Advertisement

Der Radiologe

, Volume 57, Issue 4, pp 286–295 | Cite as

Zufallsbefunde in der muskuloskeletalen Radiologie

  • F. WünnemannEmail author
  • C. Rehnitz
  • M.-A. Weber
Leitthema

Zusammenfassung

Hintergrund

Mit steigender Menge an konventionellen Röntgen- sowie CT- und MRT-Bildern im stationären, ambulanten und wissenschaftlichen Alltag steigt unweigerlich auch die Zahl der Zufallsbefunde. Die korrekte Einordnung bzgl. deren Relevanz, ob eine weitere Abklärung notwendig ist oder nicht, stellt eine wichtige Aufgabe des Radiologen dar.

Zielstellung

Vorstellung häufiger Zufallsbefunde des muskuloskeletalen Systems und deren klinische Einordnung.

Material und Methoden

Pubmed-Literaturrecherche zu den Stichworten „incidental findings”, „population-based imaging”, „musculoskeletal imaging”, „non-ossifying fibroma”, „enchondroma”, „osteodysthrophia deformans”, „chondrosarcoma”, „fibrous dysplasia”, „simple bone cyst”, „unicameral bone cyst”, „solitary bone cyst”, „aneurysmal bone cyst”, „vertebral hemangioma”, „bone island”, „osteopoikilosis”, „Tarlov cyst”, „diffuse idiopathic skeletal hyperostosis” (DISH).

Ergebnisse

Bei bis zu 40 % der Schnittbildgebungen finden sich Zufallsbefunde. Etwa 6 % der Zufallsbefunde entfallen dabei auf das Skelett. Häufige Zufallsbefunde und deren klinische Relevanz werden dargestellt.

Schlüsselwörter

Weitere Abklärung Klinische Relevanz Wirbelsäule Tumor Tumorähnliche Läsionen 

Incidental findings in musculoskeletal radiology

Abstract

Background

Increasing numbers of conventional X‑rays, computed tomography and magnetic resonance imaging in the inpatient, outpatient and scientific routine leads to an increasing number of incidental findings. The correct interpretation of these incidental findings with respect to the relevance and the evaluation concerning further work-up is an important task of radiologists.

Objective

Description of common incidental findings in musculoskeletal imaging and their clinical classification.

Material and methods

A PubMed literature search was performed using the following terms: incidental findings, population-based imaging, musculoskeletal imaging, non-ossifying fibroma, enchondroma, osteodystrophia deformans, chondrosarcoma, fibrous dysplasia, simple bone cyst, unicameral bone cyst, solitary bone cyst, aneurysmal bone cyst, vertebral hemangioma, bone island, osteopoikilosis, Tarlov cyst and diffuse idiopathic skeletal hyperostosis (DISH).

Results

Incidental findings are observed in up to 40% of imaging procedures. In up to 6% these incidental findings involve the skeletal system. Common incidental findings are discussed and their clinical relevance is explained.

Keywords

Further evaluation Clinical relevance Vertebral column Tumor Tumor-like lesions 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

