Osteosarcoma is a primary malignant bone tumor characterized by the production of an osteoid matrix. Although histology remains the definitive diagnostic standard, imaging plays a crucial role in diagnosis, therapeutic planning, and follow-up. Conventional radiography serves as the initial checkpoint for detecting this pathology, which often presents diagnostic challenges due to vague and nonspecific symptoms, especially in its early stages. Today, the integration of different imaging techniques enables an increasingly personalized diagnosis and management, with each contributing unique and complementary information. Conventional radiography typically initiates the imaging assessment, and the Bone Reporting and Data System (Bone-RADS) of the Society of Skeletal Radiology (SSR) is a valuable tool for stratifying the risk of suspicious bone lesions. CT is the preferred modality for evaluating the bone matrix, while bone scans and PET/CT are effective for detecting distant metastases. MRI reveals the extent of the lesion in adjacent soft tissues, the medullary canal, and joints, as well as its relationship to neurovascular structures and the presence of skip lesions. Advanced techniques such as dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), diffusion-weighted imaging (DWI), and perfusion MRI help characterize the tumor environment and assess treatment response. Osteosarcoma comprises a range of subtypes with differing clinical and imaging characteristics, some of which are particularly distinctive, such as in the case of telangiectatic osteosarcoma. Knowledge of these variants can guide radiologists in the differential diagnosis, which includes both central and surface forms, ranging from highly aggressive to more indolent types. In this review, we present a wide range of representative cases from our hospital case series to illustrate both typical and atypical imaging presentations. Finally, we discuss recent advancements and challenges in applying artificial intelligence approaches to the imaging of osteosarcoma.
骨肉瘤是一种以产生骨样基质为特征的原发性恶性骨肿瘤。尽管组织学检查仍是确诊的金标准，但影像学在诊断、治疗规划及随访中发挥着关键作用。常规X线摄影作为检测该病变的初始检查手段，常因症状模糊且非特异性（尤其在早期阶段）而面临诊断挑战。如今，多种影像技术的整合实现了日益个性化的诊断与管理，每种技术都能提供独特且互补的信息。常规X线摄影通常是影像评估的起点，骨骼放射学会（SSR）制定的骨报告与数据系统（Bone-RADS）是对可疑骨病变进行风险分层的重要工具。CT是评估骨基质的首选方法，而骨扫描和PET/CT对检测远处转移具有良好效果。MRI可显示病变在邻近软组织、髓腔及关节内的侵犯范围，及其与神经血管结构的关系和跳跃性病灶的存在。动态增强磁共振成像（DCE-MRI）、扩散加权成像（DWI）及灌注MRI等先进技术有助于表征肿瘤微环境并评估治疗反应。骨肉瘤包含一系列具有不同临床和影像学特征的亚型，其中部分亚型表现尤为独特，如毛细血管扩张型骨肉瘤。掌握这些变异类型有助于放射科医师进行鉴别诊断，包括从高度侵袭性到相对惰性的中央型和表面型病变。本文通过展示我院病例系列中具有代表性的广泛案例，阐释典型与非典型影像学表现。最后，我们探讨了人工智能方法在骨肉瘤影像学应用中的最新进展与挑战。
Multimodal Imaging of Osteosarcoma: From First Diagnosis to Radiomics
肿瘤(癌症)患者之家