Imaging of soft-tissue myxoma with emphasis on CT and MR and comparison of radiologic and pathologic findings

PURPOSE: To determine the imaging characteristics of soft-tissue myxoma, with emphasis on computed tomographic (CT) and magnetic resonance (MR) imaging findings and pathologic comparison. MATERIALS AND METHODS: Records of 45 pathologically confirmed soft-tissue myxomas in 44 patients were retrospectively reviewed. Patient demographics and radiographs (n = 20), bone scintigrams (n = 2), angiograms (n = 3), and ultrasonographic (US) (n = 6), CT (n = 14), and MR images (n = 33) were evaluated by two musculoskeletal radiologists with agreement by consensus for lesion location, lesion size, and intrinsic characteristics. RESULTS: Soft-tissue myxoma more commonly affected women (59%; average age 52 years) and manifested as a slowly enlarging (64%) painful (51%) mass. Lesions were most frequently intramuscular (82%) and involved the thigh (51%). An appearance similar to that of a cyst was seen at CT (at which the lesions demonstrated low attenuation) and at MR imaging (at which the lesions demonstrated markedly high signal intensity on T2-weighted images) in all cases because of the high water content of mucin that was seen histologically. The true solid architecture of these lesions was best depicted in all cases at US (at which the lesions were hypoechoic, not anechoic) and on MR images obtained with contrast material (at which the lesions demonstrated internal enhancement). A small amount of tissue similar to fat surrounding these intramuscular myxomas (71% at MR imaging) corresponded histologically (70%) to atrophy of surrounding muscle. CONCLUSION: Soft-tissue myxoma often demonstrates characteristic US, CT, and MR imaging findings, including intramuscular location, intrinsic high water content, and a surrounding rim of fat.