J Nucl Med. 2008; 49 (Supplement 1):178P
Educational Exhibits (Poster Only)Oncology Posters |
The use of multimodality imaging in the management of Ewing’s sarcoma
Babak Bagheritoolabi1,
Martin Magram2 and
Vasken Dilsizian1
1 Radiology, University of Maryland Medical Center, Baltimore, Maryland;
2 Radiology, VA Maryland Healthcare System, Baltimore, Maryland
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Learning Objectives: 1. Discuss the role of imaging in the management of Ewing’s sarcoma. 2. Discuss the role of PET/CT in the management of Ewing’s sarcoma.
Abstract Body: The Ewing family of tumors refers to closely related tumors that are derived from the same primordial bone marrow derived mesenchymal stem cell, the primitive nerve cell. The primary bone tumors are known as Ewing tumor of bone and primitive neuroectodermal tumor. The extraosseous tumor is known as extraosseous Ewing sarcoma. These tumors are the result of a genetic translocation involving the EWS (Ewing's sarcoma) gene on chromosome 22 band q12. The patient often presents with pain due to the effect of the primary tumor. Diagnosis is often made from a plain film of a bone followed by biopsy. On plain film the lesion is usually lytic with a permeative appearance but may be sclerotic and may have a soft tissue component outside of bone. There is often periosteal reaction with an onion skin or star burst appearance. The extent of the primary lesion is best assessed with MR, although CT is also used to assess the extent of bone destruction and any soft tissue component. Initial staging involves bone marrow aspiration and biopsy, chest CT to assess lung metastases, and bone scan to detect local involvement and metastatic disease. The patient is treated with chemotherapy prior to treatment of the primary lesion. The primary lesion is then treated with surgical resection with radiation therapy used for residual disease. Extraosseous Ewing is treated in a similar manner. Hybrid PET/CT can be used to assess the primary lesion, detect metastases, and evaluate treatment response, but its clinical role has not been well established. Examples of the use of multimodality imaging of this disorder are presented.
