The use of gadolinium in the MR imaging of bone tumors

Before determining the role of gadolinium in the evaluation of the solitary bone tumor, the practicing radiologist needs to determine which solitary bone lesions merit further evaluation with magnetic resonance imaging and why further imaging is required. A practical approach in applying magnetic resonance imaging to the indeterminate solitary bone lesion is outlined in this article, which serves as a guideline for logical and consistent application of MR imaging for this purpose. Although seemingly widely used, gadolinium appears to add little to the diagnostic sensitivity or specificity of MR with respect to solitary bone lesions. For selective tumors, such as osteosarcoma, gadolinium offers the potential for determining the efficacy of chemotherapy, by evaluating tumor necrosis prior and subsequent to chemotherapy. In select situations, especially sarcomas close to joints, gadolinium may aid and augment other pulse sequences in determining whether tumor resection should be intra- or extra-articular. However, gadolinium has a limited role in the evaluation of the solitary bone tumor, and its use should be the exception rather than the rule.