143 Sacrococcygeal Chordoma: Magnetic Resonance Imaging and Computed Tomography Daniel I. Rosenthal1 James A. Scotf Henry J. Mankin2 Gary L. Wismer1 Thomas J. Brady1 Received October 1 , 1984; accepted after re-il- sion February 26, 1985. This work was supported in part by the Techni- care Corp., Solon, OH, and grant PDT-245 from the American Cancer Society. J. A. Scott received a New Investigator Research Award (1R23CA33570- O1A1) from the National Cancer Institute. T. J. Brady received an RCDAAward and was supported in part by Public Health Service grant 1-KOvCA- 008482 awarded by the National Cancer Institute. 1 Department of Radiology, Harvard Medical School, Massachusetts General Hospital, 15 Park- man St., Boston, MA 021 14. Address reprint re- quests to D. I. Rosenthal (ACC-415). 2 Department of Orthopaedics, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114. AJR 145:143-147, July 1985 0361-803X/85/1451-0143 C American Roentgen Ray Society Magnetic resonance imaging (MRI) was compared to computed tomography (CT) in four cases of sacrococcygeal chordoma. Both techniques yielded important anatomic Information and represented important advances over early radiologic imaging methods. MRI provided superior contrast with surrounding soft tissues because of the prolonged Ti and T2 times of the tumors. This was especially important in a case of recurrent chordoma. The direct sagittal images obtained by MRI were valuable in determining the extent of lesions. Either MRI or direct CT coronal images were needed for the demon- stration of tumor involving the sacral nerve roots. It was not possible to reliably distinguish between tumor adherent to bowel wall and bowel wall invasion by either technique. ft Is concluded that MRI Is at least equal to CT for demonstration of these lesions and seems likely to become the imaging method of choice. Chordoma is a malignant tumor thought to arise from notochordal rests. It has little metastatic potential, but considerable local destructiveness [1 ]. Successful therapy depends almost completely on local eradication [2]. Since almost all of these lesions arise in the spine or skull base, proximity to vital structures is usual, and small differences in tumor extent can have profound clinical consequences. About 50% of chordomas are sacrococcygeal in origin [2]. If the lesion can be removed while the upper three sacral nerves on one side and two on the other side are preserved, the patient will have close to normal function. However, loss of all but the first nerve root bilaterally results in rectal and urinary incontinence and in impaired sexual function [2]. Invasion of the bowel, while uncommon, can be extensive and will necessitate rectal resection and colostomy [3,4]. There are thus great demands placed on the preoperative imaging of chordoma. Unfortunately, the lesion is poorly accessible by conventional radiography. The sacrum is a thin, deeply situated bone and may be difficult to demonstrate radiographically, even when it is normal. A variety of contrast studies have been used to determine the extent of sacral destruction and any associated soft-tissue mass. Most authorities now recognize computed tomography (CT) as the single best method in the evaluation of chordoma [4-7]. In a careful study of the use of CT for chordoma, Hudson and Galceran [8] demonstrated that although CT provides adequate demonstration of the bulk of the tumor, the appearance of localized growth could be misleading, and soft-tissue invasion was often missed. Magnetic resonance imaging (MRI) offers several potential advantages in the evaluation of these lesions. MRI has been shown to have superior contrast resolution in the demonstration of soft-tissue lesions [9, 1 0]. Since these images can be oriented in any plane, sagittal and coronal display may help to demonstrate the longitudinal extent of the tumor. To our knowledge, MRI findings have been reported in only one case of chordoma, a highly atypical intracranial intradural lesion [11]. Downloaded from www.ajronline.org by 171.243.67.90 on 05/28/23 from IP address 171.243.67.90. Copyright ARRS. For personal use only; all rights reserved
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