Question:

Concerning MRI of a chondrosarcoma, which is false?
1. MRI is the preferred imaging modality to assess sarcomas, including chondrosarcomas.
2. MRI does not well define the extent of marrow involvement, although it is highly accurate at demonstrating the soft tissue extent.
3. MRI can help distinguish between a benign enchondroma and a low-grade chondrosarcoma.
4. MRI us useful and frequently used for pre-operative planning.
5. Intense contrast enhancement can be a sign of a higher-grade chondrosarcoma.





Answer:

The correct answer for the question "Concerning MRI of a chondrosarcoma, which is false?" is:

2. MRI does not well define the extent of marrow involvement, although it is highly accurate at demonstrating the soft tissue extent.



Explanation
1. MRI does very well at defining the extent of marrow involvement.  MRI is the preferred imaging modality for assessing a sarcoma involving the bone. This is because of MRI`s  superior contrast resolution, its ability to determine extent of marrow involvement, and its accuracy at defining soft tissues invasion [10].

2. MRI does very well at defining the extent of marrow involvement [10]. See explanation #1.

3. In daily practice, MR is most often used to problem solve as it can help distinguish benign enchondroma from a low-grade chondrosarcoma [1, 4, 10].

4. It is also frequently used for pre-operative planning (to define the extent of a known chondrosarcoma) [1, 4, 10].

5. Additionally, intense peripheral, nodular and septal enhancement (both on CT and MR) suggests chondrosarcoma over enchondroma, which usually only demonstrates peripheral enhancement [1, 3-4].



From the manuscript:
Chondrosarcoma in Childhood: The Radiologic and Clinical Conundrum
Radiology Case. 2012 Dec; 6(12):32-42


This article belongs to the Pediatric section.




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From the manuscript

Chondrosarcoma in Childhood: The Radiologic and Clinical Conundrum

Free full text article: Chondrosarcoma in Childhood:  The Radiologic and Clinical Conundrum

Abstract
Less than 10% of chondrosarcomas occur in children. In addition, as little as 0.5% of low-grade chondrosarcomas arise secondarily from benign chondroid lesions. The presence of focal pain is often used to crudely distinguish a chondrosarcoma (which is usually managed with wide surgical excision), from a benign chondroid lesion (which can be followed by clinical exams and imaging surveillance). Given the difficulty of localizing pain in the pediatric population, initial radiology findings and short-interval follow-up, both imaging and clinical, are critical to accurately differentiate a chondrosarcoma from a benign chondroid lesion. To our knowledge, no case in the literature discusses a chondrosarcoma possibly arising secondarily from an enchondroma in a pediatric patient. We present a clinicopathologic and radiology review of conventional chondrosarcomas. We also attempt to further the understanding of how to manage a chondroid lesion in the pediatric patient with only vague or bilateral complaints of pain.






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