Surgical Staging 1: Primary Tumour
摘要
Local staging of primary bone tumours can be done according to different staging systems. The most important components of any staging is to delineate the extent of bony involvement (including size, epiphyseal involvement and the presence of skip lesions), the presence and extent of extraosseous soft tissue mass including involvement of the adjacent joint, and neurovascular bundle and muscle compartments, thus establishing whether limb salvage is appropriate or amputation is needed. The process is reliant on imaging and histopathology with MRI of the whole bone containing the primary tumour, including joints at both ends of long bones, being of crucial importance to show the full extent of bone marrow involvement and skip lesions. Longitudinal non-contrast T1-weighted SE sequences are the most accurate for determining intraosseous tumour extent, but assessment of neurovascular involvement is optimally demonstrated in the axial plane using fat-suppressed T2-weighted or PDW FSE sequences. Conventional static contrast-enhanced MRI is of limited use, but dynamic enhanced MRI can have a role in troubleshooting the extent of extraosseous tumour involvement.