Purpose: To review the imaging appearance of periosteal osteosarcoma, with pathologic comparison.
Materials and methods: Data for 40 pathologically confirmed periosteal osteosarcomas were retrospectively reviewed. Patient demographic data were recorded, and radiographs (n = 40), bone scintigrams (n = 10), angiograms (n = 2), and computed tomographic (CT) (n = 11) and magnetic resonance (MR) (n = 12) images were evaluated for lesion location and size, cortical changes, marrow involvement, and intrinsic characteristics by two musculoskeletal radiologists, with agreement by consensus. Pathology reports were reviewed for presence and predominance of histologic components (fibrous, chondroid, and osteoid), tumor grade, and marrow involvement.
Results: There were 25 male (62%) and 15 female (38%) patients with an age range of 10-37 years (average age, 20 years). The most frequent lesion locations were the diaphysis of the tibia (16 patients) or of the femur (15 patients). Radiographs showed a broad-based soft-tissue mass that was attached to the cortex (all patients) and showed cortical thickening (33 patients), cortical scalloping/erosion (37 patients), and/or perpendicular periosteal reaction (38 patients) extending into the soft-tissue mass. Soft-tissue masses were well defined in 91%-100% of cases and surrounded a median of 50%-55% of the cortex. Lesions commonly showed low attenuation at CT (10 patients) and high signal intensity on T2-weighted MR images (10 patients), reflecting the high water content of these largely chondroblastic lesions. Focal areas of adjacent marrow replacement were common at MR imaging (nine patients) but represented reactive changes unless they were in direct continuity with the overlying soft-tissue mass (this was rare, occurring in only one patient, and represented marrow invasion). Review of pathology reports revealed that all lesions contained chondroid tissue, which predominated in 34 patients.
Conclusion: The radiologic appearance of periosteal osteosarcoma is a broad-based surface soft-tissue mass causing extrinsic erosion of thickened underlying diaphyseal cortex and perpendicular periosteal reaction extending into the soft-tissue component. Reactive marrow changes are commonly seen at MR imaging, but true marrow invasion is rare.