Background: The purpose of this study was to evaluate a new
stereotactic method for preoperative coil-marking of musculoskeletal tumors
with use of interventional magnetic resonance imaging.
Methods: Nine patients with a soft-tissue or bone-marrow tumor were
referred to our department for preoperative marking of the extent of the
lesion. In one patient, two lesions were marked. Guidance for the punctures
and the delivery of the coils was provided by an open low-field magnetic
resonance imaging system with horizontal access. After imaging of the extent
of the lesion, magnetic resonance imaging-compatible titanium coils were
placed with use of nearly real-time or step-by-step magnetic resonance imaging
control. The coils were placed up to seventy-two hours before the surgery. The
inclusion of the tumor borders within the area of the excision was examined
with cross-sectional histological analysis of surgical specimens.
Results: The tumor-marking intervention was successfully performed
with the guidance of magnetic resonance imaging only in all patients.
Preoperatively, nineteen coils were used to mark the ten lesions in the nine
patients. All of the coils were easily located with intraoperative
fluoroscopy. No coil migrated between the time of the percutaneous marking and
the surgery. Histological examination of the resection borders revealed no
residual tumor cells. No complications were observed, and, after a mean of
twenty-three months of follow-up, no tumor had recurred.
Conclusions: Preoperative coil-marking guided by magnetic resonance
imaging for exact delineation of a musculoskeletal tumor is technically
feasible and can readily demonstrate the full extent of the tumor. Use of
magnetic resonance fluoroscopy reduces the time needed for the intervention.
We recommend the coil-marking technique.
Level of Evidence: Diagnostic study, Level II-1
(development of diagnostic criteria on the basis of consecutive patients [with
universally applied reference "gold" standard]). See Instructions
to Authors for a complete description of levels of evidence.