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In Vivo Proton Spectroscopy of Giant Cell Tumor of the Bone

Panna Lal Sah1, Raju Sharma1, Harsh Kandpal1, Ashu Seith1, Shishir Rastogi2, Suman Bandhu1 and N. R. Jagannathan3

1 Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar AIIMS, New Delhi, India.
2 Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India.
3 Department of Nuclear Magnetic Resonance, All India Institute of Medical Sciences, New Delhi, India.


Figure 1
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  		Fig. 1A —31-year-old woman with pain and swelling in left wrist for 12 months. Core biopsy and postoperative excised specimen revealed giant cell tumor (GCT) of bone. Radiographs of wrist (posteroanterior and lateral views) show expansile geographic lytic lesion involving distal epimetaphysis of radius and extending to subarticular location with narrow zone of transition, no matrix mineralization, and evidence of cortical breach posteriorly (Campanacci stage 3 GCT) [8].

 

Figure 2
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  		Fig. 1B —31-year-old woman with pain and swelling in left wrist for 12 months. Core biopsy and postoperative excised specimen revealed giant cell tumor (GCT) of bone. Radiographs of wrist (posteroanterior and lateral views) show expansile geographic lytic lesion involving distal epimetaphysis of radius and extending to subarticular location with narrow zone of transition, no matrix mineralization, and evidence of cortical breach posteriorly (Campanacci stage 3 GCT) [8].

 

Figure 3
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  		Fig. 1C —31-year-old woman with pain and swelling in left wrist for 12 months. Core biopsy and postoperative excised specimen revealed giant cell tumor (GCT) of bone. Coronal T2-weighted (C) and gadolinium-enhanced T1-weighted (D) fat-saturated MR images show lesion is predominantly intermediate signal on T2-weighted image with hyperintense areas within (suggestive of aneurysmal bone cyst component). Solid areas show homogeneous enhancement, and cystic areas show rim enhancement. Tumor showed early enhancement and prompt washout of contrast material (not shown).

 

Figure 4
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  		Fig. 1D —31-year-old woman with pain and swelling in left wrist for 12 months. Core biopsy and postoperative excised specimen revealed giant cell tumor (GCT) of bone. Coronal T2-weighted (C) and gadolinium-enhanced T1-weighted (D) fat-saturated MR images show lesion is predominantly intermediate signal on T2-weighted image with hyperintense areas within (suggestive of aneurysmal bone cyst component). Solid areas show homogeneous enhancement, and cystic areas show rim enhancement. Tumor showed early enhancement and prompt washout of contrast material (not shown).

 

Figure 5
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  		Fig. 1E —31-year-old woman with pain and swelling in left wrist for 12 months. Core biopsy and postoperative excised specimen revealed giant cell tumor (GCT) of bone. Gadolinium-enhanced fat-saturated T1-weighted coronal image shows position of voxel on enhancing portion of tumor for spectroscopy.

 

Figure 6
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  		Fig. 1F —31-year-old woman with pain and swelling in left wrist for 12 months. Core biopsy and postoperative excised specimen revealed giant cell tumor (GCT) of bone. MR spectroscopy at TE of 135 shows presence of choline (3.2 ppm) in tumor.

 

Figure 7
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  		Fig. 2A —43-year-old man with giant cell tumor of bone. BRadiographs of knee (posteroanterior and lateral views) show eccentric, expansile lytic lesion in upper end of tibia.

 

Figure 8
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  		Fig. 2B —43-year-old man with giant cell tumor of bone. Radiographs of knee (posteroanterior and lateral views) show eccentric, expansile lytic lesion in upper end of tibia.

 

Figure 9
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  		Fig. 2C —43-year-old man with giant cell tumor of bone. Proton MR spectroscopy image shows only baseline noise with no discernible metabolite peak.

 

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