Contrast-enhanced Susceptibility Weighted Imaging (CE-SWI) for the Characterization of Musculoskeletal Oncologic Pathology: A Pictorial Essay on the Initial Five-year Experience at a Cancer Institution

• DOI: 10.29328/journal.jro.1001062
• Publication Date: 2024-04-17T09:10:07Z
• Authors: Valenzuela Raul F; Duran-Sierra E; Canjirathinkal MA; Amini B; Ma J; Hwang KP; Stafford RJ; Torres Keila E; Zarzour MA; Livingston JA; Madewell JE; Murphy WA; Costelloe CM
• Keywords: Susceptibility Weighted Imaging; Synovial Sarcoma; Hemosiderin; Invasive lobular carcinoma

Susceptibility-weighted imaging (SWI) is based on a 3D high-spatial-resolution, velocity-corrected gradient-echo MRI sequence that uses magnitude and filtered-phase information to create images. It SWI tissue magnetic susceptibility differences generate signal contrast may arise from paramagnetic (hemosiderin), diamagnetic (minerals calcifications) ferromagnetic (metal) molecules. Distinguishing between calcification blood products possible through the filtered phase images, helping visualize osteoblastic osteolytic bone metastases or demonstrating calcifications osteoid production in liposarcoma osteosarcoma. When acquired combination with injection of an exogenous agent, contrast-enhanced (CE-SWI) can simultaneously detect T2* effect, T2 difference, contrast-induced T1 shortening, out-of-phase fat water chemical shift effect. Bone soft lesion features have been described, including giant cell tumors synovial sarcomas tissues. We expand appearance benign soft-tissue lesions such as hemangioma, neurofibroma, pigmented villonodular synovitis, abscess, hematoma. Most myxoid demonstrate absent just low-grade intra-tumoral hemorrhage at baseline. CE-SWI shows superior differentiation mature fibrotic dark components active enhancing shortening desmoid fibromatosis. has gained popularity oncologic MSK because its sensitivity for displaying lesions, thereby differentiate versus malignant tumors. The ability show viable, portions sarcoma separately hemorrhagic/necrotic also suggests utility biomarker tumor treatment response. essential understand appreciate spontaneous patterns high-grade those occurring therapy-induced necrosis process responding Ring-like hemosiderin pattern observed successfully treated sarcomas. demonstrates early promising results separating blooming healthy iron-loaded marrow T1-shortened enhancement displaced by tumor. oncology learning objectives: be used identify MRI. Certain correlate histologic type. discriminate immature help assess response Understanding post-surgical changes useful discriminating residual recurrent overlapping features.