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Powell GM, Littrell LA, Broski SM, Inwards CY, Wenger DE. Imaging features of intraosseous hemangiomas: beyond the mobile spine and calvarium. Skeletal Radiol 2023; 52:1739-1746. [PMID: 37052653 DOI: 10.1007/s00256-023-04339-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/03/2023] [Accepted: 04/09/2023] [Indexed: 04/14/2023]
Abstract
OBJECTIVE Describe imaging features of intraosseous hemangiomas located outside of the mobile spine and calvarium. MATERIALS AND METHODS Imaging and medical records were retrospectively reviewed for cases of intraosseous hemangiomas located outside of the calvarium and mobile spine. Evaluation included patient demographics, histologic confirmation, and imaging characteristics. RESULTS Thirty-six patients were included (25 F, 11 M; mean age 54 ± 17 years, range 10-84 years) with 37 total lesions (70% axial and 30% appendicular skeleton). Mixed lytic and sclerotic features were identified on 83-85% radiographs and CTs. Amorphous increased density mimicking osteoid matrix was present on 38-45% radiographs and CTs. Classic honeycomb or radial pattern was identified on 45% of CTs. Osseous expansion and cortical permeation were common features. CT identified periosteal reaction in 24% of lesions. All hemangiomas had heterogeneous MRI signal and most moderately or avidly enhanced. Intralesional fat was identified on 78% MRIs, often as a minor component and only detected on 24% of CTs. A soft tissue mass was present on 52% of MRIs. FDG PET/CT mean SUVmax of 3.2 ± 0.6 (range 1.9-5.0). Lesional FDG activity relative to background marrow was increased in 75% of lesions. Lesions with cortical permeation had higher metabolic activity versus those without (3.5 ± 0.7 versus 2.2 ± 0.3, p = 0.041). CONCLUSION Intraosseous hemangiomas outside of the mobile spine and calvarium demonstrate more aggressive imaging features compared to vertebral hemangiomas, including cortical permeation, soft tissue mass, amorphous increased density mimicking osteoid matrix, and increased FDG activity.
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Affiliation(s)
- G M Powell
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - L A Littrell
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - S M Broski
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - C Y Inwards
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - D E Wenger
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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Huang WS, He YL, Liang J, Su YL, Xu JH. Jejunal Cavernous Hemangioma Mimicking Malignancy With Increased Activity on 18 F-FDG PET/CT. Clin Nucl Med 2023; 48:409-410. [PMID: 36927765 DOI: 10.1097/rlu.0000000000004620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
ABSTRACT A 50-year-old woman underwent 18 F-FDG PET/CT to evaluate possible abdominal malignancy, which was revealed by CT. The images showed a large cystic-solid lesion with peripherally increased FDG activity in the left mid-abdomen. Histopathology of the excised lesion confirmed a jejunal cavernous hemangioma. We reported a rare case of jejunal cavernous hemangioma with FDG accumulation on PET/CT, mimicking malignancy.
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Affiliation(s)
- Wen-Shan Huang
- From the Department of Nuclear Medicine, Zhuhai People's Hospital (Zhuhai Hospital Affiliated With Jinan University), Zhuhai, People's Republic of China
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Dao A, O'Donohue AK, Vasiljevski E, Bobyn J, Little D, Schindeler A. Murine models of orthopedic infection featuring Staphylococcus aureus biofilm. J Bone Jt Infect 2023; 8:81-89. [PMID: 37123502 PMCID: PMC10134754 DOI: 10.5194/jbji-8-81-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 03/04/2023] [Indexed: 05/02/2023] Open
Abstract
Introduction: Osteomyelitis remains a major clinical challenge. Many published rodent fracture infection models are costly compared with murine models for rapid screening and proof-of-concept studies. We aimed to develop a dependable and cost-effective murine bone infection model that mimics bacterial bone infections associated with biofilm and metal implants. Methods: Tibial drilled hole (TDH) and needle insertion surgery (NIS) infection models were compared in C57BL/6 mice (female, N = 150 ). Metal pins were inserted selectively into the medullary canal adjacent to the defect sites on the metaphysis. Free Staphylococcus aureus (ATCC 12600) or biofilm suspension (ATCC 25923) was locally inoculated. Animals were monitored for physiological or radiographic evidence of infection without prophylactic antibiotics for up to 14 d. At the end point, bone swabs, soft-tissue biopsies, and metal pins were taken for cultures. X-ray and micro-CT scans were performed along with histology analysis. Results: TDH and NIS both achieved a 100 % infection rate in tibiae when a metal implant was present with injection of free bacteria. In the absence of an implant, inoculation with a bacterial biofilm still induced a 40 %-50 % infection rate. In contrast, freely suspended bacteria and no implant consistently showed lower or negligible infection rates. Micro-CT analysis confirmed that biofilm infection caused local bone loss even without a metal implant as a nidus. Although a metal surface permissive for biofilm formation is impermeable to create progressive bone infections in animal models, the metal implant can be dismissed if a bacterial biofilm is used. Conclusion: These models have a high potential utility for modeling surgery-related osteomyelitis, with NIS being simpler to perform than TDH.
