Imaging recommendation · Musculoskeletal

Epiphyseal lytic lesion in young adult, suspected giant cell tumor of bone

Q: What's the alternative imaging for epiphyseal lytic lesion in young adult, suspected giant cell tumor of bone when sacral gct (where surgery is morbid)?

MRI — Denosumab therapy + serial MRI (iv contrast).

Recommended: X-ray + MRI affected joint + Chest CT (for pulmonary metastases) is the preferred imaging study for epiphyseal lytic lesion in young adult, suspected giant cell tumor of bone. Benign but locally aggressive.

Recommended study

X-ray + MRI affected joint + Chest CT (for pulmonary metastases)

MRI IV contrast Preferred Musculoskeletal Outpatient Reviewed 2026-05

Benign but locally aggressive. Distal radius, knee, sacrum common. ~5% develop pulmonary metastases.

If the default doesn't apply

Sacral GCT (where surgery is morbid)

MRI Denosumab therapy + serial MRI IV contrast

Watch-outs

Local recurrence rate 20-50%

Adjuvant treatment with PMMA or denosumab reduces recurrence.

Pearls

Eccentric, lytic, subarticular extension in skeletally mature patient.
No matrix; sharp narrow zone of transition without sclerotic border.
Pulmonary metastases are benign histology but cause respiratory morbidity.