Differential CT and MR imaging diagnosis between low- and high-grade malignant vascular tumors of bone

Abstract

ObjectiveTo investigate the CT and MR imaging findings and differential diagnosis of malignant vascular tumors of bone. Materials and methodsCT and MR imaging findings of 18 patients with histopathology-proven malignant vascular tumors of bone were examined. Assessed image features included age, sex, location, CT findings, and MR imaging appearances and dynamic contrast-enhanced MR imaging. ResultsThe study group comprised 18 cases, of which 7 were categorized as low-grade malignant vascular tumors (LMT), and 11 were categorized as high-grade malignant vascular tumors (HMT). Malignant vascular tumors of bone showed osteolytic lesions with heterogeneous signs and enhancement, and frequently associated with soft tissue masses and peritumorous edema. The mean age of patient was respectively 34.7 years in LMT with 3 patients younger than 20 and 49.9 years in HMT with 3 patients older than 60 years. The mean lesion diameter was 3.6 cm (range 2–7.2) in LMT with two lesions <3 cm and 7.1 cm (range 3–13) in HMT with 3 lesions greater than 10 cm. LMT showed multifocal (57.1 %) and well-defined (71.5 %) lesions with residual bone (57.1 %), peripheral sclerosis (85.7 %), and slightly hetergeneous enhancement (71.4 %), compared to those of HMT with 9.1, 45.5, 27.3, and 72.7 %, and 9.1 % respectively. Also, HMT appeared as expansive (54.5 %), ill-defined (54.5 %), macroscopic necrosis/cystic (81.8 %) or hemorrhagic (27.3 %) lesion with pathological fracture (27.3 %), and often presented with obviously hetergeneous enhancement (81.8 %), compared to those of LMT with 42.9, 28.6, 42.9, 0, 14.3 and 14.3 % respectively.ConclusionsThere are some differences in the imaging features between LMT and HMT, while unifocal/multifocal, expansive, ill-defined, necrosis/cystic, hemorrhagic features with age, lesion diameter, peripheral sclerosis, residual bone tissue, pathological fracture and slightly/obviously hetergeneous enhancement highly suggest their differential diagnosis.

Pseudomyogenic hemangioendothelioma—A case report and review of the literature

“…The role of imaging in differentiating low- from high-grade malignant vascular tumors of bone is limited. However, Xu et al [11] have reported some imaging features that are helpful in differentiation. They reported that low-grade malignant vascular tumors of bone tend to have multifocal, well-defined lesions with residual bone, peripheral sclerosis, and slightly heterogeneous enhancement, whereas high-grade lesions are more likely to be expansile, ill defined, with necrosis and cystic areas, often hemorrhagic, and demonstrate obvious heterogeneous enhancement.…”

Computed Tomography and Magnetic Resonance Imaging of Bone Tumors

“…They are more commonly found in lower extremity long bones and are always osteolytic, variably expansile, and often heterogeneous in density/signal with avid but heterogeneous enhancement, varying somewhat depending on grade of the tumor. 73 An associated soft tissue mass and cortical destruction are common, but there is characteristically no periosteal reaction. 73,74 CT best depicts the presence and degree of cortical destruction and reactive cortical sclerosis, whereas soft tissue extension and reactive change may be better identified on MR. MR features include ill-defined high signal on T2-weighted images and enhancement, extending into the surrounding bone and soft tissues, mostly due to reactive edema based on pathologic correlation.…”

“…73 An associated soft tissue mass and cortical destruction are common, but there is characteristically no periosteal reaction. 73,74 CT best depicts the presence and degree of cortical destruction and reactive cortical sclerosis, whereas soft tissue extension and reactive change may be better identified on MR. MR features include ill-defined high signal on T2-weighted images and enhancement, extending into the surrounding bone and soft tissues, mostly due to reactive edema based on pathologic correlation. 73 Intraosseous lipomas are the most common fat-containing primary bone tumor (<0.1% of all bone tumors).…”

“…73,74 CT best depicts the presence and degree of cortical destruction and reactive cortical sclerosis, whereas soft tissue extension and reactive change may be better identified on MR. MR features include ill-defined high signal on T2-weighted images and enhancement, extending into the surrounding bone and soft tissues, mostly due to reactive edema based on pathologic correlation. 73 Intraosseous lipomas are the most common fat-containing primary bone tumor (<0.1% of all bone tumors). Although cited as very rare, the prevalence may be much greater by anectodal reports from Murphey and colleagues due to its incidental nature.…”