Abstract
A wide range of musculoskeletal tumors and tumor-like conditions may be encountered when patients undergo radiological examinations. The imaging features of certain normal, reactive, benign neoplastic, inflammatory, traumatic, and degenerative processes in the musculoskeletal system may mimic malignant tumor; misinterpretation of the imaging findings can lead to inappropriate clinical management of the patient. This review describes and illustrates a number of such mimics that we have commonly encountered in our oncological imaging practice, and provides suggestions for avoiding each of these pitfalls. Because many orthopaedic surgeons interpret radiological images themselves, they need to be as aware as radiologists about these issues.
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Cronin CG, Cashell T, Mhuircheartaigh JN, Swords R, Murray M, O’Sullivan GJ, O’Keefe D (2009) Bone biopsy of new suspicious bone lesions in patients with primary carcinoma: prevalence and probability of an alternative diagnosis. AJR Am J Roentgenol 193:W407–W410
Toomayan GA, Major NM (2011) Utility of CT-guided biopsy of suspicious skeletal lesions in patients with known primary malignancies. AJR Am J Roentgenol 196:416–423
Stacy GS, Dixon LB (2007) Pitfalls in MR image interpretation prompting referrals to an orthopedic oncology clinic. RadioGraphics 27:805–828
Kransdorf MJ, Meis JM, Jelinek JS (1991) Myositis ossificans: MR appearance with radiologic-pathologic correlation. AJR Am J Roentgenol 157:1243–1248
Naylor MF, Nascimento AG, Sherrick AD, McLeod RA (1996) Elastofibroma dorsi: radiologic findings in 12 patients. AJR Am J Roentgenol 167:683–687
Onishi Y, Kitajima K, Senda M, Sakamoto S, Suzuki K, Maeda T, Yoshikawa T, Ohno Y, Sugimura K (2011) FDG PET/CT imaging of elastofibroma dorsi. Skeletal Radiol 40:849–853
Flemming DJ, Murphey MD, Shekitka KM, Temple HT, Jelinek JJ, Kransdorf MJ (2003) Osseous involvement in calcific tendinitis: a retrospective review of 50 cases. AJR Am J Roentgenol 181:965–972
Dinter DJ, Neff WK, Klaus J, Bohm C, Hatks J, Weiss C, Schoenberg SO, Metzgeroth G (2009) Comparison of whole-body MRI imaging and conventional X-ray examination in patients with multiple myeloma and implications for therapy. Ann Hematol 88:457–464
Richardson ML, Patten RM (1994) Age-related changes in marrow distribution in the shoulder: MR imaging findings. Radiology 192:209–215
Lang P, Fritz R, Majumdar S, Vahlensieck M, Peterfy C, Genant HK (1993) Hematopoietic bone marrow in the adult knee: spin-echo and opposed-phase gradient-echo MR imaging. Skeletal Radiol 22:95–103
Hwang S, Panicek DM (2007) Magnetic resonance imaging of bone marrow in oncology, Part 1. Skeletal Radiol 36:913–920
Salavati A, Shah V, Wang ZJ, Yeh BM, Costouros NG, Coakley FV (2011) F-18 FDG PET/CT findings in postradiation pelvic insufficiency fracture. Clin Imaging 35:139–142
Tsuchida T, Kosaka N, Sugimoto K, Itoh H (2006) Sacral insufficiency fracture detected by FDG-PET/CT: report of 2 cases. Ann Nucl Med 20:445–448
Cetik O, Uslu M, Ozsar BK (2007) The relationship between Hill-Sachs lesion and recurrent anterior shoulder dislocation. Acta Orthop Belg 73:175–178
Nakamoto Y, Cohade C, Tatsumi M, Hammoud D, Wahl RL (2005) CT appearance of bone metastases detected with FDG PET as part of the same PET/CT examination. Radiology 237:627–634
Fink-Bennett DM, Shapiro EE (1984) The Angle of Louis. A potential pitfall ("Louie’s Hot Spot") in bone scan interpretation. Clin Nucl Med 9:352–354
Puig S, Staudenherz A, Steiner B, Eisenhuber E, Leitha T (1998) Differential diagnosis of atypically located single or double hot spots in whole bone scanning. J Nucl Med 39:1263–1266
Aoki J, Watanabe H, Shinozaki T, Takagishi K, Ishijima H, Oya N, Sato N, Inoue T, Endo K (2001) FDG PET of primary benign and malignant bone tumors: standardized uptake value in 52 lesions. Radiology 219:774–777
Llauger J, Palmer J, Rosón N, Cremades R, Bagué S (1999) Pigmented villonodular synovitis and giant cell tumors of the tendon sheath: radiologic and pathologic features. AJR Am J Roentgenol 172:1087–1091
Iagaru A, Henderson R (2006) PET/CT follow-up in nonossifying fibroma. AJR Am J Roentgenol 187:830–832
Goodin GS, Shulkin BL, Kaufman RA, McCarville MB (2006) PET/CT characterization of fibroosseous defects in children: 18F-FDG uptake can mimic metastatic disease. AJR Am J Roentgenol 187:1124–1128
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Ulaner, G., Hwang, S., Lefkowitz, R.A. et al. Musculoskeletal tumors and tumor-like conditions: common and avoidable pitfalls at imaging in patients with known or suspected cancer. International Orthopaedics (SICOT) 37, 871–876 (2013). https://doi.org/10.1007/s00264-013-1823-7
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DOI: https://doi.org/10.1007/s00264-013-1823-7