Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Japan.
Br J Radiol. 2019 Dec;92(1104):20190518. doi: 10.1259/bjr.20190518. Epub 2019 Aug 13.
Confirming the surgical osseous margin of a resected malignant bone tumor macroscopically before reconstruction with a prosthesis is ideal. However, making the cut-surface of the femur specimen during surgery is difficult because of the hard bone tissue. In order to resolve this problem, the possibility of intraoperative MRI was considered.
MRI was performed at the surgical unit for five malignant femoral bone tumors that included two osteosarcomas and one undifferentiated high-grade sarcoma, and two metastatic tumors immediately after the tumor resection. The specimens were prepared in plastic containers with saline.
The osseous surgical margins were confirmed to be those planned pre-operatively in all cases without metal-induced artifacts. The weighted image (WI) was useful for evaluation of the osseous surgical margin, whereas the WI was useful for confirmation of extraosseous soft-tissue.
The MRI was performed post-operatively as a preliminary evaluation of the technique. However, a limited sequence ( coronal WI) with short examination time could be performed during surgery for the sole purpose of assessing the osseous margin.
MRI examination of a resected malignant bone tumor specimen has not been reported, and can be an option for assessment of the osseous surgical margin.
在使用假体进行重建之前，通过手术确认切除的恶性骨肿瘤的宏观骨切缘是理想的。然而，由于骨组织坚硬，在手术中切割股骨标本非常困难。为了解决这个问题，考虑了术中磁共振成像（MRI）的可能性。
对 5 例恶性股骨肿瘤（包括 2 例骨肉瘤和 1 例未分化高级别肉瘤，以及 2 例转移性肿瘤）进行了手术单元的 MRI 检查，这些肿瘤在肿瘤切除后立即进行。标本用生理盐水在塑料容器中制备。
所有病例均未出现金属诱导伪影，证实骨切缘与术前计划一致。加权成像（WI）对评估骨切缘很有用，而 WI 对确认骨外软组织很有用。
术后进行 MRI 检查作为对该技术的初步评估。然而，为了仅评估骨切缘，可以在手术期间进行有限的序列（冠状 WI）和短时间的检查。
切除的恶性骨肿瘤标本的 MRI 检查尚未见报道，这可能是评估骨切缘的一种选择。
