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MRI analysis of simple and aneurysmal bone cysts in the proximal humerus: what actually matters in clinical routine

Abstract

Objective

To evaluate magnetic resonance imaging (MRI) characteristics of simple and aneurysmal bone cysts (SBC/ABC) of the proximal humerus and the intermittent difficulty in the imaging differentiation between the two in daily clinical routine.

Materials and methods

MR images of 26 patients with suspected SBC/ABC in the proximal humerus were retrospectively assessed by two independent radiologists blinded to the final histological result. Based on a standard MRI protocol, different morphologic features and signal intensities of the lesion on non-enhanced and enhanced sequences were documented. The radiological diagnosis was correlated with histology.

Results

Eighteen patients had the image-based diagnosis of an SBC, yet the histology confirmed only 12, the residual 6 were identified as an ABC, despite the imaging criteria corresponding unambiguously to the former. One of the main reasons was the unicameral morphology of lesions, found in 9/14 (64.3%) cases of all ABCs, i.e., in 19/26 cases in total. Therefore, the sensitivity of the radiological diagnosis was moderate (57.14%), yet specificity very high (100%). In total, 69.2% (18/26) presented with a pathological fracture at admission, which correlated strongly with both circumferential (MCC = 0.65, p = 0.01) and septal (MCC = 0.42, p = 0.06) enhancement patterns. Circumferential enhancement was also found to correlate strongly with the histological diagnosis, being recognized in all cases of ABC (MCC = 0.44, p = 0.06).

Conclusion

MRI characteristics of ABCs/SBCs in the proximal humerus are indifferent and ABCs may morphologically present as SBCs. Radiologists should be aware of the different, often confusing presentation of both entities in daily clinical routine.

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References

  1. Mascard E, Gomez-Brouchet A, Lambot K. Bone cysts: unicameral and aneurysmal bone cyst. Orthop Traumatol-Surg. 2015;101:119–27.

    Article  Google Scholar 

  2. Rosario MS, Yamamoto N, Hayashi K, et al. An unusual case of proximal humeral simple bone cyst in an adult from secondary cystic change. World J Surg Oncol. 2017;15:102.

    Article  Google Scholar 

  3. Huch K, Werner M, Puhl W, Delling G. Die Kalkaneuszyste: eine klassische solitäre Knochenzyste? Z Für Orthop Ihre Grenzgeb. 2004;142:625–30.

    CAS  Article  Google Scholar 

  4. Freyschmidt J, Ostertag HM, Jundt G. Knochentumoren mit Kiefertumoren: Klinik, Radiologie, Pathologie. 3., überarbeitete und erweiterte Auflage. Berlin: Springer; 2010.

    Book  Google Scholar 

  5. Noordin S, Allana S, Umer M, Jamil M, Hilal K, Uddin N. Unicameral bone cysts: current concepts. Ann Med Surg. 2018;34:43–9.

    Article  Google Scholar 

  6. Reynolds J. The, “fallen fragment sign” in the diagnosis of unicameral bone cysts. Radiology. 1969;92:949–53.

    CAS  Article  Google Scholar 

  7. Margau R, Babyn P, Cole W, Smith C, Lee F. MR imaging of simple bone cysts in children: not so simple. Pediatr Radiol. 2000;30:551–7.

    CAS  Article  Google Scholar 

  8. Jaffe HL, Lichtensteil L. Solitary unicameral bone cyst: with emphasis on the roentgen picture, the pathologic appearance and the pathogenesis. Arch Surg. 1942;44:1004–25.

    Article  Google Scholar 

  9. Wörtler K, Blasius S, Hillmann A, Marx C, Brinkschmidt C, Heindel W. MR-Morphologie der primären aneurysmatischen Knochenzyste: Retrospektive Analyse von 38 Fällen. Fortschr Röntgenstr. 2000;172:591–6.

