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Differential diagnosis of T2 hypointense masses in musculoskeletal MRI

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Abstract

Many soft tissue masses have an indeterminate appearance on MRI, often displaying varying degrees and extent of T2 hyperintensity. However, a subset of neoplasms and tumor-like lesions may exhibit prominent areas of T2 hypointensity relative to skeletal muscle. The hypointensity observed on T2-weighted MRI can be caused by a variety of substances, including evolving blood products, calcifications or other inorganic crystals, or fibrous tissue. Carefully evaluating the presence and pattern of T2 hypointensity in soft tissue masses and considering potential causes in their associated clinical contexts can help to narrow the differential diagnosis among neoplastic and non-neoplastic possibilities. These include endometriosis, aneurysmal bone cysts, tenosynovial giant cell tumor, arteriovenous malformation and pseudoaneurysm, calcium pyrophosphate and hydroxyapatite deposition diseases, tumoral calcinosis, gout, amyloidosis, hemangiomas with phleboliths, low-grade fibromyxoid sarcoma, ossifying fibromyxoid tumor, collagenous fibroma, desmoid-type fibromatosis, myxofibrosarcoma, peripheral nerve sheath tumors, dedifferentiated liposarcoma, and treated sarcoma.

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Funding

Ty K. Subhawong MD has received honoraria from iiCME for speaking activities unrelated to preparation of this manuscript; he has served as a consultant for Arog Pharmaceuticals and Imaging Law, but has received no funding for preparation of this manuscript.

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Authors and Affiliations

  1. Department of Radiology, University of Miami Miller School of Medicine/Jackson Memorial Hospital, 1611 NW 12th Ave, JMH WW 279, Miami, FL, 33136, USA

    Dara Finkelstein, Gregory Foremny, Paul Clifford & Ty K. Subhawong

  2. Department of Radiology, Emory University Hospital, Atlanta, GA, 30322, USA

    Adam Singer

  3. Department of Orthopaedics, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, FL, 33136, USA

    Juan Pretell-Mazzini

  4. Department of Pathology, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, NH, 03756, USA

    Darcy A. Kerr

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  1. Dara Finkelstein
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Finkelstein, D., Foremny, G., Singer, A. et al. Differential diagnosis of T2 hypointense masses in musculoskeletal MRI. Skeletal Radiol 50, 1981–1994 (2021). https://doi.org/10.1007/s00256-021-03711-0

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