Semin Musculoskelet Radiol 2019; 23(01): 058-075
DOI: 10.1055/s-0038-1676126
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

T2-weighted Hypointense Tumors and Tumor-like Lesions

Olympia Papakonstantinou
1   2nd Department of Radiology, National and Kapodistrian University of Athens, “Attikon” Hospital, Athens, Greece
,
Amanda Isaac
2   Guy's and St. Thomas' Hospitals NHS Foundation Trust, London, United Kingdom
3   Kings College London (KCL), London, United Kingdom
,
Danoob Dalili
2   Guy's and St. Thomas' Hospitals NHS Foundation Trust, London, United Kingdom
,
Iris-Melanie Noebauer-Huhmann
4   Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
› Author Affiliations
Further Information

Publication History

Publication Date:
30 January 2019 (online)

Abstract

Most musculoskeletal tumors are hyperintense on T2-weighted images. However, some T2-weighted hypointense tumors and tumor-like lesions are encountered in everyday clinical practice. We explore the spectrum of such T2 hypointense tumors and tumor mimickers that can arise from (1) the bones, presenting as diffuse processes or focal lesions; (2) the joints including diffuse or focal synovial disorders, loose bodies, or substance depositions; and (3) soft tissues, comprising T2 hypointense tumors and tumor mimickers (those that contain abundant fibrous tissue, mineralization, or hemosiderin deposits). Appropriate magnetic resonance imaging sequence selection is required to identify and characterize these lesions confidently when imaging musculoskeletal tumors.

