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The Journal of Bone and Joint Surgery (American) 86:1761-1767 (2004)
© 2004 The Journal of Bone and Joint Surgery, Inc.

Preoperative Marking of Musculoskeletal Tumors Guided by Magnetic Resonance Imaging

Philippe L. Pereira, MD1, Jan Fritz1, Claudius W. Koenig, MD1, Franz Maurer, MD2, Paul Boehm, MD3, Andreas Badke, MD2, Markus Mueller-Schimpfle, MD1, Michael Bitzer, MD1 and Claus D. Claussen, MD1

1 Department of Diagnostic Radiology, Eberhard-Karls-University, Hoppe-Seyler-Strasse 3, D-72076 Tuebingen, Germany. E-mail address for P.L. Pereira: philippe.pereira{at}med.uni-tuebingen.de
2 Trauma Center, Eberhard-Karls-University, Hoppe-Seyler-Strasse 3, D-72076 Tuebingen, Germany
3 Department of Orthopedic Surgery, Eberhard-Karls-University, Hoppe-Seyler-Strasse 3, D-72076 Tuebingen, Germany

Investigation performed at the Department of Diagnostic Radiology, Trauma Center, and Department of Orthopedic Surgery, Eberhard-Karls-University, Tuebingen, Germany

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: The purpose of this study was to evaluate a new stereotactic method for preoperative coil-marking of musculoskeletal tumors with use of interventional magnetic resonance imaging.

Methods: Nine patients with a soft-tissue or bone-marrow tumor were referred to our department for preoperative marking of the extent of the lesion. In one patient, two lesions were marked. Guidance for the punctures and the delivery of the coils was provided by an open low-field magnetic resonance imaging system with horizontal access. After imaging of the extent of the lesion, magnetic resonance imaging-compatible titanium coils were placed with use of nearly real-time or step-by-step magnetic resonance imaging control. The coils were placed up to seventy-two hours before the surgery. The inclusion of the tumor borders within the area of the excision was examined with cross-sectional histological analysis of surgical specimens.

Results: The tumor-marking intervention was successfully performed with the guidance of magnetic resonance imaging only in all patients. Preoperatively, nineteen coils were used to mark the ten lesions in the nine patients. All of the coils were easily located with intraoperative fluoroscopy. No coil migrated between the time of the percutaneous marking and the surgery. Histological examination of the resection borders revealed no residual tumor cells. No complications were observed, and, after a mean of twenty-three months of follow-up, no tumor had recurred.

Conclusions: Preoperative coil-marking guided by magnetic resonance imaging for exact delineation of a musculoskeletal tumor is technically feasible and can readily demonstrate the full extent of the tumor. Use of magnetic resonance fluoroscopy reduces the time needed for the intervention. We recommend the coil-marking technique.

Level of Evidence: Diagnostic study, Level II-1 (development of diagnostic criteria on the basis of consecutive patients [with universally applied reference "gold" standard]). See Instructions to Authors for a complete description of levels of evidence.


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