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Affiliation(s)
- Aiken Dao
- Orthopaedic Research and Biotechnology Unit, the Children's Hospital at
Westmead, Westmead, NSW, Australia
- The Children's Hospital at Westmead Clinical School, Faculty of Medicine
and Health, University of Sydney, Sydney, NSW, Australia
- Bioengineering & Molecular Medicine Laboratory, the Westmead Institute
for Medical Research, Westmead, NSW, Australia
| | - Alexandra K. O'Donohue
- Orthopaedic Research and Biotechnology Unit, the Children's Hospital at
Westmead, Westmead, NSW, Australia
- The Children's Hospital at Westmead Clinical School, Faculty of Medicine
and Health, University of Sydney, Sydney, NSW, Australia
- Bioengineering & Molecular Medicine Laboratory, the Westmead Institute
for Medical Research, Westmead, NSW, Australia
| | - Emily R. Vasiljevski
- Orthopaedic Research and Biotechnology Unit, the Children's Hospital at
Westmead, Westmead, NSW, Australia
- The Children's Hospital at Westmead Clinical School, Faculty of Medicine
and Health, University of Sydney, Sydney, NSW, Australia
| | - Justin D. Bobyn
- Orthopaedic Research and Biotechnology Unit, the Children's Hospital at
Westmead, Westmead, NSW, Australia
- The Children's Hospital at Westmead Clinical School, Faculty of Medicine
and Health, University of Sydney, Sydney, NSW, Australia
| | - David G. Little
- Orthopaedic Research and Biotechnology Unit, the Children's Hospital at
Westmead, Westmead, NSW, Australia
- The Children's Hospital at Westmead Clinical School, Faculty of Medicine
and Health, University of Sydney, Sydney, NSW, Australia
| | - Aaron Schindeler
- Orthopaedic Research and Biotechnology Unit, the Children's Hospital at
Westmead, Westmead, NSW, Australia
- The Children's Hospital at Westmead Clinical School, Faculty of Medicine
and Health, University of Sydney, Sydney, NSW, Australia
- Bioengineering & Molecular Medicine Laboratory, the Westmead Institute
for Medical Research, Westmead, NSW, Australia
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Cao L, Wen JX, Han SM, Wu HZ, Peng ZG, Yu BH, Zhong ZW, Sun T, Wu WJ, Gao BL. Imaging features of hemangioma in long tubular bones. BMC Musculoskelet Disord 2021; 22:27. [PMID: 33407312 PMCID: PMC7786894 DOI: 10.1186/s12891-020-03882-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 12/14/2020] [Indexed: 12/20/2022] Open
Abstract
Background To investigate the imaging features of hemangiomas in long tabular bones for better diagnosis. Methods Twenty-four patients with long bone hemangiomas confirmed by pathology were enrolled. Nineteen patients had plain radiography, fourteen patients had computed tomography (CT) and eleven had magnetic resonance imaging (MRI). The hemangioma was divided into medullary [13], periosteal [6] and intracortical type [5]. Results Among 19 patients with plain radiography, eleven patients were medullary, three periosteal, and five intracortical. In the medullary type, the lesion was primarily osteolytic, including five cases with irregular and unclear rims and one lesion having osteosclerotic and unclear rims. In three patients with the periosteal type, the lesion had clear rims with involvement of the cortical bone in the form of bone defect, including two cases with local thickened bone periosteum and one case having expansile periosteum. Five intracortical hemangiomas had intracortical osteolytic lesions with clear margins. Among 14 patients with CT imaging, 8 cases were medullary, three periosteal, and three intracortical. Among 8 medullary hemangiomas, one had ground glass opacity, and seven had osteolytic, expansile lesions like soft tissue density with no calcification. In three periosteal cases, the lesion was osteolytic with thickened periosteum and narrowed medullary cavity. In three intracortical hemangiomas, the lesion was of even soft tissue density with no calcification. Among 11 patients with MRI imaging, seven were medullary, two periosteal, and two intracortical. Among 7 medullary lesions, six were of hypointense signal on T1WI and hyperintensesignal on T2 WI. In two periosteal cases, the periosteum was thickened, with one case being of equal signal, and the other having no signal. Two intracortical hemangiomas were both of slightly low signal on T1WI but hyperintense signal on T2WI. Conclusions The long bone hemangiomas had characteristic cystic honeycomb-like presentations in plain radiograph. CT and MRI imagings are helpful for diagnosis of hemangiomas in long bone.
