Can MRI differentiate between atypical cartilaginous tumors and high-grade chondrosarcoma? A systematic review

Figures & data

Table 3. Study characteristics

Study	Study setting	Patients (n)	Tumor location (n)	MRI field strength	Intravenous contrast	MRI characteristics assessed
Conventional MRI
Crim et al. 2015	Retrospective	12 CS 1	Humerus (5), radius (1), femur (4), fibula (2)	NR	+	Length, deep endosteal scalloping, cortical breakthrough, soft tissue mass, gadolinium enhancement
Douis et al. 2014	Retrospective	28 ACT 79 CS 1 36 CS 2 13 CS 3 23 Dediff a	Humerus (58), femur (98), tibia (24)	NR	–	Bone marrow edema, soft tissue edema, bone expansion, cortical thickening, cortical destruction, active periostitis, soft tissue mass, tumor length
Douis et al. 2018 ^b	Retrospective 1980–2016	15 CS 1 3 CS 2 1 CS 3 4 Dediff a	Humerus (10), femur (9), tibia (3), fibula (1)	3T	+	Tumor length, endosteal scalloping, bone marrow edema, soft tissue edema, cortical destruction, periosteal reaction, bone expansion, macroscopic fat, calcification, soft tissue mass, hemorrhage
Errani et al. 2017	Retrospective 1986–2015	17 ACT	Humerus (5), femur (9), tibia (3)	1.5T	NR	Scalloping, soft tissue mass
Fayad et al. 2015	Retrospective 1991–2014	6 CS 2 1 CS 3	Hands and feet (7)	1.5T	+	T1 signal ^c, T1 heterogeneity ^c, T2 hyperintense ^c, T2 heterogeneity ^c, bone marrow edema, soft tissue edema, gadolinium enhancement, soft tissue mass
Kang et al. 2016	Retrospective 1993–2016	6 CS 1 15 HGCS	Para-acetabular (21)	1.5T	+	Length, high signal foci on T1 ^c, high signal on T1–T2-STIR ^c, soft-tissue mass, peritumoral edema, lobular border, acetabular cartilage destruction ^c, diffuse signal changes in acetabulum ^c, mass inside hip joint ^c, femoral head involvement ^c
Liu et al. 2017	Retrospective 2008–2015	17 Dediff a	NR	3T	+	Patterns of bone destruction, periosteal reaction, matrix mineralization, soft tissue mass, enhancement pattern, signal intensity
MacSweeney et al. 2003	Retrospective 1995–2005	8 Dediff a	Humerus (2), femur (6)	1.0 or 1.5T	+	Soft tissue extension
Yoo et al. 2009	Retrospective 1999–2008	28 LG 14 HG	Humerus (16), scapula (1), pelvic bone (9), femur (15), fibula (1)	1.0T or 1.5T	+	T1 signal ^c, entrapped fat within the tumor, lobular architecture preservation, cortical destruction, soft tissue mass, gadolinium enhancement
Yoshimura et al. 2013	Retrospective 1996–2011	6 CS 1 10 CS 2 1 CS 3 rib (1)	Humerus (4), ulna (1), phalange (2), femur (7), tibia (1), calcaneus (1),	NR	+	Entrapped fat within the tumor, lobular architecture, ring and arc enhancement, T1 signal ^c, soft tissue mass, gadolinium enhancement
Diffusion weighted imaging
Douis et al. 2015	Retrospective 2012–2013	5 ACT 15 CS 1 3 CS 2 2 CS 3 3 Dediff a	Humerus (19), rib (2), hand (3), spine (1), pelvis (5), femur (17), tibia (5) ^d	3T	–	Apparent diffusion coefficient
Müller et al. 2016	Retrospective 2007–2012	8 CS 1	Skull base	NR	NR	Apparent diffusion coefficient
Welzel et al. 2018	Retrospective 2009–2014	24 CS 1 10 CS 2 1 CS 3	Skull base	3T	+	Apparent diffusion coefficient
Dynamic contrast-enhanced MRI
Douis et al. 2018	Retrospective 1980–2016	15 CS 1 3 CS 2 1 CS 3 4 Dediff a	Humerus (10), femur (9), tibia (3), fibula (1)	3T	+	Dynamic contrast-enhanced (DCE) MRI parameters; angle of DCE-MRI curve, absolute enhancement and relative enhancement
Quantitative texture analysis
Lisson et al. 2018	Retrospective	11 CS1	NR	1.5 & 3T	+	Quantitative texture analysis to assess tumor heterogeneity

NR = not reported.

^a Dedifferentiated chondrosarcoma.

^b Study mentioned twice as different imaging modalities are used in the same study.

^c MRI characteristic not analyzed in our systematic review.

^d 24 enchondroma tumors are included in description of tumor location.

Figure 1. PRISMA flow diagram.

Figure 2. Forest plots of proportions of the reported presence of (a) entrapped fat, (b) bone marrow edema, (c) cortical breakthrough, (d) extra-osseous soft tissue expansion, and (e) ring and arc enhancement on conventional MRI in atypical cartilaginous tumors (ACT) and high-grade chondrosarcoma (HGCS).

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