Radiologic Assessment of Osteosarcoma Lung Metastases: State of the Art and Recent Advances

Anna Maria Chiesa, Paolo Spinnato, Marco Miceli, Giancarlo Facchini, Anna Maria Chiesa, Paolo Spinnato, Marco Miceli, Giancarlo Facchini

Abstract

The lung is the most frequent site of osteosarcoma (OS) metastases, which are a critical point in defining a patient's prognosis. Chest computed tomography (CT) represents the gold standard for the detection of lung metastases even if its sensitivity widely ranges in the literature since lung localizations are often atypical. ESMO guidelines represent one of the major references for the follow-up program of OS patients. The development of new reconstruction techniques, such as the iterative method and the deep learning-based image reconstruction (DLIR), has led to a significant reduction of the radiation dose with the low-dose CT. The improvement of these techniques has great importance considering the young-onset of the disease and the strict chest surveillance during follow-up programs. The use of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT is still controversial, while volume doubling time (VDT) and computer-aided diagnosis (CAD) systems are recent diagnostic tools that could support radiologists for lung nodules evaluation. Their use, well-established for other malignancies, needs to be further evaluated, focusing on OS patients.

Keywords: computed tomography; lung; metastases; nodules; osteosarcoma.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Chest computed tomography (CT) of a 36-year-old woman with osteosarcoma at baseline (panel (A,B)) with standard protocol (DLP = 248 mGy/cm) and at two-month follow-up (panel (C,D)) with full IR model-based (MBIR) algorithm (VEO) protocol (DLP = 45 mGy/cm) both well demonstrate a small solid nodule (arrows-diameter 2 mm). DLP = dose length product.
Figure 2
Figure 2
CT scan with nodule volume evaluation (mm3) and maximum diameters.
Figure 3
Figure 3
Computer-aided diagnosis (CAD) CT (A) figure nodule localizer (red), (B) CT scan, (C) CT scan nodule identification (red), (D) nodule volume rendering.

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