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Affiliation(s)
- Lei Cao
- Department of Radiology the Third Hospital, Hebei Medical University, 139 Ziqiang Road, 050051, Shijiazhuang, Hebei Province, China
| | - Jin-Xu Wen
- Department of Radiology the Third Hospital, Hebei Medical University, 139 Ziqiang Road, 050051, Shijiazhuang, Hebei Province, China
| | - Shu-Man Han
- Department of Radiology the Third Hospital, Hebei Medical University, 139 Ziqiang Road, 050051, Shijiazhuang, Hebei Province, China
| | - Hui-Zhao Wu
- Department of Radiology the Third Hospital, Hebei Medical University, 139 Ziqiang Road, 050051, Shijiazhuang, Hebei Province, China
| | - Zhi-Gang Peng
- Department of Radiology the Third Hospital, Hebei Medical University, 139 Ziqiang Road, 050051, Shijiazhuang, Hebei Province, China
| | - Bao-Hai Yu
- Department of Radiology the Third Hospital, Hebei Medical University, 139 Ziqiang Road, 050051, Shijiazhuang, Hebei Province, China
| | - Zhi-Wei Zhong
- Department of Radiology the Third Hospital, Hebei Medical University, 139 Ziqiang Road, 050051, Shijiazhuang, Hebei Province, China
| | - Tao Sun
- Department of Radiology the Third Hospital, Hebei Medical University, 139 Ziqiang Road, 050051, Shijiazhuang, Hebei Province, China
| | - Wen-Juan Wu
- Department of Radiology the Third Hospital, Hebei Medical University, 139 Ziqiang Road, 050051, Shijiazhuang, Hebei Province, China.
| | - Bu-Lang Gao
- Department of Radiology the Third Hospital, Hebei Medical University, 139 Ziqiang Road, 050051, Shijiazhuang, Hebei Province, China
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5
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Barsales KA, Javier J, Catibog JJ, de Dios AV, Wang EH. Huge Intraosseous Tibial Haemangioma Managed with Embolisation, Excision and Fibular Ilizarov Reconstruction: A Case Report. Strategies Trauma Limb Reconstr 2021; 16:60-63. [PMID: 34326904 PMCID: PMC8311747 DOI: 10.5005/jp-journals-10080-1518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim Our aim is to report the successful treatment of an intraosseous haemangioma of tibia with an atypical presentation through a multidisciplinary approach of preoperative embolisation, a subtotal resection of the tibia and subsequent reconstruction with the Ilizarov medial fibular translation technique. Background En bloc excision is the treatment of choice for large tumours of the tibia. However, there is no single recommended method for the reconstruction of the resulting bony defect. Case A 22-year-old female presented with a massive intraosseous haemangioma of the entire tibia. Sequential, multimodal treatment consisted of (1) preembolisation, (2) en bloc resection and (3) reconstruction of the extensive skeletal defect via the Ilizarov method of fibular medialisation. Radiologic union occurred at 6 months and graft hypertrophy at 22 months. At 45 months, the patient was fully weight-bearing without need for an assistive device. Conclusion Resection and reconstruction of a large intraosseous haemangioma of the tibia can be treated successfully using a well-planned sequential management of embolisation, resection and Ilizarov fibular grafting. Significance This report highlights the successful management of an unusually extensive and difficult tumour through appropriate and meticulous perioperative multidisciplinary planning, execution and follow-up. How to cite this article Barsales KAD, Javier J, Catibog JJ, et al. Huge Intraosseous Tibial Haemangioma Managed with Embolisation, Excision and Fibular Ilizarov Reconstruction: A Case Report. Strategies Trauma Limb Reconstr 2021;16(1):60–63.
