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1
Department of Medical Imaging, Mount Sinai Hospital and the University Health
Network, University of Toronto, 600 University Ave., Toronto, Ontario, Canada
M5G 1X5.
2
Present address: Department of Radiology, St. James University Hospital,
Beckett St., Leeds LS9 7TF, United Kingdom.
3
Department of Radiology, St. Louis University School of Medicine, Health
Sciences Center, St. Louis, MO 63110-0250.
4
Present address: Department of Radiology, Mayo Clinic, 200 First St., S.W.,
Rochester, MN 55905.
5
Department of Pathology, Mount Sinai Hospital, University of Toronto, Toronto,
Ontario, Canada M5G 1X5.
6
Department of Orthopedic Oncology, Mount Sinai Hospital, University of
Toronto, Toronto, Ontario, Canada M5G 1X5.
7
Department of Orthopedic Surgery, St. Louis University School of Medicine,
Health Sciences Center, St. Louis, MO 63110-0250.
8
Department of Pathology, St. Louis University School of Medicine, Health
Sciences Center, St. Louis, MO 63110-0250.
OBJECTIVE. The purpose of this study was to determine whether the imaging features of periosteal chondroid tumors correlate with histopathology.
MATERIALS AND METHODS. Twenty-two patients (nine women and 13 men; mean age, 33 years) with pathologically proven periosteal chondroid lesions were retrospectively reviewed. The imaging modalities included conventional radiography (n = 17), CT (n = 10), and MR imaging (n = 14). The images were reviewed by two osteoradiologists, with agreement by consensus. Evaluation criteria included lesion location, mineralization, and size; periosteal reaction; and cortical response. Intramedullary extension, adjacent intramedullary edema, soft-tissue edema, and intrinsic characteristics were also evaluated on MR imaging. After the evaluation, a radiologic diagnosis of chondroma or chondrosarcoma was obtained. An experienced osteopathologist who was unaware of the patient's medical history and radiologic findings reviewed all histopathology. Agreement between the radiologic and the histopathologic diagnosis was tested using the kappa analysis. Imaging features were correlated with the pathologic findings, and a statistical analysis was performed.
RESULTS. Using strict pathologic criteria, we diagnosed 11
chondromas and 11 chondrosarcomas (nine, grade I; two, grade II). Moderate
agreement was reached between the radiologic and the pathologic diagnosis
(
= 0.55). The size of periosteal chondrosarcomas (range, 3-14 cm;
median, 4 cm) was considerably larger than the size of the chondromas (range,
1-6.5 cm; median, 2.5 cm; p < 0.05). Other imaging features did
not significantly correlate with benign versus malignant disease at pathology
(all p > 0.05).
CONCLUSION. A variable overlap existed in the imaging appearances of benign and malignant periosteal chondroid lesions, with size being the most reliable indicator in distinguishing the two lesions. This and the fact that histologic differentiation of the entities can be difficult, suggests that surgical wide excision may be the most appropriate procedure in treating patients with lesions greater than 3 cm.
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