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MR Imaging Differentiation of Soft-Tissue Hemangiomas from Malignant Soft-Tissue Masses

¹ Section of Pediatric Radiology, Department of Radiology, C. S. Mott Children's Hospital, University of Michigan Health Centers, Ann Arbor, MI 48109-0252.
² Present address: 26 Leedon Rd., Singapore 1026.

View larger version (12K): [in a new window]   Fig. 1. —Diagram shows septations and lobulations. In a septate mass, septa do not form lobulations.

View larger version (133K): [in a new window]   Fig. 2A. —10-year-old boy with hemangioma of lower extremity. Axial T1-weighted MR image (TR/TE, 500/16) shows low signal intensity of tumor (arrows) with interspersed areas of high signal intensity representing fat.

View larger version (104K): [in a new window]   Fig. 2B. —10-year-old boy with hemangioma of lower extremity. Axial T2-weighted MR image (4000/85) shows lobulated high-signal-intensity lesion. Note several central low-signal-intensity dots (arrows).

View larger version (129K): [in a new window]   Fig. 2C. —10-year-old boy with hemangioma of lower extremity. Gadolinium-enhanced T1-weighted MR image (500/16) shows marked enhancement of lesion. Central low-intensity dots seen on B are not seen after contrast administration, suggesting vascular nature.

View larger version (131K): [in a new window]   Fig. 3A. —7-year-old girl with malignant sarcoma of lower extremity. Axial T2-weighted MR image (TR/TE, 4500/90) shows high-signal-intensity mass posterior to femur. Note septations within mass, giving mass slightly lobulated appearance. Also note low-signal-intensity dots within mass (arrows); however, dots are not centrally located in a lobulation.

View larger version (121K): [in a new window]   Fig. 3B. —7-year-old girl with malignant sarcoma of lower extremity. T1-weighted image (500/8) shows marked enhancement. Low-signal-intensity dots (arrow) in mass remain visible.

View larger version (14K): [in a new window]   Fig. 4. —Box plot shows signal-intensity ratios between tumor and muscle on T2-weighted MR imaging. Note that signal-intensity ratios are higher for hemangiomas than for malignant tumors. Upper margin of each box represents 75th percentile; lower margin represents 25th percentile. Line in middle of box represents median. Stars indicate outside values.

View larger version (14K): [in a new window]   Fig. 5. —Box plot shows signal intensity ratio between tumor and muscle on T1-weighted imaging after gadolinium administration. Note that enhancement with contrast material was higher for hemangiomas than for malignant soft-tissue tumors. Upper margin of box represents 75th percentile; lower margin represents 25th percentile. Line in middle of box represents median. Star indicates outside values.

View larger version (13K): [in a new window]   Fig. 6. —Box plot shows calculated T2-weighted MR imaging of hemangiomas and malignant soft-tissue tumors. Note higher values for hemangiomas. Upper margin of box represents 75th percentile; lower margin represents 25th percentile. Line in middle of box represents median. Circle indicates faroutside value.

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