 
  • References

  • 1 Gatehouse PD, Bydder GM. Magnetic resonance imaging of short T2 components in tissue. Clin Radiol 2003; 58 (01) 1-19
  • 2 Hodgson RJ, O'Connor PJ, Grainger AJ. Tendon and ligament imaging. Br J Radiol 2012; 85 (1016): 1157-1172
  • 3 Song YS, Lee IS, Choi KU. , et al. Soft tissue masses showing low signal intensity on T2-weighted images: correlation with pathologic findings. J Korean Soc Magn Reson Med 2014; 18 (04) 279-289
  • 4 Mitchel DG. MRI Principles. Philadelphia, PA: WB Saunders; 1999: 191-211
  • 5 Del Grande F, Santini F, Herzka DA. , et al. Fat-suppression techniques for 3-T MR imaging of the musculoskeletal system. Radiographics 2014; 34 (01) 217-233
  • 6 Guerini H, Omoumi P, Guichoux F. , et al. Fat suppression with Dixon techniques in musculoskeletal magnetic resonance imaging: a pictorial review. Semin Musculoskelet Radiol 2015; 19 (04) 335-347
  • 7 Chang EY, Du J, Bae WC, Chung CB. Qualitative and quantitative ultrashort echo time imaging of musculoskeletal tissues. Semin Musculoskelet Radiol 2015; 19 (04) 375-386
  • 8 Doyle EK, Toy K, Valdez B, Chia JM, Coates T, Wood JC. Ultra-short echo time images quantify high liver iron. Magn Reson Med 2018; 79 (03) 1579-1585
  • 9 Hall-Craggs MA, Porter J, Gatehouse PD, Bydder GM. Ultrashort echo time (UTE) MRI of the spine in thalassaemia. Br J Radiol 2004; 77 (914) 104-110
  • 10 Nörenberg D, Ebersberger HU, Walter T. , et al. Diagnosis of calcific tendonitis of the rotator cuff by using susceptibility-weighted MR imaging. Radiology 2016; 278 (02) 475-484
  • 11 Akyuz B, Polat AV, Ozturk M, Aslan K, Tomak L, Selcuk MB. Contribution of 3-T susceptibility-weighted MRI to detection of intraarticular hemosiderin accumulation in patients with hemophilia. AJR Am J Roentgenol 2018; 210 (05) 1141-1147
  • 12 Moulopoulos LA, Koutoulidis V. Bone Marrow MRI: A Pattern-based Approach. Milan, Italy: Springer; 2015: 1-11
  • 13 Nöbauer I, Uffmann M. Differential diagnosis of focal and diffuse neoplastic diseases of bone marrow in MRI. Eur J Radiol 2005; 55 (01) 2-32
  • 14 Mugera C, Suh KJ, Huisman TA. , et al. Sclerotic lesions of the spine: MRI assessment. J Magn Reson Imaging 2013; 38 (06) 1310-1324
  • 15 Schweitzer ME, Levine C, Mitchell DG, Gannon FH, Gomella LG. Bull's-eyes and halos: useful MR discriminators of osseous metastases. Radiology 1993; 188 (01) 249-252
  • 16 Navarro SM, Matcuk GR, Patel DB. , et al. Musculoskeletal imaging findings of haematological malignancies. Radiographics 2017; 37 (03) 881-900
  • 17 Krishnan A, Shirkhoda A, Tehranzadeh J, Armin AR, Irwin R, Les K. Primary bone lymphoma: radiographic-MR imaging correlation. Radiographics 2003; 23 (06) 1371-1383; discussion 1384–1387
  • 18 Guermazi A, de Kerviler E, Cazals-Hatem D, Zagdanski AM, Frija J. Imaging findings in patients with myelofibrosis. Eur Radiol 1999; 9 (07) 1366-1375
  • 19 Papakonstantinou O, Alexopoulou E, Economopoulos N. , et al. Assessment of iron distribution between liver, spleen, pancreas, bone marrow, and myocardium by means of R2 relaxometry with MRI in patients with beta-thalassemia major. J Magn Reson Imaging 2009; 29 (04) 853-859
  • 20 Levin TL, Sheth SS, Ruzal-Shapiro C, Abramson S, Piomelli S, Berdon WE. MRI marrow observations in thalassemia: the effects of the primary disease, transfusional therapy, and chelation. Pediatr Radiol 1995; 25 (08) 607-613
  • 21 Maas M, Kuijper M, Akkerman EM. From Gaucher's disease to metabolic radiology: translational radiological research and clinical practice. Semin Musculoskelet Radiol 2011; 15 (03) 301-306
  • 22 Robertson PL, Maas M, Goldblatt J. Semiquantitative assessment of skeletal response to enzyme replacement therapy for Gaucher's disease using the bone marrow burden score. AJR Am J Roentgenol 2007; 188 (06) 1521-1528
  • 23 Jevtic V. Imaging of renal osteodystrophy. Eur J Radiol 2003; 46 (02) 85-95
  • 24 Stoker DJ. Osteopetrosis. Semin Musculoskelet Radiol 2002; 6 (04) 299-305
  • 25 Allen GM. Dark t1 bone marrow. Semin Musculoskelet Radiol 2011; 15 (03) 247-256
  • 26 Fitzpatrick KA, Taljanovic MS, Speer DP. , et al. Imaging findings of fibrous dysplasia with histopathologic and intraoperative correlation. AJR Am J Roentgenol 2004; 182 (06) 1389-1398
  • 27 Lalam R, Bloem JL, Noebauer-Huhmann IM. , et al. ESSR consensus document for detection, characterization and referral pathway for tumours and tumour-like lesions of bone. Semin Musculoskelet Radiol 2017; 21 (05) 630-647
  • 28 Trotta B, Fox MG. Benign osteoid-producing bone lesions: update on imaging and treatment. Semin Musculoskelet Radiol 2013; 17 (02) 116-122
  • 29 Greenspan A. Bone island (enostosis): current concept—a review. Skeletal Radiol 1995; 24 (02) 111-115
  • 30 Fox MG, Trotta BM. Osteosarcoma: review of the various types with emphasis on recent advancements in imaging. Semin Musculoskelet Radiol 2013; 17 (02) 123-136
  • 31 Laux CJ, Berzaczy G, Weber M. , et al. Tumour response of osteosarcoma to neoadjuvant chemotherapy evaluated by magnetic resonance imaging as prognostic factor for outcome. Int Orthop 2015; 39 (01) 97-104
  • 32 Hong WS, Sung MS, Chun KA. , et al. Emphasis on the MR imaging findings of brown tumor: a report of five cases. Skeletal Radiol 2011; 40 (02) 205-213
  • 33 Mhuircheartaigh JN, Lin YC, Wu JS. Bone tumor mimickers: a pictorial essay. Indian J Radiol Imaging 2014; 24 (03) 225-236
