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Skeletal Radiology

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01-08-2013 | Scientific Article

Ewing sarcoma versus osteomyelitis: differential diagnosis with magnetic resonance imaging

Authors: B. Henninger, B. Glodny, A. Rudisch, T. Trieb, A. Loizides, D. Putzer, W. Judmaier, M. F. Schocke

Published in: Skeletal Radiology | Issue 8/2013

Abstract

Objective

To find and evaluate characteristic magnetic resonance imaging (MRI) patterns for the differentiation between Ewing sarcoma and osteomyelitis.

Materials and methods

We identified 28 consecutive patients referred to our department for MRI (1.5 T) of an unclear bone lesion with clinical symptoms suggestive of Ewing sarcoma or osteomyelitis. MRI scans were re-evaluated by two experienced radiologists, typical MR imaging features were documented and a diagnostic decision between Ewing sarcoma and osteomyelitis was made. Statistical significance of the association between MRI features and the biopsy-based diagnosis was assessed using Fisher’s exact test.

Results

The most clear-cut pattern for determining the correct diagnosis was the presence of a sharp and defined margin of the bone lesion, which was found in all patients with Ewing sarcoma, but in none of the patients with osteomyelitis (P < 0.0001). Contrast enhancing soft tissue was present in all cases with Ewing sarcoma and absent in 4 patients with osteomyelitis (P = 0.0103). Cortical destruction was found in all patients with Ewing sarcoma, 4 patients with osteomyelitis did not present any cortical reaction (P = 0.0103). Cystic or necrotic areas were identified in 13 patients with Ewing sarcoma and in 1 patient with osteomyelitis (P = 0.004). Interobserver reliability was very good (kappa = 1) in Ewing sarcoma and moderate (kappa = 0.6) in patients with osteomyelitis.

Conclusions

A sharp and defined margin, optimally visualized on T1-weighted images in comparison to short tau inversion recovery (STIR) images, is the most significant feature of Ewing sarcoma in differentiating from osteomyelitis.

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Title: Ewing sarcoma versus osteomyelitis: differential diagnosis with magnetic resonance imaging
Authors: B. Henninger
B. Glodny
A. Rudisch
T. Trieb
A. Loizides
D. Putzer
W. Judmaier
M. F. Schocke
Publication date: 01-08-2013
Publisher: Springer-Verlag
Published in: Skeletal Radiology / Issue 8/2013
Print ISSN: 0364-2348
Electronic ISSN: 1432-2161
DOI: https://doi.org/10.1007/s00256-013-1632-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Ewing sarcoma versus osteomyelitis: differential diagnosis with magnetic resonance imaging

Abstract

Objective

Materials and methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objective

Materials and methods

Results

Conclusions

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