Abstract
Objective
To evaluate a range of pathologically proven malignant bone tumours, including primary bone sarcoma and metastatic bone lesions, referred to a tertiary referral centre for the presence of the flow-void sign on MR imaging.
Materials and methods
A retrospective search was performed using the radiology information system and oncology database in our institution to identify patients over the age of 40 years referred with a solitary bone lesion. Patients with a range of pathologically proven malignant bone tumours, including primary bone tumours and metastatic bone lesions, were included in the study. MRI images were reviewed for the presence of the flow-void sign. The presence and type of the flow-void sign were correlated with lesion size.
Results
Two hundred and sixty-six cases were included in the study. Overall, the flow-void sign was identified in 40.9% of cases. The flow-void sign was most frequently seen in renal cell carcinoma metastasis (90.0%). The sign is highly sensitive (90%) for renal cell carcinoma metastases with a high negative predictive value (98.09%). When the flow-void sign is identified, the lesion is almost three times more likely to represent a renal cell carcinoma metastasis than any other malignant tumour in patients over the age of 40 years with a solitary bone lesion.
Conclusion
The flow-void sign is highly sensitive for renal cell carcinoma bone metastases and could negate the need for biopsy in patients with a known history of renal cell carcinoma or in whom an occult renal cell carcinoma is subsequently identified.
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Data Availability
The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request.
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Acknowledgements
Figure 1 was published in Clinical Radiology 74 (2) Murphy J, Patel A, James SL, Botchu R, Davies AM. “Flow-void” sign in osseous metastatic renal cell carcinoma, pages 111–115. Copyright Elsevier (2019). Permission has been granted for its use in this manuscript.
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Murphy, J., Rajakulasingam, R., Iqbal, A. et al. The use of the flow-void sign on MRI: highly sensitive sign in detecting bone metastases from renal cell carcinoma. Skeletal Radiol 53, 917–922 (2024). https://doi.org/10.1007/s00256-023-04512-3
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DOI: https://doi.org/10.1007/s00256-023-04512-3