Advertisement

European Radiology

, Volume 16, Issue 12, pp 2644–2651 | Cite as

Prevalence, extension and characteristics of fluid-fluid levels in bone and soft tissue tumors

  • P. Van DyckEmail author
  • F. M. Vanhoenacker
  • J. Vogel
  • C. Venstermans
  • H. M. Kroon
  • J. Gielen
  • P. M. Parizel
  • J. L. Bloem
  • A. M. A. De Schepper
Musculoskeletal

Abstract

The purpose of this study was to determine the prevalence, extension and signal characteristics of fluid-fluid levels in a large series of 700 bone and 700 soft tissue tumors. Out of a multi-institutional database, MRI of 700 consecutive patients with a bone tumor and MRI of 700 consecutive patients with a soft tissue neoplasm were retrospectively reviewed for the presence of fluid-fluid levels. Extension (single, multiple and proportion of the lesion occupied by fluid-fluid levels) and signal characteristics on magnetic resonance imaging of fluid-fluid levels were determined. In all patients, pathologic correlation was available. Of 700 patients with a bone tumor, 19 (10 male and 9 female; mean age, 29 years) presented with a fluid-fluid level (prevalence 2.7%). Multiple fluid-fluid levels occupying at least one half of the total volume of the lesion were found in the majority of patients. Diagnoses included aneurysmal bone cyst (ten cases), fibrous dysplasia (two cases), osteoblastoma (one case), simple bone cyst (one case), telangiectatic osteosarcoma (one case), “brown tumor” (one case), chondroblastoma (one case) and giant cell tumor (two cases). Of 700 patients with a soft tissue tumor, 20 (9 males and 11 females; mean age, 34 years) presented with a fluid-fluid level (prevalence 2.9%). Multiple fluid-fluid levels occupying at least one half of the total volume of the lesion were found in the majority of patients. Diagnoses included cavernous hemangioma (12 cases), synovial sarcoma (3 cases), angiosarcoma (1 case), aneurysmal bone cyst of soft tissue (1 case), myxofibrosarcoma (1 case) and high-grade sarcoma “not otherwise specified” (2 cases). In our series, the largest reported in the literature to the best of our knowledge, the presence of fluid-fluid levels is a rare finding with a prevalence of 2.7 and 2.9% in bone and soft tissue tumors, respectively. Fluid-fluid levels remain a non-specific finding and can occur in a wide range of bone and soft tissue tumors, both benign and malignant. Therefore, they cannot be considered diagnostic of any particular type of tumor, and the diagnosis should be made on the basis of other radiological and clinical findings.

