Table 8 Pitfalls
From: The role of magnetic resonance imaging in the evaluation of bone tumours and tumour-like lesions
Pitfall | Explanation | Distinguishing features/ recommendations |
|---|---|---|
Very infiltrative lesions (e.g. MM) | Can preserve bone marrow fat [15] (normal signal on T1WI and signal drop in out of phase) | Can be undetectable |
Anaemia, rebound following chemotherapy or treatment with colony-stimulating factor | Marked haematopoiesis increases the amount of red marrow, resembling recurrent tumoral disease | Usually bilateral and symmetric -Signal intensity > than that of muscle on T1WI USPIO-enhanced MRI can differentiate these from tumour deposits (RES cells are present in the reconverted marrow but not present/substantially reduced in tumour deposits [24] |
Post-chemotherapy osteosarcoma “size increase” | Sometimes even in “good responders” the primary lesion does not diminish in size or appears to enlarge | Therapy has low impact on the mineralised matrix of osteogenic sarcoma Matrix maturation/ossification (presence of fatty marrow) |
Benign GCT may show elevated choline levels on proton MR spectroscopy [46] | May be related to the degree of their local aggressiveness | Use radiographs and conventional MRI for diagnosis |