiol 2008; 14 (3) 142-152
62 Jelinek JS, Murphey MD, Kransdorf MJ, Shmookler BM, Malawer MM, Hur RC. Parosteal osteosarcoma: value of MR imaging and CT in the prediction of histologic grade. Radiology 1996; 201 (3) 837-842
63 Azura M, Vanel D, Alberghini M, Picci P, Staals E, Mercuri M. Parosteal osteosarcoma dedifferentiating into telangiectatic osteosarcoma: importance of lytic changes and fluid cavities at imaging. Skeletal Radiol 2009; 38 (7) 685-690
64 Okada K, Frassica FJ, Sim FH, Beabout JW, Bond JR, Unni KK. Parosteal osteosarcoma. A clinicopathological study. J Bone Joint Surg Am 1994; 76 (3) 366-378
65 Johnson K, Davies AM, Evans N, Grimer RJ. Imaging recurrent parosteal osteosarcoma. Eur Radiol 2001; 11 (3) 460-466
66 Shuhaibar H, Friedman L. Dedifferentiated parosteal osteosarcoma with high-grade osteoclast-rich osteogenic sarcoma at presentation. Skeletal Radiol 1998; 27 (10) 574-577
67 Bertoni F, Bacchini P, Staals EL, Davidovitz P. Dedifferentiated parosteal osteosarcoma: the experience of the Rizzoli Institute. Cancer 2005; 103 (11) 2373-2382
68 Lin J, Yao L, Mirra JM, Bahk WJ. Osteochondromalike parosteal osteosarcoma: a report of six cases of a new entity. AJR Am J Roentgenol 1998; 170 (6) 1571-1577
69 Staals EL, Bacchini P, Bertoni F. High-grade surface osteosarcoma: a review of 25 cases from the Rizzoli Institute. Cancer 2008; 112 (7) 1592-1599
70 Kyriakos M. Intracortical osteosarcoma. Cancer 1980; 46 (11) 2525-2533
71 Hermann G, Klein MJ, Springfield D, Abdelwahab IF, Dan SJ. Intracortical osteosarcoma; two-year delay in diagnosis. Skeletal Radiol 2002; 31 (10) 592-596
72 Hasegawa T, Shimoda T, Yokoyama R, Beppu Y, Hirohashi S, Maeda S. Intracortical osteoblastic osteosarcoma with oncogenic rickets. Skeletal Radiol 1999; 28 (1) 41-45
73 Logan PM, Mitchell MJ, Munk PL. Imaging of variant osteosarcomas with an emphasis on CT and MR imaging. AJR Am J Roentgenol 1998; 171 (6) 1531-1537
74 Kaushik S, Smoker WR, Frable WJ. Malignant transformation of fibrous dysplasia into chondroblastic osteosarcoma. Skeletal Radiol 2002; 31 (2) 103-106
75 Abdelwahab IF, Klein MJ, Hermann G, Steiner GC, Yang DC. Osteosarcoma arising in a desmoplastic fibroma of the proximal tibia. AJR Am J Roentgenol 2002; 178 (3) 613-615
76 Brien EW, Mirra JM, Kessler S, Suen M, Ho JK, Yang WT. Benign giant cell tumor of bone with osteosarcomatous transformation (“dedifferentiated” primary malignant GCT): report of two cases. Skeletal Radiol 1997; 26 (4) 246-255
77 Iwasawa T, Tanaka Y, Aida N, Okuzumi S, Nishihira H, Nishimura G. Microscopic intraosseous extension of osteosarcoma: assessment on dynamic contrast-enhanced MRI. Skeletal Radiol 1997; 26 (4) 214-221
78 Ryan SP, Weinberger E, White KS , et al. MR imaging of bone marrow in children with osteosarcoma: effect of granulocyte colony-stimulating factor. AJR Am J Roentgenol 1995; 165 (4) 915-920
79 Han G, Wang Y, Bi WZ , et al. Magnetic resonance imaging is appropriate for determining the osteotomy plane for appendicular osteosarcoma after neoadjuvant chemotherapy. Med Oncol 2012; 29 (2) 1347-1353
80 Masrouha KZ, Musallam KM, Samra AB , et al. Correlation of non-mass-like abnormal MR signal intensity with pathological findings surrounding pediatric osteosarcoma and Ewing's sarcoma. Skeletal Radiol 2012; 41 (11) 1453-1461
81 Shin KH, Moon SH, Suh JS, Yang WI. Tumor volume change as a predictor of chemotherapeutic response in osteosarcoma. Clin Orthop Relat Res 2000; (376) 200-208