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Affiliation(s)
- Ken Ad Barsales
- Department of Orthopedics, University of the Philippines - Philippine General Hospital, Manila, Philippines
| | - Juanito Javier
- Department of Orthopedics, Ilizarov Section, University of the Philippines - Philippine General Hospital, Manila, Philippines
| | - Jolly J Catibog
- Department of Radiology, Section of Interventional Radiology, University of the Philippines - Philippine General Hospital, Manila, Philippines
| | - Ariel Vergel de Dios
- Department of Pathology, Section of Musculoskeletal Tumor Pathology, University of the Philippines - Philippine General Hospital, Manila, Philippines
| | - Edward Hm Wang
- Department of Orthopedics, Tumor Section, University of the Philippines - Philippine General Hospital, Manila, Philippines
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Zhou Q, Lu L, Yang Z, Su S, Hong G. Hemangioma of long tubular bone: imaging characteristics with emphasis on magnetic resonance imaging. Skeletal Radiol 2020; 49:2029-2038. [PMID: 32594199 DOI: 10.1007/s00256-020-03527-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 06/17/2020] [Accepted: 06/18/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the imaging findings, especially the MRI findings, of intraosseous hemangioma of long tubular bones and to improve the recognition of this rare tumor. MATERIALS AND METHODS The imaging characteristics of 16 histopathologically diagnosed long tubular bone hemangioma lesions were retrospectively reviewed on radiography (n = 16), CT (n = 16), and MRI (n = 15). RESULTS Thirteen of 16 lesions were intramedullary, whereas the other three were cortical, subperiosteal, and mixed intracortical and intramedullary, respectively. The radiologic appearance of long bone intraosseous hemangioma was divided into five types: cyst-like (n = 7), mesh- or honeycomb-like (n = 6), medullary sclerosis (n = 1), cortical thickening (n = 1), and cortical lytic type (n = 1). Radiography and CT allowed the identification of sclerotic margins in eight cases, thickened trabeculae in six cases, internal calcification in one case, cortical thickening in one case, and fracture in four cases. Two lesions were confusing on radiography but clearly identifiable on MRI. All intraosseous hemangioma showed high signal intensity on T2-weighted imaging and intermediate signal intensity on T1-weighted imaging. Four cyst-like lesions showed peripheral and filling enhancement, whereas others exhibited diffuse enhancement with an intensity similar to adjacent vessels. CONCLUSION Cystic and mesh types are the most common types of hemangioma in long tubular bones. MRI can help to define the location and extent of lesions. The tumor usually shows high signal intensity on T2-weighted imaging and intermediate signal intensity on T1-weighted imaging. Peripheral and filling or diffuse enhancement with an intensity similar to vessels is helpful for the diagnosis of intraosseous hemangioma.
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Affiliation(s)
- Qin Zhou
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
| | - Liangji Lu
- Department of Radiology, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, 310009, China
| | - Zhiyun Yang
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
| | - Shu Su
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
| | - Guixun Hong
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China.
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A rare proximal tibial intraosseous hemangioma treated with en bloc resection and total knee arthroplasty: a case report. CURRENT ORTHOPAEDIC PRACTICE 2020. [DOI: 10.1097/bco.0000000000000922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Batouli A, Gholamrezanezhad A, Petrov D, Rudkin S, Matcuk G, Jadvar H. Management of Primary Osseous Spinal Tumors with PET. PET Clin 2018; 14:91-101. [PMID: 30420225 DOI: 10.1016/j.cpet.2018.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Knowledge of the PET imaging findings of osseous spinal neoplasms is essential, because they are common incidental findings on PET scans done for staging of unrelated primary malignancies. Additionally, PET can help differentiate lesions that are not clearly defined by anatomic modalities alone. PET can also be used for follow-up of aggressive tumors to assess response to treatment, often proving superior to CT or MR imaging alone for this purpose. This review discusses the role of PET/CT and PET/MR imaging in the diagnosis and management of primary benign and malignant osseous tumors of the spine.
