Intraosseous Ganglion Cysts of the Ankle: A Report of Three Cases with Long-term Follow-up

Ferkel, Richard D.; Field, Justin; Scherer, William P.; Bernstein, Mark L.; Kasimian, Dennis

doi:10.1177/107110079902000608

Cited by 19 publications

(19 citation statements)

References 21 publications

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“…In our retrospective analysis we found only three intraosseous ganglia (1.8%) located in the calcaneus, cuboid, and metatarsal bone. Surprisingly, we found no intraosseous ganglia in the malleoli, which have been reported to be the most frequent site of intraosseous ganglia in the foot and ankle (21).…”

Section: Discussioncontrasting

confidence: 80%

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MRI of the foot and ankle: Prevalence and distribution of occult and palpable ganglia

Weishaupt

Schweitzer

Morrison

et al. 2001

Magnetic Resonance Imaging

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The purpose of this study was to evaluate the prevalence and anatomic distribution of occult and palpable ganglia of the foot and ankle as seen by MRI. Within a 7-year period MRI of the ankle was performed on 2813 patients, and MRI of the foot on 2277 patients using a 1.5T magnet. In all, 167 ganglia in 155 patients were detected. MR images of these patients were reviewed retrospectively by two observers with regard to prevalence, imaging characteristics, and exact anatomic location of ganglia. Clinical findings and (when available) surgical reports were also reviewed. One hundred fifty-seven ganglia in 145 patients were present on MR images of the ankle, and 10 ganglia in 10 patients on MR images of the foot, resulting in a prevalence of 5.6% ( Index terms: magnetic resonance imaging; foot; ankle; ganglia; benign soft-tissue tumors A GANGLION IS A MYXOID CYSTIC LESION arising in association with periarticular and articular structures, tendon sheaths, and, less frequently, with muscle or periosteum (1). MRI has been shown to be useful in identifying ganglia (2-5).The majority of patients with ganglia of the foot and ankle present either with a palpable mass as the only symptom (6), or with the lesion as an incidental finding on MR images. However, a small subset of ganglia of the foot and ankle may cause symptoms such as discomfort or pain, and entrapment neuropathies (6,7).After the hand and wrist, the foot and ankle are considered the second most common location of ganglia (6). Although ganglia of the foot and ankle are reported to be common, little attention has been focused on the prevalence and anatomic distribution of these lesions (6 -8).Consequently, the purpose of this study was to determine the prevalence and distribution of both occult and palpable ganglia of the foot and ankle. PATIENTS AND METHODS PopulationBetween February 1992 and October 1999, 2813 patients underwent MRI of the ankle, and 2277 patients underwent MRI of the forefoot at our institution. All patients were referred for evaluation of foot or ankle pain or evaluation of a soft-tissue mass. The patients were mainly referred by orthopedic foot surgeons and sports medicine physicians. The radiological reports of all these patients were reviewed for the presence of ganglia. A total of 167 ganglia in 159 feet of 155 patients (87 women and 68 men, mean age: 44.5 years; range: 9 -71 years) were described in the reports of these studies. The MRIs of all these patients were retrospectively reviewed. MRIAll MRIs were performed with a 1.5 T MR scanner (Signa EchoSpeed or Signa Horizon LX; GE Medical Systems, Milwaukee, WI). An extremity coil was used for imaging all patients (field of view: 12-20 cm). MRI protocol of the ankle included T1-weighted spin-echo (SE) and fast SE (FSE) short inversion time inversion-recovery (STIR) sequences in the sagittal plane, T1-weighted SE and T2-

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Section: Discussioncontrasting

confidence: 80%

“…Intraosseous ganglia in the foot and ankle are uncommon (21). In our retrospective analysis we found only three intraosseous ganglia (1.8%) located in the calcaneus, cuboid, and metatarsal bone.…”

Section: Discussioncontrasting

confidence: 49%

MRI of the foot and ankle: Prevalence and distribution of occult and palpable ganglia

Weishaupt

Schweitzer

Morrison

et al. 2001

Magnetic Resonance Imaging

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“…It has rarely been described in children [20]. There is a predilection for the long bones of the lower limb [7,10,12,14,16,19,21,22], although the carpal bones are another well-recognized site (Fig. 1) [23,24].…”

