Imaging features of subperiosteal aneurysmal bone cyst

PURPOSE: To analyze the imaging features of subperiosteal aneurysmal bone cyst. MATERIAL AND METHODS: The imaging material of 6 patients with biopsy-proved subperiosteal aneurysmal bone cyst was reviewed. Evaluation included patient demographics, lesion location and size, radiographic features, and intrinsic characteristics on CT and MR images. Review of histologic specimens was carried out by an experienced musculoskeletal pathologist. RESULTS: All lesions were located at the surface of long tubular bones (femur 3, tibia 2, humerus 1): 3 involved the diaphysis, 2 the dia/metaphysis, and 1 exclusively the metaphysis. Lesion size ranged from 2.5 to 6 cm in maximum diameter. Radiographs and CT images always showed a superficial bone defect, which on radiographs demonstrated irregular margins in 4 cases. All lesions caused an interrupted periosteal reaction (shell 3, trabeculated shell 1, Codman angle 2). MR images always showed a multicystic appearance with a hypointense rim, contrast-enhancing cyst walls, and fluid levels. Edema of adjacent soft tissues was present in all cases. CONCLUSION: Aneurysmal bone cyst in a subperiosteal location can demonstrate an aggressive radiographic appearance. MR imaging appears to be most valuable in the differential diagnosis, since it can demonstrate typical morphological features of the underlying process.     

Occipital aneurysmal bone cyst: CT features

A case of aneurysmal bone cyst arising from the lower occipital squama with intracranial extension is presented. The case is unique in that the cyst showed fluid levels on CT. Another peculiarity of this case was postoperative recurrence.     

Radiological and clinical features of aneurysmal bone cyst of the jaws

PURPOSE: To evaluate the clinical and radiological features of aneurysmal bone cyst (ABC) of the jaws. MATERIALS AND METHODS: A total of 64 cases (60 from the English-language literature and four new cases) were studied and critically evaluated with emphasis on the radiological features. RESULTS: Age at time of initial diagnosis ranged from 4-78 years, with a mean age of 21.5 years and median age of 17 years. There were no differences in gender distribution. The ratio between the mandible and maxilla was 2.4:1. Ninety-two per cent of the lesions were located in the posterior region of the jaws. Lesions were radiolucent in 87% of cases, radiopaque in 2% and mixed in 11%. Fifty-three per cent were multilocular, 43% unilocular and 3% not loculated. The border of the lesions was defined but not corticated in 39%, well defined in 33% and diffuse in 28%. CONCLUSIONS: ABC has a variable radiological appearance and should be considered in the differential diagnosis of any unilocular or multilocular radiolucent lesion of the jaws as well as any mixed radiolucent-radiopaque lesion.     

Fibro-osseous lesions of the face and skull with aneurysmal bone cyst formation

Aneurysmal bone cyst engraftment on benign fibro-osseous lesions, well known to occur in the extracranial skeleton, has been reported infrequently in the craniofacial bones. When this combined lesion occurs in the skull the clinical and radiographic features often suggest an aggressive neoplasm. The clinical, radiographic, and pathologic features of five cases are presented, and this uncommon lesion of the craniofacial bones is discussed in view of these cases and those reported in the literature.     

Giant-cell tumor of bone and aneurysmal bone cyst

A correlated histologic and radiographic study of nine giant-cell tumors, six aneurysmal bone cysts, and one combined lesion is presented. Clinical findings and plain radiographic appearances were found to overlap. Angiographically, the giant-cell tumors were richly vascularized, with a marked intratumoral contrast uptake, occasional irregular tumor vessles, a prominent peritumoral arterial net-work, and early draining veins. Microscopic examination revealed fine, capillary-like and somewhat larger, angulated, sinusoid vessels, and occasional small, bloodfilled cysts within the tumor. Conspicuous arteries, veins, and capillaries surrounded the tumor. The aneurysmal bone cysts at angiography were predominantly avascular in the interior, surrounded by a thin hyperemic zone in the peritumoral tissue, with sometimes early filling of veins. Microscopically, the aneurysmal bone cysts showed large, anastomosing, bloodfilled vascular channels, and a moderate number of capillaries within the solid, fibrous areas and the granulation tissue. It is concluded that angiography, particularly with a subtraction technique, may be a valuable diagnostic method in the pre-operative differentiation of giant-cell tumors from aneurysmal bone cysts.     

