This Article Abstract Full Text Full Text (PDF) Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Shah, Z K Articles by Shek, T W H Search for Related Content PubMed PubMed Citation Articles by Shah, Z K Articles by Shek, T W H

Magnetic resonance imaging appearances of fibrous dysplasia

¹ Department of Diagnostic Radiology, Changi General Hospital, Singapore and ² Department of Pathology, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China

View larger version (71K): [in a new window]   Figure 1. Photomicrograph shows typical features of fibrous dysplasia. There are multiple fibroblasts in a collagenous matrix. The bony trabecular pattern resembles "Chinese characters". Haematoxylin and eosin stain, x 20.

View larger version (98K): [in a new window]   Figure 2. Photomicrograph shows typical features of fibrous dysplasia. There is haphazard arrangement of the bony trabeculae with background fibroblasts, so-called "alphabet soup". Haematoxylin and eosin stain, x 66.

View larger version (81K): [in a new window]   Figure 3. (Case 16) Radiograph of the forearm shows a large expanded lesion in the distal shaft of the radius, with homogeneous "ground-glass" matrix and "cloud of smoke" calcification.

View larger version (158K): [in a new window]   Figure 4. (a) (Case 14) Radiograph of the pelvis shows a well-defined lesion within the neck and intertrochanteric area of the right femur with a ground-glass appearance and minimal expansion of the bone. (b) (Case 14) Coronal T1 weighted image of the right femur shows the true extent of the lesion within the marrow. The lesion is larger than appreciated on the radiograph. It is predominantly T1 isointense with a more hypointense area in the distal portion. It is minimally expanded with well-defined margins. (c) (Case 14) Coronal fat-suppressed T2 weighted image shows shows a heterogeneously hyperintense lesion with a more markedly hyperintense area at its distal aspect. (d) (Case 14) Coronal contrast-enhanced fat-suppressed T1 weighted image shows heterogeneous enhancement with a non-enhancing area corresponding to the T1 hypointense and T2 markedly-hyperintense area in the distal portion, consistent with cystic change.

View larger version (81K): [in a new window]   Figure 5. (a) (Case 10) Radiograph shows an expansile lesion in the left femoral neck and upper shaft with a thick sclerotic rim and matrix calcifications. (b) (Case 10) Coronal T1 weighted image shows an isointense (to skeletal muscle) lesion with some foci of hypointensity in the distal portion. (c) (Case 10) Coronal fat-suppressed T2 weighted image shows a heterogeneously hyperintense lesion with small hypointense foci distally. (d) (Case 10) Coronal contrast-enhanced fat-suppressed T1 weighted image shows patchy enhancement of most of the lesion. The hypointense foci in the distal aspect of the lesion seen on the T2 weighted image do not enhance and are consistent with calcifications seen on the radiograph. The more proximal area that is T1 and T2 isointense may represent non- or minimally enhancing fibrous tissue.

View larger version (96K): [in a new window]   Figure 6. (a) (Case 8) Coronal T1 weighted image of the hip shows an expansile isointense lesion within the intertrochanteric region and the shaft of the left femur, with focal hyperintense areas within due to fatty components. (b) (Case 8) Coronal fat-suppressed T2 weighted image shows a heterogeneously hyperintense lesion and multiple linear hypointense areas. (c) (Case 8) Coronal contrast-enhanced fat-suppressed T1 weighted image shows patchy central and peripheral enhancement. The foci of very low signal intensity in the region of the greater trochanter correspond to the fatty areas identified on Figure 6a.

View larger version (81K): [in a new window]   Figure 7. (a) (Case 7) Lateral radiograph of the knee joint shows an expansile lytic lesion in the distal shaft of the femur with a sclerotic rim. (b) (Case 7) Sagittal T2 weighted image shows a heterogeneous lesion, which is mostly isointense with some hyperintense areas and curvilinear hypointensities representing septations. The central portion of the lesion is more hyperintense compared with the more peripheral portion. (c) (Case 7) Sagittal contrast-enhanced fat-suppressed T1 weighted image shows central enhancement at the site of the hyperintense signal on the T2 weighted image. The peripheral areas that are T2 isointense may represent non or minimally enhancing fibrous tissue.

View larger version (103K): [in a new window]   Figure 8. (a) (Case 6) Coronal T1 weighted image shows an expansile lesion in the ischial tuberosity which is homogeneously isointense. (b) (Case 6) Coronal fat-suppressed T2 weighted image shows a T2 hyperintense lesion with a small septated area at the inferolateral aspect. (c) (Case 6) Coronal contrast-enhanced fat-suppressed T1 weighted image shows typical rim enhancement pattern.

View larger version (115K): [in a new window]   Figure 9. (a) (Case 16) Axial T1 weighted image of the right humerus shows a well defined, homogeneously isointense area within the medullary cavity. (b) (Case 16) Axial fat-suppressed T2 weighted image shows the lesion to be homogeneously hyperintense. (c) (Case 16) Axial contrast-enhanced fat-suppressed T1 weighted image shows homogeneous contrast uptake by the lesion. As this image was acquired after the patient had shifted position, the axial images do not exactly match the T1 and T2 weighted images.

View larger version (104K): [in a new window]   Figure 10. (a) (Case 9) Anteroposterior radiograph shows an osteolytic lesion in the medial aspect of the proximal end of the tibia with a thin sclerotic rim. There is a large area of calcification in the central region. (b) (Case 9) Coronal contrast-enhanced fat-suppressed T1 weighted image shows patchy central enhancement and a peripheral enhancing rim. There is a non-enhancing hypointense area corresponding to the calcification on the radiograph. In addition, there is a focal extension of the lesion through the medial cortex. (c) (Case 9) Axial contrast-enhanced fat-suppressed T1 weighted image confirms a break through the medial cortex at the level of the enhancing lesion, consistent with a pathological fracture.

View larger version (105K): [in a new window]   Figure 11. (a) (Case 12) Radiograph shows an expansile lesion in the right femur involving the lesser trochanter and the proximal shaft. (b) (Case 12) Radiograph, taken 1 year after open surgical curettage and treatment with bone grafting, shows multiple radiodense areas within the lesion corresponding to the areas of bone graft. (c) (Case 12) Coronal T1 weighted image shows a heterogeneous appearance of the lesion, which is predominantly isointense to skeletal muscle, with multiple hypointense foci. A few small hyperintense areas are also seen within it. (d) (Case 12) Coronal contrast-enhanced fat-suppressed T1 weighted image shows multiple areas of enhancement at the periphery of the lesion.