Keywords

Bone and soft tissue tumor Fluid-fluid levels MR imaging 

References

  1. 1.
    Hudson T (1984) Fluid levels in aneurysmal bone cysts: a CT feature. AJR 141:1001–1004Google Scholar
  2. 2.
    Hertzanu Y, Mendelsohn D, Gottschalk F (1984) Aneurysmal bone cyst of the calcaneus. Radiology 151:51–52PubMedGoogle Scholar
  3. 3.
    Ehara S, Sone M, Tamakawa Y, Nishida J, Abe M, Hachiya J (1994) Fluid-fluid levels in cavernous hemangioma of soft tissue. Skeletal Radiol 23:107–109CrossRefPubMedGoogle Scholar
  4. 4.
    Tsai J, Dalinka M, Fallon M, Zlatkin M, Kressel H (1990) Fluid-fluid level:a non-specific finding in tumors of bone and soft tissue. Radiology 175:779–782PubMedGoogle Scholar
  5. 5.
    O’Donnell P, Saifuddin A (2004) The prevalence and diagnostic significance of fluid-fluid levels in focal lesions of bone. Skeletal Radiol 33:330–336CrossRefPubMedGoogle Scholar
  6. 6.
    Gielen JLMA, De Schepper AMA, Vanhoenacker FM, Parizel PM, Wang X, Sciot R, Weyler J (2004) Accuracy of MRI in characterization of soft tissue tumors and tumor-like lesions. A prospective study in 548 patients. Eur Radiol 14:2320–2330CrossRefPubMedGoogle Scholar
  7. 7.
    Davies AM, Mehr A, Parsonage S, Evans N, Grimer RJ, Pynsent PB (2004) MR imaging in the assessment of residual tumor following inadequate primary excision of soft tissue sarcomas. Eur Radiol 14:506–513CrossRefPubMedGoogle Scholar
  8. 8.
    Davies AM, Cassar-Pullicino VN, Grimer RJ (1992) The incidence and significance of fluid-fluid levels on computed tomography of osseous lesions. Br J Radiol 65:193–198PubMedGoogle Scholar
  9. 9.
    Jones B, Sundaram M, Kransdorf M (1993) Synovial sarcoma:MR imaging findings in 34 patients. AJR 161:827–830PubMedGoogle Scholar
  10. 10.
    Vanel D, Tcheng S, Contesso G, Zafrani B, Kalifa C, Dubousset J, Kron P (1987) The radiological appearances of telangiectatic osteosarcoma. A study of 14 cases. Skeletal Radiol 16:196–200CrossRefPubMedGoogle Scholar
  11. 11.
    Kendi ATK, Kara S, Altinok D, Keskil S (2003) Sinonasal ossifying fibroma with fluid-fluid levels on MR images. AJNR Am J Neuroradiol 24:1639–1641PubMedGoogle Scholar
  12. 12.
    Vilanova JC, Dolz JL, Maestro de Leon JL, Aparicio A, Aldoma J, Capdevila A (1998) MR imaging of a malignant schwannoma and an osteoblastoma with fluid-fluid levels. Report of two new cases. Eur Radiol 8:1359–1362CrossRefPubMedGoogle Scholar
  13. 13.
    Davila JA (2004) Chondroblastoma of the hands and feet. Skeletal Radiol 33:582–587CrossRefPubMedGoogle Scholar
  14. 14.
    Margau R, Babyn P, Cole W, Smith C, Lee F (2000) MR imaging of simple bone cysts in children:not so simple. Pediatr Radiol 30:551–557CrossRefPubMedGoogle Scholar
  15. 15.
    Gibson MJ, Middlemiss JH (1971) Fibrous dysplasia of bone. Br J Radiol 44:1–13PubMedCrossRefGoogle Scholar
  16. 16.
    Davies AM, Evans N, Mangham C, Grimer R (2001) MR imaging of brown tumor with fluid-fluid levels:a report of three cases. Eur Radiol 11:1445–1449CrossRefPubMedGoogle Scholar
  17. 17.
    Mendez JC, Saucedo G, Melendez B (2004) Cystic trigeminal schwannoma with fluid-fluid levels. Eur Radiol 14:1941–1943PubMedCrossRefGoogle Scholar
  18. 18.
    Nakanishi H, Araki N, Sawai Y, Kudawara I, Mano M, Ishiguro S, Ueda T, Yoshikawa H (2003) Cystic synovial sarcomas:imaging features with clinical and histopathologic correlation. Skeletal Radiol 32:701–707CrossRefPubMedGoogle Scholar
  19. 19.
    Wang XL, Gielen JL, Salgado R, Delrue F, De Schepper AMA (2004) Soft tissue aneurysmal bone cyst. Skeletal Radiol 33:477–480CrossRefPubMedGoogle Scholar
  20. 20.
    Coldwell DM, Baron RL, Charnsangavej C (1989) Angiosarcoma:diagnosis and clinical course. Acta Radiol 32:613–631Google Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • P. Van Dyck
    • 1
    • 5
    Email author
  • F. M. Vanhoenacker
    • 1
    • 2
  • J. Vogel
    • 3
  • C. Venstermans
    • 1
  • H. M. Kroon
    • 4
  • J. Gielen
    • 1
  • P. M. Parizel
    • 1
  • J. L. Bloem
    • 4
  • A. M. A. De Schepper
    • 1
    • 4
  1. 1.Department of RadiologyUniversity Hospital AntwerpEdegemBelgium
  2. 2.Department of RadiologyAZ St-MaartenDuffel/MechelenBelgium
  3. 3.Department of OrthopedicsLeiden University Medical CentreLeidenThe Netherlands
  4. 4.Department of RadiologyLeiden University Medical CentreLeidenThe Netherlands
  5. 5.EdegemBelgium

Personalised recommendations