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Affiliation(s)
- Ali Batouli
- Department of Radiology, Division of Neuroradiology, Oregon Health and Science University, 8833 Southwest 30th Avenue, Portland, OR 97219, USA.
| | - Ali Gholamrezanezhad
- Department of Radiology, Division of Musculoskeletal Radiology, Keck School of Medicine, University of Southern California, 2250 Alcazar Street, CSC 102, Los Angeles, CA 90033, USA
| | - David Petrov
- Department of Radiology, Allegheny Health Network, 320 East North Avenue, Pittsburgh, PA 15214, USA
| | - Scott Rudkin
- Department of Radiology, Allegheny Health Network, 320 East North Avenue, Pittsburgh, PA 15214, USA
| | - George Matcuk
- Department of Radiology, Division of Musculoskeletal Radiology, Keck School of Medicine, University of Southern California, 2250 Alcazar Street, CSC 102, Los Angeles, CA 90033, USA
| | - Hossein Jadvar
- Department of Radiology, Division of Nuclear Medicine, Keck School of Medicine, University of Southern California, 2250 Alcazar Street, CSC 102, Los Angeles, CA 90033, USA; Department of Radiology, Keck School of Medicine, University of Southern California, 2250 Alcazar Street, CSC 102, Los Angeles, CA 90033, USA
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Shikhare S, Sittampalam K, Peh W, Shimpi T. Proximal Ulna: A Rare Location for Solitary Intraosseous Hemangioma. Oman Med J 2018; 33:260-263. [PMID: 29896337 DOI: 10.5001/omj.2018.48] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Intraosseous hemangiomas are rare, benign bone tumors usually affecting the bones of the axial skeleton. Its incidence in the long bones is extremely rare. We report a 19-year-old boy with solitary intraosseous hemangioma of the proximal ulna. Radiographs and computed tomography images showed a well-defined osteolytic lesion involving the right proximal ulna. Magnetic resonance imaging showed intermediate signal intensity on T1-weighted images and increased signal intensity on T2-weighted images with internal trabeculae and peripheral post-contrast enhancement. Postcurettage histologic diagnosis of intraosseous hemangioma was made.
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Affiliation(s)
- Sumer Shikhare
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Yishun, Singapore
| | | | - Wilfred Peh
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Yishun, Singapore
| | - Trishna Shimpi
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Yishun, Singapore
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Ishibashi M, Tanabe Y, Fujii S, Ogawa T. Pictorial review of 18F-FDG PET/CT findings in musculoskeletal lesions. Ann Nucl Med 2017; 31:437-453. [PMID: 28585058 DOI: 10.1007/s12149-017-1182-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 05/27/2017] [Indexed: 11/26/2022]
Abstract
We herein reviewed 18F-fluoro-2-deoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) findings in a number of musculoskeletal lesions including malignant tumors, benign tumors, and tumor-like lesions with correlations to other radiographic imaging modalities, and described the diversity of the 18F-FDG PET/CT findings of this entity. Malignant primary musculoskeletal tumors are typically 18F-FDG avid, whereas low-grade malignant tumors show mild uptake. Benign musculoskeletal tumors generally show a faint uptake of 18F-FDG, and tumor-like conditions also display various uptake patterns of 18F-FDG. Although musculoskeletal tumors show various uptakes of 18F-FDG on PET/CT, its addition to morphological imaging modalities such as CT and MRI is useful for the characterization and differentiation of musculoskeletal lesions.
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Affiliation(s)
- Mana Ishibashi
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, 36-1 Nishicho, Yonago, 683-8504, Japan.
