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Milk cloud appearance—a characteristic sign of fibrous dysplasia on contrast-enhanced MR imaging

  • Musculoskeletal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To evaluate contrast-enhanced T1-weighted magnetic resonance (MR) images in histologically proven fibrous dysplasia (FD) for the prevalence of “milk cloud appearance” and its association with ground-glass appearance (GGA) on radiography or computed tomography (CT).

Methods

For this retrospective cohort study, 37 patients with histologically proven FD imaged preoperatively with contrast-enhanced MR imaging and radiography or CT were identified at our institution. Three radiologists independently evaluated MR images for the presence of milk cloud appearance on T1-weighted contrast-enhanced images, sites of skeletal involvement, type of bone involved, uni- vs. multifocality, mono- vs. polyostotic disease, maximum diameter, proportion of bone involved, expansile remodeling, and T2 homogeneity. The presence or absence of GGA on radiography or CT was determined in consensus. Inter-reader agreement was evaluated for milk cloud appearance using Cohen’s kappa, and associations between milk cloud appearance and other imaging parameters were tested using Spearman’s rho.

Results

Among the 37 histologically proven FD lesions, GGA was identified in 70% of the lesions, while milk cloud appearance was found in 82% of the lesions. Inter-reader agreement for milk cloud appearance on MR imaging was good to excellent (κ 0.65, 0.82, and 0.8). A significant correlation was found between milk cloud appearance and GGA (ρ = 0.31, p < 0.001).

Conclusion

Milk cloud appearance is a characteristic sign of FD on contrast-enhanced T1-weighted MR images. Recognition of this feature may be helpful when radiographs are equivocal or unremarkable or when MR imaging is performed as the primary imaging modality in cases of FD.

Key Points

• Fibrous dysplasia displays a characteristic feature on contrast-enhanced T1-weighted MR imaging: milk cloud appearance.

• Milk cloud appearance correlates well with the radiographic or CT finding of ground-glass appearance.

• Recognition of milk cloud appearance on contrast-enhanced MR imaging may be helpful when radiographs are equivocal or unremarkable or when MR imaging is performed as the primary imaging modality in cases of fibrous dysplasia.

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Abbreviations

CE:

Contrast-enhanced

CT:

Computed tomography

FD:

Fibrous dysplasia

GGA:

Ground-glass appearance

MR:

Magnetic resonance

T1 TSE:

T1-weighted turbo-spin-echo sequence

T2 TSE:

T2-weighted turbo-spin-echo sequence

TE:

Echo time

TR:

Repetition time

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany

    Daniela Franz, Judith Wechselberger, Michael Rasper, Ernst J. Rummeny & Klaus Woertler

  2. Institute of Pathology, School of Medicine, Technical University of Munich, Munich, Germany

    Katja Specht

  3. Wilhelm Sander Bone and Soft Tissue Sarcoma Center, Munich, Germany

    Katja Specht & Klaus Woertler

  4. Institute of Medical Informatics, Statistics and Epidemiology, School of Medicine, Technical University of Munich, Munich, Germany

    Victoria Kehl

Authors
  1. Daniela Franz
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  2. Judith Wechselberger
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  3. Michael Rasper
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  4. Katja Specht
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  5. Victoria Kehl
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  6. Ernst J. Rummeny
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  7. Klaus Woertler
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Corresponding author

Correspondence to Daniela Franz.

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Guarantor

The scientific guarantor of this publication is Prof. Klaus Woertler.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Victoria Kehl kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Retrospective

• Cross-sectional study

• Performed at one institution

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Franz, D., Wechselberger, J., Rasper, M. et al. Milk cloud appearance—a characteristic sign of fibrous dysplasia on contrast-enhanced MR imaging. Eur Radiol 29, 3424–3430 (2019). https://doi.org/10.1007/s00330-019-06245-1

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  • DOI: https://doi.org/10.1007/s00330-019-06245-1

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