Date : 00.00.00
Name of the Patient : Abc Xyzootwlmn / M / 14 yrs.
Referred by : Dr. Abc Xyz. Kapadia.
Examination : M.R.I. of the Left Distal Femur.
CLINICAL PROFILE :
Known C/O osteosarcoma in the left femur. Has received 3 cycles of chemotherapy.
M.R.I of the left distal femur was performed using the following parameters :
7 mm thick T1 Weighted and STIR sagittal images.
7 mm thick T1 Weighted and STIR coronal images.
10 mm thick T1 Weighted and T2 Weighted (with fat saturation) axial images.
There is still seen a fairly large, well-defined mass lesion in the lower one third of the left femur which extends cranially for about 14.5 cms from the left knee joint. There is a clear zone of transition between the lesion and normal marrow. Mixed signal intensity areas are seen in this lesion on the T1 Weighted images which are seen to turn heterogeneously hyperintense on the T2 Weighted and STIR images. There is break in the anterior and posterior cortex with periosteal elevation and spread of the pathology in the adjacent soft tissue. The lesion is predominantly metaphyseal. The epiphysis shows a mottled appearance in the medial and lateral condyle and is hypointense on the T1 Weighted images and turns hyperintense on the T2 Weighted and STIR images suggestive of its involvement.
The left knee joint per se however appears to be spared.
The scar of the previous surgery is noted along the antero-lateral margin of the distal left thigh at about the level of the upper margin of the tumor. The subcutaneous fat and the quadriceps muscles in the distal left thigh show a hyperintense signal on the T2 Weighted and STIR images. The fat planes around these muscles are however well identified. Atrophy of the muscles of the left thigh are noted when compared to the right. No obvious vascular encasement is noted.
Small effusion is noted within the left knee joint.
The femoral attachment of the anterior and posterior cruciate ligament of the femur is also involved.
The MRI features are suggestive of a mass lesion in the distal metaphysis of the left femur with its cranio-caudate extension measuring 14.5 cms with involvement of the epiphysis and periosteal extensions as described. The biopsy is suggestive of an osteosarcoma.
Altered signal in the quadriceps muscles and in the subcutaneous fat in the distal left thigh may either represent soft tissue edema, the sequelae of previous surgery or may represent tumor infiltration. Atrophy of the muscles of the left thigh is noted.
As compared to the previous MRI dated 00.00.00 (study no:00008), there is no significant change in the size and extent of the lesion. Altered signal is however noted in the quadriceps muscles as described, which extends upto the mid-thigh level.