Pathological fracture in non-ossifying fibroma with histological features simulating aneurysmal bone cyst

A 12-year-old-girl presented with a fracture of an osteolytic lesion of the distal radius. A 7-year-old girl presented with a fracture of an osteolytic lesion of the femoral shaft. In both cases it was a non-ossifying fibroma with fracture misdiagnosed at pathology as aneurysmal bone cyst. Fractures through non-ossifying fibromas may alter the histological pattern of the initial lesion in two ways: firstly, by the presence of blood pigments due to the fracture, and secondly, by formation of new bone. Radiological–pathological correlation is essential to avoid histological errors after pathological fracture in a non-ossifying fibroma. Received: 27 January 1998; Revision received: 17 June 1998; Accepted: 25 July 1998     

动脉瘤样骨囊肿的影像学研究

目的:评价影像学检查对动脉瘤样骨囊肿的诊断价值.方法:对26例经手术病理证实的动脉瘤样骨囊肿的影像学表现进行回顾性分析.26例均摄了平片,CY检查10例、MRI检查6例、DSA检查2例.结果:26例动脉瘤样骨囊肿发生于长管状骨18例,脊柱4例,骨盆3例,跖骨1例.平片和CT多表现为偏心膨胀性骨破坏,CT常可显示骨性分隔及液-液平,MRI检查多表现为多囊长T1、长T2信号特点,CT和MRI检查16例中有6例出现液-液平面.DSA表现实质期可见中等量肿瘤染色.结论:动脉瘤样骨囊肿具有一定的影像学特征,CT特别是MRI对动脉瘤样骨囊肿诊断较平片有优势,综合影像学检查能提高动脉瘤样骨囊肿诊断符合率.     

Solid aneurysmal bone cyst in the humerus

We report on a 69-year-old woman with a solid variant of aneurysmal bone cyst (solid ABC) in the left humerus with a pathological fracture. Radiographically, the lesion exhibited a relatively well-defined osteolytic lesion in the diaphysis of the left humerus. On magnetic resonance (MR) imaging, the medullary lesion exhibited a homogeneous signal intensity isointense with surrounding normal muscles on the T1-weighted images and a mixture of low and high signal intensity on the T2-weighted images. Contrast-enhanced T1-weighted images revealed diffuse enhancement of the entire lesion. The pathological study showed a proliferation of fibroblasts, histiocytes, chronic inflammatory cells and numerous multinucleated giant cells in a collagenous matrix. Abundant osteoid formation in the matrix was observed, but the cells were devoid of nuclear atypia. Aneurysmal cystic cavities were absent. A review of the English literature found 22 cases of solid ABC of the long bones. Received: 15 February 2000 Revision requested: 18 March 2000 Revision received: 17 April 2000 Accepted: 19 April 2000     

Therapeutic embolization of aneurysmal bone cyst

Results of therapeutic embolization of aneurysmal bone cysts in five patients are described. Transcatheter arterial embolization was performed with Ivalon and Gelfoam particles and Gianturco coils. The postembolization period was characterized by complete relief of pain and decrease in size of the aneurysmal bone cyst in all patients. In patients whose follow-up was longer than 12 months, sclerosis and recalcification of bone were present. There were no complications.     

Secondary aneurysmal bone cysts and associated primary lesions: imaging features of 49 cases

