Qualitative evaluation of MRI features in aneurysmal bone cysts after percutaneous sclerotherapy
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SCIENTIFIC ARTICLE
Qualitative evaluation of MRI features in aneurysmal bone cysts after percutaneous sclerotherapy Eric S. Bih 1 & Kimberly Dao 2 & Horacio Padua 1 & Raja Shaikh 1 Received: 25 June 2020 / Revised: 27 August 2020 / Accepted: 10 September 2020 # ISS 2020
Abstract Objective To report MRI findings of changes seen in aneurysmal bone cysts after percutaneous sclerotherapy treatment. Materials and methods After applying exclusion criteria, a total of 36 patients who had aneurysmal bone cysts and undergone percutaneous sclerotherapy were included in this study. The pre-treatment and post-treatment MRIs were reviewed and multiple pre-determined MRI findings were evaluated. The presence of each post-treatment finding, as well as the time for each finding to develop, was recorded. Results Early post-sclerotherapy changes include increased perilesional edema and enhancement, which appear on MRI on average 5.1 months after the initial sclerotherapy. This is followed by decreased cystic areas, which can be seen on average 5.9 months after the initial treatment. The presence of fibrosis, improved cortical integrity, and improving mass effect are later post-treatment changes and appear on MRI on average 9.7 months, 10.6 months, and 16.1 months after the initial sclerotherapy, respectively. Conclusion The early and late post-sclerotherapy MR findings of aneurysmal bone cysts were reported in this study. Keywords Aneurysmal bone cysts . Percutaneous sclerotherapy . MRI
Introduction Aneurysmal bone cysts (ABCs) are benign bone lesions that can occur in the pediatric population with a median age of 13 years and 90% of lesions are found before the age of 30 [1, 2]. The lesions account for approximately 1% of all bone tumors, and about 70% of ABCs arise de novo as primary bone tumors, while 30% of ABCs secondarily arise from other bone tumors [2, 3]. The etiology of ABCs varies in literature, but has recently been linked to a genetic translocation t(16;17) (q22;p13) causing fusion of the promoter of the osteoblast cadherin 11 gene on chromosome 16q22 to the ubiquitin protease USP6 gene on chromosome 17p13. This has been associated with upregulation of USP6
* Raja Shaikh [email protected] 1
Department of Radiology, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA
2
Boston University Medical Center, Boston University School of Medicine, Boston, MA, USA
protein expression, which may in turn increase matrix metalloproteinase production. Such changes may result in the expansile osteolysis, inflammation, and vascularization that are seen in ABC lesions [4–7]. On radiographs and computed tomography (CT) imaging, an ABC most commonly appears as an expansile metaphyseal lucent lesion with a narrow zone of transition and a sclerotic margin. Fluid-fluid levels may be seen on CT [8]. On magnetic resonance imaging (MRI), an ABC often presents as a characteristic expansile thin-walled locular lesion with septations and intralocular hyperintense T2 signal and fluidfluid levels. On T1-
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