F. Wünnemann, C. Rehnitz und M.-A. Weber geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Literatur

  1. 1.
    Arata MA, Peterson HA, Dahlin DC (1981) Pathological fractures through non-ossifying fibromas. Review of the Mayo Clinic experience. J Bone Joint Surg Am 63:980–988CrossRefPubMedGoogle Scholar
  2. 2.
    Bamberg F, Kauczor H‑U, Weckbach S et al (2015) Whole-body MR imaging in the German national cohort: rationale, design, and technical background. Radiology 277:206–220. doi: 10.1148/radiol.2015142272 CrossRefPubMedGoogle Scholar
  3. 3.
    Belsuzarri TAB, Araujo JFM, Melro CAM et al (2016) McCune-Albright syndrome with craniofacial dysplasia: Clinical review and surgical management. Surg Neurol Int 7:S165–S169. doi: 10.4103/2152-7806.178567 CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Berlin L, Berlin JW (1995) Malpractice and radiologists in Cook County, IL: trends in 20 years of litigation. AJR Am J Roentgenol 165:781–788. doi: 10.2214/ajr.165.4.7676967 CrossRefPubMedGoogle Scholar
  5. 5.
    Bohndorf K, Imhof H, Wörtler K (2013) Radiologische Diagnostik der Knochen und Gelenke. Thieme, StuttgartGoogle Scholar
  6. 6.
    Cammisa M, De Serio A, Guglielmi G (1998) Diffuse idiopathic skeletal hyperostosis. Eur J Radiol 27(Suppl 1):S7–S11CrossRefPubMedGoogle Scholar
  7. 7.
    Destatis SB (2015) Fallpauschalenbezogene Krankenhausstatistik (DRG-Statistik) Operationen und Prozeduren der vollstationären Patientinnen und Patienten in Krankenhäusern – Ausführliche Darstellung – 2015, S 1–84, Statistisches Bundesamt, WiesbadenGoogle Scholar
  8. 8.
    Douis H, Saifuddin A (2013) The imaging of cartilaginous bone tumours. II. Chondrosarcoma. Skeletal Radiol 42:611–626. doi: 10.1007/s00256-012-1521-3 CrossRefPubMedGoogle Scholar
  9. 9.
    Erlemann R, Jundt G (2016) Tumor-like lesions of bone. Radiologe 56:507–519. doi: 10.1007/s00117-016-0113-y CrossRefPubMedGoogle Scholar
  10. 10.
    Fitzpatrick KA, Taljanovic MS, Speer DP et al (2004) Imaging findings of fibrous dysplasia with histopathologic and intraoperative correlation. AJR Am J Roentgenol 182:1389–1398. doi: 10.2214/ajr.182.6.1821389 CrossRefPubMedGoogle Scholar
  11. 11.
    Freyschmidt J (2016) Zufallsbefunde in der Skelettradiologie. Thieme, StuttgartCrossRefGoogle Scholar
  12. 12.
    Freyschmidt J, Stäbler A (2006) Handbuch diagnostische Radiologie. Springer, Berlin Heidelberg doi: 10.1007/b137523 Google Scholar
  13. 13.
    Gaudino S, Martucci M, Colantonio R et al (2015) A systematic approach to vertebral hemangioma. Skeletal Radiol 44:25–36. doi: 10.1007/s00256-014-2035-y CrossRefPubMedGoogle Scholar
  14. 14.
    Greenspan A (1995) Bone island (enostosis): current concept – a review. Skeletal Radiol 24:111–115PubMedGoogle Scholar
  15. 15.
    Hegenscheid K, Seipel R, Schmidt CO et al (2013) Potentially relevant incidental findings on research whole-body MRI in the general adult population: frequencies and management. Eur Radiol 23:816–826. doi: 10.1007/s00330-012-2636-6 CrossRefPubMedGoogle Scholar
  16. 16.
    Herget GW, Mauer D, Krauß T et al (2016) Non-ossifying fibroma: natural history with an emphasis on a stage-related growth, fracture risk and the need for follow-up. BMC Musculoskelet Disord 17:147. doi: 10.1186/s12891-016-1004-0 CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Langdown AJ, Grundy JRB, Birch NC (2005) The clinical relevance of Tarlov cysts. J Spinal Disord Tech 18:29–33CrossRefPubMedGoogle Scholar
  18. 18.
