Osseous lesions of the pelvis and long tubular bones containing both fat and fluid-like signal intensity: an analysis of 28 patients

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Abstract

Purpose: The purpose of this study was to explore the nature of lesions in the pelvis and the long tubular bones that, with MR imaging, were found to contain both fat and fluid-like signal intensity and to correlate these findings with those of radiography, histologic analysis, and clinical and radiographic follow-up. Materials and methods: A retrospective review of the radiologic, clinical and histologic parameters of 28 patients with lesions in the pelvis and long tubular bones comprised of elements that demonstrated both fat and fluid signal intensity characteristics by MR imaging was performed. Several parameters were analyzed. Histologic analysis was available in 12 patients. Clinical and, or imaging follow-up was available in 13 patients. Results: Imaging and histologic findings suggested the presence of fat and fluid and fluid components in all lesions with which could be divided into distinct MR imaging patterns. Histologic analysis suggested the possibility of a shared pathogenesis among several different lesions. Conclusion: All lesions of the long tubular bones in our series revealing both fat and fluid-like signal intensities with MR imaging were nonaggressive on the basis of other imaging findings, follow-up assessment, histologic analysis, or combinations of the three. Histologic findings suggest a relationship among lipomas, fat necrosis and cystic infarct of bone.

Introduction

The evaluation of musculoskeletal neoplasms often proves a diagnostic challenge to the clinician, radiologist, and pathologist. It is clear that the advent of MR imaging revolutionized the diagnosis and evaluation of musculoskeletal neoplasms. Initially it was hypothesized that the signal characteristics on MR images could be used to determine the histologic composition of neoplasms. Although this hypothesis has not proven completely true, there is no doubt that the signal characteristics on MR imaging studies offer us a window through which to view the histologic nature of tissue.

The purpose of this study was to explore the nature of lesions in long tubular bones containing both fat and fluid signal intensities on MR imaging by correlation of the findings with those of radiography, histologic analysis and clinical and, or radiographic follow-up.

Section snippets

Materials and methods

This was a retrospective review of the radiologic, clinical and histologic parameters of 28 patients with lesions in the pelvis and long tubular bones comprised of elements that demonstrated fat and fluid signal intensity characteristics by MR imaging. The patient population was selected, in part (n=6), from a computer-generated database focusing on lesions containing fat and fluid signal intensity on MR imaging studies at a single institution over a 4-year period. Inclusion criteria included

Results

Of the 28 patients included in the study, there were 17 males and 11 females who ranged in age from 17 to 71 years. Sixteen patients presented with a history of pain in the region of the lesion, whereas in 12 patients, the lesions were initially identified as incidental findings on studies performed for other purposes.

The lesions were located in the femur (n=13), the humerus (n=12), the tibia (n=1), or the ilium (n=2). The vast majority of lesions occurring in long tubular bones appeared to be

Discussion

Despite the variation in patterns of the MR imaging appearance of these osseous lesions, they have in common the presence of signal characteristics suggesting fat and fluid-like cystic components. The nonspecific nature of the MR imaging findings is reflected in the histologic findings, which demonstrated some variability but held as a pervasive theme the presence of adipose tissue and cystic components. Given the means of specimen acquisition, it is not surprising that cyst-like elements were

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