Diagnostic imaging of primary malignant bone tumors in children (osteosarcoma, Ewings sarcoma) : part II

Neoplastic conditions of developmental period are an important problem in oncology and pediatrics. Multi-agent chemotherapy introduced in the 1970's of the last century significantly improved the results of treatment but still these tumors are the 2nd cause of death in children and adolescents. Primary malignant bone tumors account for 1-1.5% of all neoplasms and for 7% of developmental period tumors. Depending on the kind of tissue, bone tumors demonstrate various patterns of growth, infiltration and internal architecture. Imaging methods are an important part of diagnostics and the most effective tool of monitoring response to treatment. Plains films were the only imaging technique for many years. In the 2nd half of 20th century, angiography was introduced. Despite invasiveness, it showed malignant character of the tumor and its extension in soft tissues. In the 7th decade of the last century, ultrasound and computed tomography started being routinely used in clinical practice. After a few years, resolution of these modalities was improved so that they could better visualize musculoskeletal tumors. Magnetic resonance imaging was the next step, this method came into use in Poland 16 years ago. MRI is the best modality to show the extent of marrow involvement, All the imaging techniques have their place in the diagnostic algorithm of bone tumors. Scintigraphy plays an important role in detecting skeletal metastases and disseminated disease. Fusion of radiological and nuclear medicine methods, PET-CT, brings new possibilities to musculoskeletal tumor diagnostics.