    Langner S, Buelow R, Fleck S et al (2016) Management of intracranial incidental findings on brain MRI. Rofo 188:1123–1133. doi: 10.1055/s-0042-111075 CrossRefPubMedGoogle Scholar
  19. 19.
    Mahajan PS, Jayaram AP, Negi VC (2015) Rare case of multiple aggressive vertebral hemangiomas. J Nat Sci Biol Med 6:439–442. doi: 10.4103/0976-9668.160030 CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    McAllister VL, Kendall BE, Bull JW (1975) Symptomatic vertebral haemangiomas. Brain 98:71–80CrossRefPubMedGoogle Scholar
  21. 21.
    McGlynn FJ, Mickelson MR, El-Khoury GY (1981) The fallen fragment sign in unicameral bone cyst. Clin Orthop Relat Res:157–159. doi: 10.1097/00003086-198105000-00020
  22. 22.
    Miller TT (2008) Bone tumors and tumorlike conditions: analysis with conventional radiography. Radiology 246:662–674. doi: 10.1148/radiol.2463061038 CrossRefPubMedGoogle Scholar
  23. 23.
    Murphy K, Oaklander AL, Elias G et al (2016) Treatment of 213 patients with symptomatic Tarlov cysts by CT-guided percutaneous injection of fibrin sealant. AJNR Am J Neuroradiol 37:373–379. doi: 10.3174/ajnr.A4517 CrossRefPubMedGoogle Scholar
  24. 24.
    Negi RS, Manchanda KL, Sanga S et al (2013) Osteopoikilosis – spotted bone disease. Med J Armed Forces India 69:196–198. doi: 10.1016/j.mjafi.2012.05.009 CrossRefPubMedGoogle Scholar
  25. 25.
    Onitsuka H (1977) Roentgenologic aspects of bone islands. Radiology 123:607–612. doi: 10.1148/123.3.607 CrossRefPubMedGoogle Scholar
  26. 26.
    Orme NM, Fletcher JG, Siddiki HA et al (2010) Incidental findings in imaging research: evaluating incidence, benefit, and burden. Arch Intern Med 170:1525–1532. doi: 10.1001/archinternmed.2010.317 CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Parlier-Cuau C, Bousson V, Ogilvie CM et al (2011) When should we biopsy a solitary central cartilaginous tumor of long bones? Literature review and management proposal. Eur J Radiol 77:6–12. doi: 10.1016/j.ejrad.2010.06.051 CrossRefPubMedGoogle Scholar
  28. 28.
    Ritschl P, Karnel F, Hajek P (1988) Fibrous metaphyseal defects – determination of their origin and natural history using a radiomorphological study. Skeletal Radiol 17:8–15CrossRefPubMedGoogle Scholar
  29. 29.
    Sferopoulos NK (2016) Giant bone island of the tibia in a child. Am J Orthop 45:38–41PubMedGoogle Scholar
  30. 30.
    Taljanovic MS, Hunter TB, Wisneski RJ et al (2009) Imaging characteristics of diffuse idiopathic skeletal hyperostosis with an emphasis on acute spinal fractures: review. AJR Am J Roentgenol 193:S10–9. doi: 10.2214/AJR.07.7102 (Quiz S20–4)CrossRefPubMedGoogle Scholar
  31. 31.
    Tutar S, Ulusoy OL, Ozturk E et al (2016) Aggressive vertebral hemangioma of the thoracic spine. Spine J 16:e489. doi: 10.1016/j.spinee.2016.01.014 CrossRefPubMedGoogle Scholar
  32. 32.
    Walden MJ, Murphey MD, Vidal JA (2008) Incidental enchondromas of the knee. AJR Am J Roentgenol 190:1611–1615. doi: 10.2214/AJR.07.2796 CrossRefPubMedGoogle Scholar
  33. 33.
    Walsh JP (2004) Paget’s disease of bone. Med J Aust 181:262–265PubMedGoogle Scholar
  34. 34.
    Weigel R, Polemikos M, Uksul N, Krauss JK (2016) Tarlov cysts: long-term follow-up after microsurgical inverted plication and sacroplasty. Eur Spine J 25:3403–3410. doi: 10.1007/s00586-016-4744-5 CrossRefPubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH 2017

Authors and Affiliations

  1. 1.Klinik für Diagnostische und Interventionelle RadiologieUniversitätsklinikum HeidelbergHeidelbergDeutschland

Personalised recommendations