PurposeTo describe the imaging, anatomic, and clinical features of a series of secondary aneurysmal bone cysts (ABC) and to ascertain their most commonly associated primary bone lesions.MethodsForty-nine cases of histopathologically proven secondary ABCs were retrospectively reviewed. Demographic data and clinical history were obtained. Radiographic, computed tomographic, magnetic resonance, and nuclear medicine imaging were analyzed. Lesion location, imaging characteristics, and associated primary lesions were documented. Linear regression analysis and Chi-squared testing was performed for statistical analysis.ResultsTwenty-four males and 25 females were included, with an age range of 8—79 years (mean 29.7 + − 4.5 years). Eleven types of primary bone lesion were identified, with giant-cell tumor (n = 17, 35%), chondroblastoma (n = 11, 22%), fibrous dysplasia (n = 6, 12%), osteoblastoma (n = 4, 8%) and osteosarcoma (n = 4, 8%) being the most frequent. The lesions involved chiefly the long bone epiphyses (n = 25, 51%). Secondary ABC imaging findings and locations most closely approximated those of their primary counterparts, although fluid-fluid levels were seen at a higher frequency than previously reported in primary chondroblastoma (9/11, 82%), fibrous dysplasia (2/6, 33%), osteoblastoma (4/4, 100%), osteosarcoma (3/4, 75%), and chondromyxoid fibroma (1/2, 50%).ConclusionThe most common primary lesions associated with secondary ABC were giant cell tumor and chondroblastoma, located in the long bone epiphyses. The majority of the secondary ABCs demonstrate predominant imaging characteristics typical of the primary bone lesions, but with a higher presence of fluid-fluid levels.     

Optic neuropathy secondary to cat scratch disease: distinguishing MR imaging features from other types of optic neuropathies

BACKGROUND AND PURPOSE: MR imaging characteristics of optic neuropathy caused by cat scratch disease have not yet been described; this lack of information may result in incorrect diagnosis and may contribute to initiation of inappropriate therapy. Our study was based on the hypothesis that cat scratch disease-related optic neuropathy has distinct MR imaging features compared with those of other types of optic neuropathies. METHODS: Eighty-two patients with various causes of optic neuropathy and available MR imaging examinations were included in this study. Two readers blinded to the diagnosis reviewed the MR images independently in regard to presence, location, and extent of optic nerve enhancement. The MR imaging findings were correlated with the final diagnosis. RESULTS: Eleven percent (9/82) of the patients received a final diagnosis of cat scratch disease. Optic nerve enhancement in patients with cat scratch disease (5/37) was localized to a 3- to 4-mm segment at the optic nerve-globe junction. All other patients with optic neuropathy (31/37) with one exception showed enhancement away from the optic nerve-globe junction or a long-segment enhancement when the optic nerve-globe junction was also involved. Four patients with cat scratch disease did not show any optic nerve MR abnormalities. CONCLUSION: Unilateral, short-segment enhancement localized to the optic nerve-globe junction is highly specific for cat scratch disease as the underlying cause of optic neuropathy and may help in establishing the diagnosis of this condition.     

Diagnosis of aneurysmal bone cyst of the mandible. A report of two cases with emphasis on scintigraphic approaches

Aneurysmal bone cyst is rarely found in the mandible, and roentgenographic diagnosis of this condition is not easily made. In this report, the diagnostic value of bone scintigraphy and radionuclide angiography and CT imaging in two cases of aneurysmal bone cyst of the mandible are discussed. Bone scintigraphy with Tc-99m MDP demonstrated ring-like or doughnut-pattern accumulation of radioactivity, which corresponded to the expansile character of the bony lesion. The accumulation of radioactivity was intensive in the peripheral region despite the fact that the lesion was benign. Furthermore, the central rarefaction showed that the lesion was cystic. Radionuclide angiography with Tc-99m HSA, including blood pool scan, did not detect radioactive concentration. Thus bone scintigraphy and radionuclide angiography were found to be essential in the differential diagnosis of aneurysmal bone cyst from other forms of tumor, especially hypervascularized tumor and central hemangioma of the mandible.     

原发性与继发性动脉瘤样骨囊肿CT表现

目的评价CT对诊断与鉴别原发性与继发性动脉瘤样骨囊肿的价值。方法回顾性分析9例经手术病理证实原发性与继发性动脉瘤样骨囊肿的CT征象,并进行献复习。结果9例患中骨皮质缺损征象出现率(67％)高于“液一液平面”出现率(44％)。继发性动脉瘤样骨囊肿骨嵴明显粗大,可构成分房。9例病灶内呈不均匀软组织密度,增强后强化明显。结论CT检查有助于动脉瘤样骨囊肿早期定性诊断,并有助于鉴别原发性与继发性病灶。