Radiologic Evaluation of Soft-Tissue Masses
A Current Perspective
Mark J. Kransdorf1,2 and
Mark D. Murphey2,3,4
1
Department of Radiology, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL
32224-3899.
2
Department of Radiologic Pathology, Armed Forces Institute of Pathology,
Walter Reed Army Medical Center, Bldg. 54, Alaska and Georgia Aves.,
Washington, DC 20306-6000.
3
Department of Radiology and Nuclear Medicine, Uniformed Services University of
the Health Sciences, 4301 Jones Bridge Rd., Bethesda, MD 20814-4799.
4
Department of Radiology, University of Maryland School of Medicine, 22 South
Greene St., Baltimore, MD 21201-1595.
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Lewis G. Cole 18th President of ARRS 1917-1918
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Willis F. Manges 19th President of ARRS 1918-1919
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Fig. 1. —36-year-old woman with neurofibromatosis and multiple neurofibromas.
Coronal contrast-enhanced T1-weighted spin-echo MR image (500/15, TR/TE) shows
multiple left paraspinal masses with cystic change.
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Fig. 2A. —35-year-old woman with metastatic melanoma and multiple metastases.
Coronal T1-weighted spin-echo MR image (600/20, TR/TE) shows lobulated nodule
(asterisk) in subcutaneous adipose tissue of buttocks. Note subtle
intraosseous metastasis (arrow) in ischium.
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Fig. 2B. —35-year-old woman with metastatic melanoma and multiple metastases.
Axial conventional T2-weighted MR image (2500/80) shows fluid-fluid level
(arrow) indicative of previous hemorrhage.
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Fig. 3A. —52-year-old man with hemangioma of hypothenar eminence of hand.
Radiograph shows multiple small, smooth, rounded calcifications (solid
arrow), more opaque peripherally, characteristic of phleboliths. Note
small nonspecific calcifications (open arrow).
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Fig. 3B. —52-year-old man with hemangioma of hypothenar eminence of hand.
Corresponding intraoperative photograph shows multiple phleboliths within
interstices of hemangioma.
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Fig. 4A. —17-year-old girl with synovial sarcoma of foot who presented with
slowly growing painless mass. Axial conventional T2-weighted spin-echo MR
image (1800/80, TR/TE) shows well-defined nonspecific soft-tissue mass
(asterisk).
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Fig. 4B. —17-year-old girl with synovial sarcoma of foot who presented with
slowly growing painless mass. Corresponding radiograph shows peripheral and
central clacification. This radiographic appearance (calcified soft-tissue
mass) in context of slowly growing juxtaarticular mass in young adult strongly
suggests appropriate diagnosis of synovial sarcoma.
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Fig. 5A. —27-year-old woman with foreign body and associated abscess. Oblique
radiograph of foot shows irregular opacity (arrow), initially
interpreted as calcification.
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Fig. 5B. —27-year-old woman with foreign body and associated abscess. Coronal
T1-weighted spin-echo MR image (600/15, TR/TE) shows prominent signal void
(asterisk), with "parenthetic" artifact, compatible with
foreign body.
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Fig. 5C. —27-year-old woman with foreign body and associated abscess.
Corresponding conventional T2-weighted spin-echo MR image (2500/80) shows
foreign body (asterisk) with associated inflammatory change.
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Fig. 5D. —27-year-old woman with foreign body and associated abscess.
Gradient-echo MR image (15/12, 15° flip angle) shows
"blooming" (asterisk) caused by greater magnetic
susceptibility.
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Fig. 6. —54-year-old woman with mild lipomatosis of right lower extremity,
who presented with "fullness" around knee. Axial T1-weighted
spin-echo MR image (700/16, TR/TE) of both distal thighs shows increased
adipose tissue on right as compared with contralateral side. Images of both
distal thighs were obtained after no cause for clinical findings was found on
axial images of right knee.
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Fig. 7A. —35-year-old man with extra articular synovial chondromatosis,
mimicking loculated fluid. Axial T1-weighted spin-echo MR image (763/18,
TR/TE) shows large lobulated mass, with signal intensity similar to that of
skeletal muscle, in adductor compartment (asterisk).
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Fig. 7B. —35-year-old man with extra articular synovial chondromatosis,
mimicking loculated fluid. Corresponding conventional T2-weighted spin-echo MR
image (2912/80) shows lesion to have signal intensity greater than that of
fat.
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Fig. 7C. —35-year-old man with extra articular synovial chondromatosis,
mimicking loculated fluid. Fat-suppressed axial T1-weighted spin-echo MR image
(475/18) after contrast material administration shows peripheral and septal
enhancement, suggesting loculated fluid.
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Fig. 7D. —35-year-old man with extra articular synovial chondromatosis,
mimicking loculated fluid. Radiograph shows nonspecific calcifications
(arrowheads) within mass.