82 Holscher HC, Bloem JL, Vanel D , et al. Osteosarcoma: chemotherapy-induced changes at MR imaging. Radiology 1992; 182 (3) 839-844
83 Holscher HC, Bloem JL, van der Woude HJ , et al. Can MRI predict the histopathological response in patients with osteosarcoma after the first cycle of chemotherapy?. Clin Radiol 1995; 50 (6) 384-390
84 Ongolo-Zogo P, Thiesse P, Sau J , et al. Assessment of osteosarcoma response to neoadjuvant chemotherapy: comparative usefulness of dynamic gadolinium-enhanced spin-echo magnetic resonance imaging and technetium-99m skeletal angioscintigraphy. Eur Radiol 1999; 9 (5) 907-914
85 Reddick WE, Wang S, Xiong X , et al. Dynamic magnetic resonance imaging of regional contrast access as an additional prognostic factor in pediatric osteosarcoma. Cancer 2001; 91 (12) 2230-2237
86 Dyke JP, Panicek DM, Healey JH , et al. Osteogenic and Ewing sarcomas: estimation of necrotic fraction during induction chemotherapy with dynamic contrast-enhanced MR imaging. Radiology 2003; 228 (1) 271-278
87 Reddick WE, Bhargava R, Taylor JS, Meyer WH, Fletcher BD. Dynamic contrast-enhanced MR imaging evaluation of osteosarcoma response to neoadjuvant chemotherapy. J Magn Reson Imaging 1995; 5 (6) 689-694
88 Hayashida Y, Yakushiji T, Awai K , et al. Monitoring therapeutic responses of primary bone tumors by diffusion-weighted image: initial results. Eur Radiol 2006; 16 (12) 2637-2643
89 Oka K, Yakushiji T, Sato H, Hirai T, Yamashita Y, Mizuta H. The value of diffusion-weighted imaging for monitoring the chemotherapeutic response of osteosarcoma: a comparison between average apparent diffusion coefficient and minimum apparent diffusion coefficient. Skeletal Radiol 2010; 39 (2) 141-146
90 Körholz D, Wirtz I, Vosberg H, Rüther W, Jürgens H, Göbel U. The role of bone scintigraphy in the follow-up of osteogenic sarcoma. Eur J Cancer 1996; 32A (3) 461-464
91 Herrlin K, Willén H, Wiebe T. Flare phenomenon in osteosarcoma after complete remission. J Nucl Med 1995; 36 (8) 1429-1431
92 Bakri D, Bar-Shalom R, Ben Arush MW, Postovsky S. Value of routine bone scans in patients with bone sarcomas before local treatment. J Pediatr Hematol Oncol 2011; 33 (2) 103-106
93 Cheon GJ, Kim MS, Lee JA , et al. Prediction model of chemotherapy response in osteosarcoma by 18F-FDG PET and MRI. J Nucl Med 2009; 50 (9) 1435-1440
94 Schulte M, Brecht-Krauss D, Werner M , et al. Evaluation of neoadjuvant therapy response of osteogenic sarcoma using FDG PET. J Nucl Med 1999; 40 (10) 1637-1643
95 Miwa S, Shirai T, Taki J , et al. Use of 99mTc-MIBI scintigraphy in the evaluation of the response to chemotherapy for osteosarcoma: comparison with 201Tl scintigraphy and angiography. Int J Clin Oncol 2011; 16 (4) 373-378
96 Ayerza MA, Farfalli GL, Aponte-Tinao L, Muscolo DL. Does increased rate of limb-sparing surgery affect survival in osteosarcoma?. Clin Orthop Relat Res 2010; 468 (11) 2854-2859
97 Hao YK, Zhang YK, Yang ZP, Li X, Yang Q, Li JM. The accuracy of magnetic resonance imaging in determining the osteotomy plane in osteosarcoma. Orthopedics 2008; 31 (6) 544
98 Chen W, Zhu H, Zhang L , et al. Primary bone malignancy: effective treatment with high-intensity focused ultrasound ablation. Radiology 2010; 255 (3) 967-978
99 Garner HW, Kransdorf MJ, Peterson JJ. Posttherapy imaging of musculoskeletal neoplasms. Radiol Clin North Am 2011; 49 (6) 1307-1323 , vii