Abstract
BACKGROUND: Although intraoperative magnetic resonance imaging (iMRI) is well established in neurosurgery, its role in musculoskeletal oncology remains unclear. PURPOSE: To assess the feasibility and safety of iMRI in bone and soft tissue tumor surgery, focusing on giant cell tumor of bone (GCTB) after denosumab. MATERIAL AND METHODS: Fourteen patients (12 GCTB, 1 undifferentiated pleomorphic sarcoma [UPS], 1 chondroblastoma) underwent tumor resection with intraoperative 0.4 T MRI between 2017 and 2024. Outcomes included residual tumor detection, recurrence, and safety. RESULTS: iMRI identified residual tumor in 7 of 12 GCTB patients (58.3%), all histologically confirmed. At a median follow-up of 42 months, recurrence occurred in one GCTB case (8.3%). iMRI guided complete resection in a femoral head chondroblastoma, enabling full functional recovery. Soft tissue assessment was limited in the UPS case. No iMRI-related complications occurred. CONCLUSION: iMRI is a feasible and safe adjunct in bone tumor surgery, enhancing detection of residual tumor and supporting joint-preserving procedures, particularly in GCTB after denosumab.