Fig. 6.10.1 Fig. 6.10.2
Fig. 6.10.4 Fig. 6.10.3
ն ҷ ҷ
ն
52-year-old woman with incidental fi nding on plain fi lm obtained after trauma.
Comments Enchondroma is a common chondroid musculoskeletal neoplasm representing 3–17% of
primary bone tumors. It may be solitary or multiple (enchondromatosis – Ollier’s dis- ease). Enchondroma is the result of the continued growth of residual benign cartilaginous remains that are displaced from the growth plate. The neoplasm is usually discovered in the third or fourth decade of life with the same frequency in men and woman. Malignant transformation is exceptional.
Between 40–65% of solitary enchondromas occur in the hand, although long tubular bones are affected in 25% of cases, more frequently in the bones of the upper extremity.
Enchondromas are usually located in the metaphysis of a long tubular bone or in the di- aphysis of a short tubular bone.
Cartilaginous tumors are typically recognized on radiographs as a lytic lesion with mineralized cartilage matrix within and lobulated contour, but CT is the best modal- ity to detect mineralization characteristic of a chondroid neoplasm, showing the typical rings and arcs pattern. Scintigraphic bone scans show slightly increased activity. On MRI, enchondroma appears as a well-circumscribed lobulated lesion of low signal intensity on T1-weighted images, intermediate intensity on T2-weighted images, and high signal on T2-weighted fat-suppression sequences. Calcifi ed foci have low signal intensity on all sequences.
Low-grade chondrosarcoma may be indistinguishable from enchondroma; however, in most cases, chondrosarcoma has certain imaging features that are indicative of its ag- gressive behavior. Cortical breakthrough, soft-tissue mass, and deep endosteal scalloping of the cortex are three features that are described more frequently in chondrosarcoma.
Imaging Findings On plain radiography, the classic pattern of calcifi cations, described as rings and arcs, is
pathognomonic for enchondroma (Fig. 6.10.1). Bone scintigraphy shows only mild uptake (dotted arrow) in the right humerus (Fig. 6.10.2). Oblique coronal T2-weighted MR image (Fig. 6.10.3) shows intermediate signal intensity from entrapment of residual normal fatty marrow with a cluster of numerous tiny low signal intensity foci (arrows) representing mineralized matrix (Fig. 6.10.3)
Oblique sagittal T2-weighted fat-suppression MR image (Fig. 6.10.4) reveals calcifi ed foci as areas of low signal intensity, and hyperintense areas with lobulated margins corre- spond to chondroid tumor (openarrowheads). Enchondroma spares the cortex and there is no soft-tissue extension or other signs of an aggressive lesion.
Further Readings
Books
Arthritis: in Black and White. Brower AC, Flemming DJ (1997) Saunders (W.B). ISBN-13: 9780721651521
Diagnosis of Bone and Joint Disorders. Vol 1–5. Resnik D (2002) Saunders (W.B). ISBN-13: 9780721689210
Fundamentals of Skeletal Radiology. Helms CA (2005) Saun- ders (W.B). ISBN-13: 9780721605708
Imaging of Soft Tissue Tumors. 3rd ed. De Schepper AM (2005) Springer, Berlin. ISBN-13: 9783540248095
Magnetic Resonance Imaging in Orthopaedics and Sports Medicine. Stoller DW (2006) Lippincott Williams &
Wilkins. ISBN-13: 9780781773577
Musculoskeletal MRI. Kaplan PA, Helms CA, Dussault R, Anderson MW, Major NM (2001) Saunders (W.B). ISBN- 13: 9780721690278
Musculoskeletal Imaging: The Requisites (Requisites in Ra- diology). 3rd ed. Manaster BJ, May DA, Disler DG (2006) Mosby. ISBN-13: 9780323043618
Orthopedic Radiology: A Practical Approach. 3rd ed. Greens- pan A (2000) Lippincott Williams & Wilkins. ISBN-13:
9780781715898
Spinal Imaging: Diagnostic Imaging of the Spine and Spi- nal Cord. Van Goethem JW, Hauwe L, Parizel PM (2007) Springer, Berlin. ISBN-13: 9783540213444
Ultrasound of the Musculoskeletal System. Bianchi S, Mar- tinoli C (2007) Springer, Berlin. ISBN-13: 9783540422679
Web Sites
http://bonetumor.org/tumors/pages/page174.html http://chorus.rad.mcw.edu/index/6.html (Chorus: collab-
orative hypertext of radiology>musculoskeletal system) http://emedicine.com/radio/MUSCULOSKELETAL.htm http://gentili.net/ (The Musculoskeletal Radiologist Guide
to the Internet. A. Gentili, MD, A.P. Lai, MD. UCLA and WLA VAMC. Los Angeles, California)
http://indyrad.iupui.edu/public/ddaven/main.htm (Skeletal Radiology Tutorial. Department of Radiology. Indiana University Medical Center)
http://med-ed.virginia.edu/courses/rad/ext/ (Introduction to radiology > skeletal trauma radiology)
http://orthop.washington.edu/
http://rad.washington.edu/mskbook (Approaches to Dif- ferential Diagnosis in Musculoskeletal Imaging by Rich- ardson ML)
http://radiographics.rsnajnls.org/cgi/collection/skeletal_
radiology
https://skeletalrad.org/Default.aspx (American Society of Skeletal Radiology)
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