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Incidental Enchondromas of the Knee

¹ Department of Radiology, Walter Reed Army Medical Center, Washington, DC 20306.
² Department of Radiologic Pathology, Armed Forces Institute of Pathology, 6825 16th St. NW, Bldg. 54, Washington, DC 20306.
³ Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, MD.

View larger version (169K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —Incidental enchondroma in distal femur of 51-year-old woman with medial meniscal tear as cause of clinical symptoms. Sagittal T1-weighted (A, TR/TE, 367/20) and fat-suppressed proton density-weighted (B, 2,250/13) MR images show focal area of marrow replacement with high signal intensity on long-TR image (arrows) in distal femoral metaphysis. Lesion is centrally located in medullary canal, has mildly lobulated borders, and is juxtaposed to old epiphyseal plate (arrowheads, A).

View larger version (147K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —Incidental enchondroma in distal femur of 51-year-old woman with medial meniscal tear as cause of clinical symptoms. Sagittal T1-weighted (A, TR/TE, 367/20) and fat-suppressed proton density-weighted (B, 2,250/13) MR images show focal area of marrow replacement with high signal intensity on long-TR image (arrows) in distal femoral metaphysis. Lesion is centrally located in medullary canal, has mildly lobulated borders, and is juxtaposed to old epiphyseal plate (arrowheads, A).

View larger version (113K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —Incidental enchondromas in distal femoral diaphysis of 24-year-old woman with anterior knee pain caused by patellofemoral disease. Sagittal scout gradient-echo (TR/TE, 92/1.6; flip angle, 30°) MR image shows two foci of marrow replacement in distal femoral diaphysis (arrows).

View larger version (156K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —Incidental enchondromas in distal femoral diaphysis of 24-year-old woman with anterior knee pain caused by patellofemoral disease. Axial fat-suppressed T2-weighted (4,650/36) MR image through more inferior lesion reveals high signal intensity in eccentric intramedullary lesion and mildly lobulated margins (arrowsheads). No endosteal scalloping is present. Patient's symptoms and cause for MRI was patellofemoral disease (not shown).

View larger version (158K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —Minute enchondroma or cartilage rest in distal femur of 33-year-old man with knee pain associated with quadriceps and patellar tendon tendinopathy. Coronal T1-weighted (A, TR/TE, 400/18) and fat-suppressed T2-weighted (B, 4,417/41) MR images show minute focal area of marrow replacement with prominent high signal intensity on long-TR image in distal femoral metadiaphysis (arrows). Lesion reveals minimally lobulated margins on T2-weighted image and is more than 1.5 cm from physeal scar (arrowheads). Cause for MRI was quadriceps and patellar tendon tendinopathy (not shown).

View larger version (127K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —Minute enchondroma or cartilage rest in distal femur of 33-year-old man with knee pain associated with quadriceps and patellar tendon tendinopathy. Coronal T1-weighted (A, TR/TE, 400/18) and fat-suppressed T2-weighted (B, 4,417/41) MR images show minute focal area of marrow replacement with prominent high signal intensity on long-TR image in distal femoral metadiaphysis (arrows). Lesion reveals minimally lobulated margins on T2-weighted image and is more than 1.5 cm from physeal scar (arrowheads). Cause for MRI was quadriceps and patellar tendon tendinopathy (not shown).

View larger version (177K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —Incidental enchondroma of distal femur and small subchondral cyst or intraosseous ganglion in 53-year-old woman with knee pain associated with medial and lateral meniscal tears. Coronal T1-weighted (A, TR/TE, 550/15) and fat-suppressed T2-weighted (B, 4,867/50) MR images reveal proximal tibial epiphyseal lesion with marrow replacement and high signal intensity on long-TR image (arrows). These intrinsic MR characteristics simulate enchondroma.

View larger version (164K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —Incidental enchondroma of distal femur and small subchondral cyst or intraosseous ganglion in 53-year-old woman with knee pain associated with medial and lateral meniscal tears. Coronal T1-weighted (A, TR/TE, 550/15) and fat-suppressed T2-weighted (B, 4,867/50) MR images reveal proximal tibial epiphyseal lesion with marrow replacement and high signal intensity on long-TR image (arrows). These intrinsic MR characteristics simulate enchondroma.

View larger version (200K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4C —Incidental enchondroma of distal femur and small subchondral cyst or intraosseous ganglion in 53-year-old woman with knee pain associated with medial and lateral meniscal tears. Sagittal T1-weighted (C, 550/15) and gradient-echo (D, 577/10; flip angle, 30°) MR images reveal cleftlike extension to subchondral bone (arrowheads) that shows high signal intensity on long-TR and gradient-echo images. This feature is not seen in enchondromas and suggests correct diagnosis of subchondral cyst or intraosseous ganglion. Note distal femoral enchondroma (arrows) with typical features on sagittal images.

View larger version (185K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4D —Incidental enchondroma of distal femur and small subchondral cyst or intraosseous ganglion in 53-year-old woman with knee pain associated with medial and lateral meniscal tears. Sagittal T1-weighted (C, 550/15) and gradient-echo (D, 577/10; flip angle, 30°) MR images reveal cleftlike extension to subchondral bone (arrowheads) that shows high signal intensity on long-TR and gradient-echo images. This feature is not seen in enchondromas and suggests correct diagnosis of subchondral cyst or intraosseous ganglion. Note distal femoral enchondroma (arrows) with typical features on sagittal images.

View larger version (168K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —Incidental enchondroma in proximal tibia of 32-year-old woman with meniscal tear. Coronal T1-weighted (A, TR/TE, 500/15) and sagittal fat-suppressed T2-weighted (B, 4,000/103) MR images show small focal area of marrow replacement (arrows). Lesion reveals high signal on T2 weighting, has mildly lobular borders, is juxtaposed to epiphyseal plate scar (arrowheads, A), and is slightly eccentrically located in medullary canal.

View larger version (165K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —Incidental enchondroma in proximal tibia of 32-year-old woman with meniscal tear. Coronal T1-weighted (A, TR/TE, 500/15) and sagittal fat-suppressed T2-weighted (B, 4,000/103) MR images show small focal area of marrow replacement (arrows). Lesion reveals high signal on T2 weighting, has mildly lobular borders, is juxtaposed to epiphyseal plate scar (arrowheads, A), and is slightly eccentrically located in medullary canal.

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