Section: Discussionmentioning

confidence: 98%

Imaging features of intraosseous ganglia: a report of 45 cases

et al. 2004

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The aim of this study is to report the spectrum of imaging findings of intraosseous ganglia (IG) with particular emphasis on the radiographic and magnetic resonance (MR) features. Forty-five patients with a final diagnosis of IG were referred to a specialist orthopaedic oncology service with the presumptive diagnosis of either a primary or secondary bone tumour. The diagnosis was established by histology in 25 cases. In the remainder, the imaging features were considered characteristic and the lesion was stable on follow-up radiographic examination. Radiographs were available for retrospective review in all cases and MR imaging in 29. There was a minor male preponderance with a wide adult age range. Three quarters were found in relation to the weight-bearing long bones of the lower limb, particularly round the knee. On radiographs all were juxta-articular and osteolytic; 74% were eccentric in location, 80% had a sclerotic endosteal margin and 60% of cases showed a degree of trabeculation. Periosteal new bone formation and matrix mineralization were not present. Of the 29 cases that underwent MR imaging, 66% were multiloculated. On T1-weighted images the IG contents were isointense or mildly hypointense in 90% cases. Forty-one per cent of the cases showed a slightly hyperintense rim lining that enhanced with a gadolinium chelate. Thirty-eight per cent were associated with soft tissue extension and 17% with a defect of the adjacent articular cortex. Fifty-five per cent showed surrounding marrow oedema on T2-weighted or STIR images and two cases (7%) a fluid-fluid level prior to any surgical intervention. The authors contend that it is semantics to differentiate between an IG and a degenerate subchondral cyst as, while the initial pathogenesis may vary, the histological endpoint is identical, as are the imaging features apart from the degree of associated degenerative joint disease. IGs, particularly when large, may be mistaken for a bone tumour. Correlation of the typical radiographic and MR imaging features will indicate the correct diagnosis and obviate the need for biopsy.

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“…Radiographs and CT scans typically show eccentrically located, well-defined, rounded or ovoid lucent defects with a surrounding zone of sclerosis adjacent to the articular surface (24,25). No expansion of the cortex, periosteal reaction or internal calcification are observed, and these features can help to distinguish between the intraosseous ganglion and numerous other lesions, such as degenerative cysts, giant cell tumors and osteoid osteomas (26). The joint space is normal in all intraosseous ganglia, while certain lesions present a communication in particular with the scapholunate joint (24,25).…”

Section: Discussionmentioning

confidence: 99%

Therapeutic effect of bone cement injection in the treatment of intraosseous ganglion of the carpal bones

Shao

Tian

et al. 2016

Experimental and Therapeutic Medicine

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Abstract. The aim of the present study was to treat intraosseous ganglia of the carpal bones with injectable bone cement grafting. Between January 2012 and December 2013, 4 patients (3 men and 1 woman) presenting with wrist pain and activity limitation were diagnosed with intraosseous ganglion of the carpal bones by radiography. The patients were treated with minimal invasive curettage and bone cement injection surgery. All patients were followed up for a mean time of 17 months (range, 12-22 months). The wrist pain was significantly reduced in all patients following surgery. In addition, the activity range and grip strength were also improved compared with the preoperative parameters. Subsequent to treatment, the Mayo wrist score and the Disabilities of the Arm, Shoulder and Hand score presented mean values of 78.8 (range, 75-80) and 11 (range, 7.7-15.0), respectively. These results suggested that the patients showed a good recovery. All patients were satisfied with the postoperative results and returned to work within 4 weeks. In conclusion, bone cement injection is an effective and safe therapeutic strategy for the treatment of intraosseous ganglia of the carpal bone.

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Intraosseous Ganglion Cysts of the Ankle: A Report of Three Cases with Long-term Follow-up

Cited by 19 publications

References 21 publications

MRI of the foot and ankle: Prevalence and distribution of occult and palpable ganglia

MRI of the foot and ankle: Prevalence and distribution of occult and palpable ganglia

Imaging features of intraosseous ganglia: a report of 45 cases

Therapeutic effect of bone cement injection in the treatment of intraosseous ganglion of the carpal bones

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