Intra-arterial cis-platinum in osteosarcoma.

Conventional radiography continues to be the most important imaging modality in the initial diagnosis and assessment of skeletal neoplasms. However, this technique is usually inadequate to determine the local extent of the tumor, particularly in malignancies. Angiography also fails to define accurately the local extent of most skeletal neoplasms. Computed tomography, however, demonstrates the intramedullary and extraosseous extent of skeletal neoplasms much more accurately and is currently the modality most frequently used for this purpose. The use of angiography in skeletal neoplasms is now almost completely limited to those that are managed with intra-arterial therapy, either infusion chemotherapy or embolization, including osteosarcomas, nonresectable giant cell tumors, and metastases. Angiography is employed to define the vascular anatomy for optimal catheter placement and also to assess the therapeutic response, including detection of residual or recurrent tumor. In addition, demonstration of abnormal vascularity is employed in the planning of the biopsy with some neoplasms.