  • 34 Chung CB, Boucher R, Resnick D. MR imaging of synovial disorders of the knee. Semin Musculoskelet Radiol 2009; 13 (04) 303-325
  • 35 Huang GS, Lee CH, Chan WP, Chen CY, Yu JS, Resnick D. Localized nodular synovitis of the knee: MR imaging appearance and clinical correlates in 21 patients. AJR Am J Roentgenol 2003; 181 (02) 539-543
  • 36 Murphey MD, Rhee JH, Lewis RB, Fanburg-Smith JC, Flemming DJ, Walker EA. Pigmented villonodular synovitis: radiologic-pathologic correlation. Radiographics 2008; 28 (05) 1493-1518
  • 37 Wadhwa V, Cho G, Moore D, Pezeshk P, Coyner K, Chhabra A. T2 black lesions on routine knee MRI: differential considerations. Eur Radiol 2016; 26 (07) 2387-2399
  • 38 Wang C, Song RR, Kuang PD, Wang LH, Zhang MM. Giant cell tumor of the tendon sheath: magnetic resonance imaging findings in 38 patients. Oncol Lett 2017; 13 (06) 4459-4462
  • 39 Keshava SN, Gibikote S, Doria AS. Imaging evaluation of hemophilia: musculoskeletal approach. Semin Thromb Hemost 2015; 41 (08) 880-893
  • 40 Hart AJ, Sabah SA, Sampson B. , et al. Surveillance of patients with metal-on-metal hip resurfacing and total hip prostheses: a prospective cohort study to investigate the relationship between blood metal ion levels and implant failure. J Bone Joint Surg Am 2014; 96 (13) 1091-1099
  • 41 Yu JS, Chung C, Recht M, Dailiana T, Jurdi R. MR imaging of tophaceous gout. AJR Am J Roentgenol 1997; 168 (02) 523-527
  • 42 Llauger J, Palmer J, Rosón N, Bagué S, Camins A, Cremades R. Nonseptic monoarthritis: imaging features with clinical and histopathologic correlation. Radiographics 2000; 20 (Spec No): S263-S278
  • 43 Sheldon PJ, Forrester DM. Imaging of amyloid arthropathy. Semin Musculoskelet Radiol 2003; 7 (03) 195-203
  • 44 Murphey MD, Vidal JA, Fanburg-Smith JC, Gajewski DA. Imaging of synovial chondromatosis with radiologic-pathologic correlation. Radiographics 2007; 27 (05) 1465-1488
  • 45 Recht MP, Kramer J. MR imaging of the postoperative knee: a pictorial essay. Radiographics 2002; 22 (04) 765-774
  • 46 Huang GS, Lee CH, Chen WP, Lee HS, Chen CY, Yu JS. Acute anterior cruciate ligament stump entrapment in anterior cruciate ligament tears: MR imaging appearance. Radiology 2002; 225 (02) 537-540
  • 47 Murphey MD, Ruble CM, Tyszko SM, Zbojniewicz AM, Potter BK, Miettinen M. From the archives of the AFIP: musculoskeletal fibromatoses: radiologic-pathologic correlation. Radiographics 2009; 29 (07) 2143-2173
  • 48 Dinauer PA, Brixey CJ, Moncur JT, Fanburg-Smith JC, Murphey MD. Pathologic and MR imaging features of benign fibrous soft-tissue tumors in adults. Radiographics 2007; 27 (01) 173-187
  • 49 Fox MG, Kransdorf MJ, Bancroft LW, Peterson JJ, Flemming DJ. MR imaging of fibroma of the tendon sheath. AJR Am J Roentgenol 2003; 180 (05) 1449-1453
  • 50 Bestic JM, Kransdorf MJ, White LM. , et al. Sclerosing variant of well-differentiated liposarcoma: relative prevalence and spectrum of CT and MRI features. AJR Am J Roentgenol 2013; 201 (01) 154-161
  • 51 Mc Auley G, Jagannathan J, O'Regan K. , et al. Extraskeletal osteosarcoma: spectrum of imaging findings. AJR Am J Roentgenol 2012; 198 (01) W31-7
  • 52 Bencardino J, Rosenberg ZS, Beltran J, Liu X, Marty-Delfaut E. Morton's neuroma: is it always symptomatic?. AJR Am J Roentgenol 2000; 175 (03) 649-653
  • 53 Studler U, Mengiardi B, Bode B. , et al. Fibrosis and adventitious bursae in plantar fat pad of forefoot: MR imaging findings in asymptomatic volunteers and MR imaging-histologic comparison. Radiology 2008; 246 (03) 863-870
  • 54 Brandser EA, Goree JC, El-Khoury GY. Elastofibroma dorsi: prevalence in an elderly patient population as revealed by CT. AJR Am J Roentgenol 1998; 171 (04) 977-980
  • 55 Tsubakimoto M, Yamashiro T, Tsuchiya N. , et al. MRI findings and demographics of elastofibroma dorsi: assessment of diffusion-weighted imaging and contrast enhancement patterns. Acta Radiol 2018; 59 (06) 709-715
  • 56 Wu JS, Hochman MG. Soft-tissue tumors and tumorlike lesions: a systematic imaging approach. Radiology 2009; 253 (02) 297-316
  • 57 Olsen KM, Chew FS. Tumoral calcinosis: pearls, polemics, and alternative possibilities. Radiographics 2006; 26 (03) 871-885
  • 58 Malghem J, Omoumi P, Lecouvet F, Vande Berg B. Intraosseous migration of tendinous calcifications: cortical erosions, subcortical migration and extensive intramedullary diffusion, a SIMS series. Skeletal Radiol 2015; 44 (10) 1403-1412
  • 59 Scutellari PN, Galeotti R, Leprotti S, Ridolfi M, Franciosi R, Antinolfi G. The crowned dens syndrome. Evaluation with CT imaging. Radiol Med (Torino) 2007; 112 (02) 195-207
  • 60 Aoki T, Nakata H, Watanabe H. , et al. The radiological findings in chronic expanding hematoma. Skeletal Radiol 1999; 28 (07) 396-401
  • 61 Lee YS, Kwon ST, Kim JO, Choi ES. Serial MR imaging of intramuscular hematoma: experimental study in a rat model with the pathologic correlation. Korean J Radiol 2011; 12 (01) 66-77
  • 62 Flores DV, Mejía Gómez C, Estrada-Castrillón M, Smitaman E, Pathria MN. MR imaging of muscle trauma: anatomy, biomechanics, pathophysiology, and imaging appearance. Radiographics 2018; 38 (01) 124-148
  • 63 Crundwell N, O'Donnell P, Saifuddin A. Non-neoplastic conditions presenting as soft-tissue tumours. Clin Radiol 2007; 62 (01) 18-27
  • 64 Noebauer-Huhmann IM, Weber MA, Lalam RK. , et al. Soft tissue tumors in adults: ESSR-approved guidelines for diagnostic imaging. Semin Musculoskelet Radiol 2015; 19 (05) 475-482