diltiazem hcl Supplier br Results Twenty seven bone lesions
Results Twenty-seven bone lesions were analyzed in 27 patients. Twelve of the patients were female and 15 were male. The mean age of the patients was 58 years with a range of 21–84 years. Ten lesions were determined to be malignant and 17 benign. Benign lesions of bone dropped in signal on out-of-phase imaging by an average of 37.1% (range 4–82.3%) when compared to in-phase-imaging. Five of the 17 benign lesions (29%) decreased in signal by less than 20%. Two benign lesions showed an increase in signal suggesting hemorrhage, consistent with osteoporotic diltiazem hcl Supplier fracture or edema. There were 10 malignant bone lesions, which dropped in signal by an average of 0.69% (range 2.9–49.8%). Six of these lesions demonstrated a rise in signal. Only one of the 10 malignant lesions showed a greater than 20% drop; this outlier represents bony extension of a soft tissue sarcoma, in a patient approximately 1 month postoperative from resection of her soft tissue mass. The abnormally large drop in signal may be explained by postoperative bony edema in the area of resection (see Table 1). When evaluating standard MRI sequences (standard T1 and T2) concern for malignancy in benign lesions was 2.95 and 1.79 for resident and attending, respectively (see Table 2). This decreased to 2.11 and 1.47 with the addition of opposed-phase sequences. Concern for malignancy in malignant lesions was 3.78 and 4.11 for radiology resident and staff, respectively. This increased to 4.56 and 4.56 with the addition of opposed-phase sequences. Compared with standard MRI, overall confidence in diagnosis increased from 3.36 to 4.29 for the radiology resident with the addition of OP sequences and from 3.96 to 4.43 for the radiology attending.
Discussion The merit of opposed-phase MRI imaging in characterizing and diagnosing bone lesions has been suggested in recent years [3–5]. The value of this technique has been shown in differentiating benign spine fractures from pathologic fractures . It has also been used to identify lipid-containing adrenal adenomas and liver tumors [6,7]. The goal of our study was to investigate the enhancement of diagnostic capability in musculoskeletal oncology as result of this additional MRI sequence, as well as to explore any resultant difference in confidence in diagnosis for the radiologist. Our findings showed that this technique is a useful additional tool for differentiating between benign and malignant bone lesions, and utilization of this technique did significantly improve the radiologists\' confidence levels in terms of diagnosis. Both the clinical and financial value of this technique is important to consider, as the ability to confidently identify benign lesions from malignant ones can obviate the need for unnecessary biopsies and surgical procedures (see Fig. 4a–d).
Level of evidence: IV
Patients and methods We analyzed the survival, local recurrence, and distant metastasis outcomes using survivorship techniques. Duration of symptoms was analyzed with t-test of student. We used Kaplan–Meier survival analysis to determine the cumulative probability of survival, survivorship free of recurrence, and survivorship free of metastasis. Differences in survivorship curves were evaluated using log-rank tests and p values less than 0.05 were considered significant. Statistical summaries, analyses, and plotting of survival curves were performed using SPSS version 22.
Discussion In the literature, the proportion of surface osteosarcoma is much lower. They do not exceed 8% of all osteosarcoma. cPOS is the most frequent lesion with about 5% of all osteosarcoma [okada, campanacci]. PerOS and HGSO are much more unfrequent and represent respectively 1–2% and 0.5% of all osteosarcoma. The high rate of DPOS and HGSO reported in our series is probably related to the fact that we did not exclude cases with medullary extension which precludes the diagnosis of surface osteosarcoma for some authors [2,3]. We think that the frequency of HGSO and DPOS are under estimated in the literature. Due to the permeative pattern and the rapid evolution of these lesions, a large number of them are misdiagnosed as convetional osteosarcoma.