| | - Yoshio Tanabe
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, 36-1 Nishicho, Yonago, 683-8504, Japan
| | - Shinya Fujii
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, 36-1 Nishicho, Yonago, 683-8504, Japan
| | - Toshihide Ogawa
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, 36-1 Nishicho, Yonago, 683-8504, Japan
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Kwee TC, de Klerk JMH, Nix M, Heggelman BGF, Dubois SV, Adams HJA. Benign Bone Conditions That May Be FDG-avid and Mimic Malignancy. Semin Nucl Med 2017; 47:322-351. [PMID: 28583274 DOI: 10.1053/j.semnuclmed.2017.02.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Positron emission tomography with the radiotracer 18F-fluoro-2-deoxy-d-glucose (FDG) plays an important role in the evaluation of bone pathology. However, FDG is not a cancer-specific agent, and knowledge of the differential diagnosis of benign FDG-avid bone alterations that may resemble malignancy is important for correct patient management, including the avoidance of unnecessary additional invasive tests such as bone biopsy. This review summarizes and illustrates the spectrum of benign bone conditions that may be FDG-avid and mimic malignancy, including osteomyelitis, bone lesions due to benign systemic diseases (Brown tumor, Erdheim-Chester disease, Gaucher disease, gout and other types of arthritis, Langerhans cell histiocytosis, and sarcoidosis), benign primary bone lesions (bone cysts, chondroblastoma, chondromyxoid fibroma, desmoplastic fibroma, enchondroma, giant cell tumor and granuloma, hemangioma, nonossifying fibroma, and osteoid osteoma and osteoblastoma), and a group of miscellaneous benign bone conditions (post bone marrow biopsy or harvest status, bone marrow hyperplasia, fibrous dysplasia, fractures, osteonecrosis, Paget disease of bone, particle disease, and Schmorl nodes). Several ancillary clinical and imaging findings may be helpful in discriminating benign from malignant FDG-avid bone lesions. However, this distinction is sometimes difficult or even impossible, and tissue acquisition will be required to establish the final diagnosis.
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Affiliation(s)
- Thomas C Kwee
- Department of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands.
| | - John M H de Klerk
- Department of Nuclear Medicine, Meander Medical Center, Amersfoort, The Netherlands
| | - Maarten Nix
- Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands
| | - Ben G F Heggelman
- Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands
| | - Stefan V Dubois
- Department of Pathology, Meander Medical Center, Amersfoort, The Netherlands
| | - Hugo J A Adams
- Department of Radiology and Nuclear Medicine, Deventer Ziekenhuis, Deventer, The Netherlands
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12
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Matsumoto Y, Takahashi Y, Haraguchi A, Okamoto T, Harimaya K, Matsunobu T, Endo M, Oda Y, Iwamoto Y. Intraosseous hemangioma arising in the clavicle. Skeletal Radiol 2014; 43:89-93. [PMID: 23990112 DOI: 10.1007/s00256-013-1715-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 08/06/2013] [Accepted: 08/08/2013] [Indexed: 02/02/2023]
Abstract
Intraosseous hemangioma (IH) is commonly seen in the vertebral column and skull: however, IH occurring in the appendicular skeleton, including the clavicle, is uncommon. We herein report the case of a 69-year-old female presenting with IH of the left clavicle. The findings of preoperative imaging studies, including radiographs, computed tomography (CT), magnetic resonance imaging, fluorine-18-fludeoxyglucose ((18)F-FDG) positron emission tomography (PET)/CT and ultrasonography, are described. In particular, (18)F-FDG PET/CT showed an ill-defined osteolytic lesion with abnormally high FDG uptake. Surgical en bloc resection with preoperative embolization was carried out and a histopathological examination confirmed the presence of an intraosseous cavernous hemangioma in the clavicle.
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Affiliation(s)
- Yoshihiro Matsumoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan,
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13
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Ko SW, Park JG. Cavernous hemangioma of the ilium mimicking aggressive malignant bone tumor with increased activity on (18)F-FDG PET/CT. Korean J Radiol 2013; 14:294-8. [PMID: 23482507 PMCID: PMC3590343 DOI: 10.3348/kjr.2013.14.2.294] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 09/17/2012] [Indexed: 12/05/2022] Open
Abstract
Osseous hemangioma is a benign vascular tumor, and it usually occurs in the vertebrae and the skull. However, hemangiomas of flat bones are rare, and there are very few reports that describe the radiologic findings of osseous hemangioma of the ilium. We report a unique case of large cavernous hemangioma mimicking a chondrogenic malignant bone tumor originated from the ilium in a 22-year-old female. The mass showed stippled calcifications, heterogeneous enhancement with thick septa and enhanced soft tissue components on CT and MR, and also this mass demonstrated heterogeneous 2-fluoro [fluorine-18]-2-deoxy-D-glucose (18F-FDG) uptake on 18F-FDG PET/CT.
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Affiliation(s)
- Seog Wan Ko
- Department of Diagnostic Radiology, Dong-A Hospital, Gwangju 503-300, Korea.
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