    Article  Google Scholar 

  10. Bih ES, Dao K, Padua H, Shaikh R. Qualitative evaluation of MRI features in aneurysmal bone cysts after percutaneous sclerotherapy. Skeletal Radiol. 2021;50:585–90.

    Article  Google Scholar 

  11. Dabska M, Buraczewski J. Aneurysmal bone cyst. Pathology, Clinical Course and Radiologic Appearances. Cancer. 1969;23:371–89.

    CAS  Article  Google Scholar 

  12. Warren M, Xu D, Li X. Gene fusions PAFAH1B1 – USP6 and RUNX2 – USP6 in aneurysmal bone cysts identified by next generation sequencing. Cancer Genet. 2017;212–213:13–8.

    Article  Google Scholar 

  13. Forssell K, Forssell H, Happonen R-P, Neva M. Simple bone cyst. Review of the literature and analysis of 23 cases. Int J Oral Maxillofac Surg. 1988;17:21–4.

    CAS  Article  Google Scholar 

  14. Mahnken A, Nolte-Ernsting C, Wildberger J, et al. Aneurysmal bone cyst: value of MR imaging and conventional radiography. Eur Radiol. 2003;13:1118–24.

    CAS  Article  Google Scholar 

  15. Boubbou M, Atarraf K, Chater L, Afifi A, Tizniti S. Aneurysmal bone cyst primary. About eight pediatric cases: radiological aspects and review of the literature. Pan Afr Med J. 2013;15. Available from: http://www.panafrican-med-journal.com/content/article/15/111/full/. Accessed 13 Apr 2021.

  16. Subramanian S, Kemp AK, Viswanathan VK. Bone cyst. StatPearls. Treasure Island (FL): StatPearls Publishing; 2021. Available from: http://www.ncbi.nlm.nih.gov/books/NBK539849/. Accessed 13 Apr 2021.

  17. R Development Core Team. Version 4.0.5. Vienna, Austria; 2006. http://www.R-project.org. Accessed 13 Apr 2021.

  18. Kransdorf MJ, Sweet DE. Aneurysmal bone cyst: concept, controversy, clinical presentation, and imaging. Am J Roentgenol. 1995;164:573–80.

    CAS  Article  Google Scholar 

  19. Bertram C, Braatz F. Aneurysmatische Knochenzyste. In: Peters KM, König DP, editors. Fortbild Osteol 1. Darmstadt: Steinkopff-Verlag; 2006. p. 58–61. Available from: http://link.springer.com/10.1007/3-7985-1602-2_12. Accessed 17 Mar 2021.

  20. Tsai JC, Dalinka MK, Fallon MD, Zlatkin MB, Kressel HY. Fluid-fluid level: a nonspecific finding in tumors of bone and soft tissue. Radiology. 1990;175:779–82.

    CAS  Article  Google Scholar 

  21. Burr BA, Resnick D, Syklawer R, Haghighi P. Fluid-fluid levels in a unicameral bone cyst: CT and MR findings. J Comput Assist Tomogr. 1993;17:134–6.

    CAS  Article  Google Scholar 

  22. Dormans JP, Hanna BG, Johnston DR, Khurana JS. Surgical treatment and recurrence rate of aneurysmal bone cysts in children. Clin Orthop. 2004;421:205–11.

    Article  Google Scholar 

  23. Sharma PK, Kundu ZS, Lamba A, Singh S. Diaphyseal aneurysmal bone cysts (ABCs) of long bones in extremities: analysis of surgical management and comparison with metaphyseal lesions. J Clin Orthop Trauma. 2021;18:74–9.

    Article  Google Scholar 

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Josip, E., Kremser, C., Haider, B. et al. MRI analysis of simple and aneurysmal bone cysts in the proximal humerus: what actually matters in clinical routine. Skeletal Radiol 51, 819–827 (2022). https://doi.org/10.1007/s00256-021-03889-3

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  • DOI: https://doi.org/10.1007/s00256-021-03889-3

Keywords

  • Simple bone cysts
  • Aneurysmal bone cysts
  • MRI
  • Humerus