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Fig. 8. —36-year-old woman with intramuscular lipoma. Coronal T1-weighted
spin-echo MR image (600/14, TR/TE) shows mass in right neck, with signal
intensity identical to that of fat on all pulse sequences. Diagnosis can be
made with confidence on basis of signal intensity.
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Fig. 9A. —41-year-old woman with hemangioma of foot. Axial T1-weighted
spin-echo MR image (600/15, TR/TE) shows large lobulated mass with signal
intensity similar to that of skeletal muscle infiltrating soft tissue of first
interspace and fat (arrow) within interstices of lesion.
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Fig. 9B. —41-year-old woman with hemangioma of foot. Corresponding
conventional T2-weighted spin-echo MR image (2500/80) shows lesion to have
signal intensity greater than that of fat. Infiltrating pattern of growth,
interspersed adipose tissue, and signal intensity are highly characteristic of
diagnosis.
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Fig. 10A. —22-year-old man with schwannoma in upper arm. Axial T2-weighted
spin-echo MR image (2000/80, TR/TE) shows large mass associated with
neurovascular bundle with target sign, characteristic of peripheral nerve
sheath tumor.
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Fig. 10B. —22-year-old man with schwannoma in upper arm. Corresponding coronal
T1-weighted spin-echo MR image (650/20) shows lesion is contiguous with median
nerve (arrow). Signal intensity of lesion, target sign, and location
allow diagnosis of peripheral nerve sheath tumor to be made with
confidence.
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Fig. 11A. —34-year-old man with malignant fibrous histiocytoma of thigh, who
presented with slowly growing painless mass. Axial conventional T2-weighted
spin-echo MR image (1800/80, TR/TE) shows relatively well-defined mass in
anterior compartment of thigh with nonspecific high signal intensity.
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Fig. 11B. —34-year-old man with malignant fibrous histiocytoma of thigh, who
presented with slowly growing painless mass. Corresponding unenhanced
(B) and contrast-enhanced (C) axial T1-weighted spin-echo MR
images (400/20) show uniform enhancement. Although appearance of lesion is
nonspecific, malignant fibrous histiocytoma is statistically most likely
diagnosis based on patient age and lesion location.
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Fig. 11C. —34-year-old man with malignant fibrous histiocytoma of thigh, who
presented with slowly growing painless mass. Corresponding unenhanced
(B) and contrast-enhanced (C) axial T1-weighted spin-echo MR
images (400/20) show uniform enhancement. Although appearance of lesion is
nonspecific, malignant fibrous histiocytoma is statistically most likely
diagnosis based on patient age and lesion location.
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Fig. 12A. —14-year-old boy with myositis ossificans in forearm. Axial fast
spin-echo T2-weighted spin-echo MR image (2600/80, TR/TE) shows poorly defined
mass in extensor compartment of forearm and adjacent to ulna. Lesion
predominantly involves extensor carpi ulnaris, although there is abnormal
signal in and between adjacent muscles.
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Fig. 12B. —14-year-old boy with myositis ossificans in forearm. Corresponding
axial T1-weighted spin-echo MR image (650/20) shows only minimal signal
alteration with effacement of subcutaneous adipose tissue
(arrow).
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Fig. 13A. —15-year-old girl with rhabdomyosarcoma of leg. Sagittal T1-weighted
spin-echo MR image (641/16, TR/TE) shows large mass with bone invasion.
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Fig. 13B. —15-year-old girl with rhabdomyosarcoma of leg. Corresponding
contrast-enhanced MR image (641/16) shows nonenhancing area compatible with
necrosis. Bone invasion and necrosis are both specific for malignancy. Note
nodal involvement (arrows).
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Fig. 14A. —57-year-old woman with liposarcoma of thigh. Axial fast spin-echo
T2-weighted MR image (3200/102, TR/TE) shows large mass with mixed
intermediate signal intensity.
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Fig. 14B. —57-year-old woman with liposarcoma of thigh. Corresponding coronal
unenhanced (B) and contrast-enhanced (C) T1-weighted spin-echo
MR images (600/16) show adipose tissue within lesion, compatible with fat
differentiation. Enhancement in portions of tumor is extensive. Large size and
deep location with adipose differentiation suggest diagnosis of
liposarcoma.
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Fig. 14C. —57-year-old woman with liposarcoma of thigh. Corresponding coronal
unenhanced (B) and contrast-enhanced (C) T1-weighted spin-echo
MR images (600/16) show adipose tissue within lesion, compatible with fat
differentiation. Enhancement in portions of tumor is extensive. Large size and
deep location with adipose differentiation suggest diagnosis of
liposarcoma.
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Copyright © 2000 by the American Roentgen Ray Society.
