P O'Donnell1, A Saifuddin. 1. The Department of Radiology, Royal National Orthopaedic Hospital NHS Trust, The London Bone and Soft Tissue Tumour Service, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK. paul.odonnell@lineone.net
Abstract
OBJECTIVE: To determine the prevalence and diagnostic significance of fluid-fluid levels (FFLs) in focal bone lesions. DESIGN AND PATIENTS: Clinical and radiological details of 738 consecutive patients referred with focal lesions of bone and who had undergone MRI were reviewed. FFLs were identified in 83 (11.2%). The proportion of the lesion occupied by FFLs was estimated, based on imaging in all available planes, as <1/3, 1/3-2/3, >2/3 but not the entire lesion, and complete. The degree of FFL change in each lesion was correlated with the final diagnosis, which was either histological (n=80) or clinicoradiological (n=3). There were 31 female and 52 male patients, mean age 25.5 years (range 5-83 years). RESULTS: Histology revealed 46 benign, 32 malignant and 2 non-neoplastic lesions. A clinicoradiological diagnosis was made in the 3 lesions without histology: 2 were benign (simple bone cyst and intraosseous lipoma) and 1 malignant (a metastasis). Malignant neoplasms commonly showed FFLs which occupied <1/3 of the entire lesion (n=22/32, 68.8%), and 50% of all the lesions in this group were conventional intramedullary osteosarcomas (n=16). With increasing FFL change, malignancy became less frequent: with >2/3 (but incomplete) FFL change, 81% (n=13/16) of tumours were benign. If the entire tumour showed FFL change, the histology was benign in 100% (n=11). CONCLUSIONS: The extent of FFLs within a focal bone lesion appears to be inversely related to the degree of malignancy. If at least 2/3 of the lesion shows FFL change, 89% of diagnoses are benign. Copyright 2004 ISS
OBJECTIVE: To determine the prevalence and diagnostic significance of fluid-fluid levels (FFLs) in focal bone lesions. DESIGN AND PATIENTS: Clinical and radiological details of 738 consecutive patients referred with focal lesions of bone and who had undergone MRI were reviewed. FFLs were identified in 83 (11.2%). The proportion of the lesion occupied by FFLs was estimated, based on imaging in all available planes, as <1/3, 1/3-2/3, >2/3 but not the entire lesion, and complete. The degree of FFL change in each lesion was correlated with the final diagnosis, which was either histological (n=80) or clinicoradiological (n=3). There were 31 female and 52 male patients, mean age 25.5 years (range 5-83 years). RESULTS: Histology revealed 46 benign, 32 malignant and 2 non-neoplastic lesions. A clinicoradiological diagnosis was made in the 3 lesions without histology: 2 were benign (simple bone cyst and intraosseous lipoma) and 1 malignant (a metastasis). Malignant neoplasms commonly showed FFLs which occupied <1/3 of the entire lesion (n=22/32, 68.8%), and 50% of all the lesions in this group were conventional intramedullary osteosarcomas (n=16). With increasing FFL change, malignancy became less frequent: with >2/3 (but incomplete) FFL change, 81% (n=13/16) of tumours were benign. If the entire tumour showed FFL change, the histology was benign in 100% (n=11). CONCLUSIONS: The extent of FFLs within a focal bone lesion appears to be inversely related to the degree of malignancy. If at least 2/3 of the lesion shows FFL change, 89% of diagnoses are benign. Copyright 2004 ISS
Authors: S A Nabavizadeh; L T Bilaniuk; T Feygin; K V Shekdar; R A Zimmerman; A Vossough Journal: AJNR Am J Neuroradiol Date: 2013-08-22 Impact factor: 3.825