Ultrasound and MRI findings in appendicular and truncal fat necrosis
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SCIENTIFIC ARTICLE
Ultrasound and MRI findings in appendicular and truncal fat necrosis Philip Robinson & Joanna M. Farrant & Grainne Bourke & William Merchant & Scott McKie & Kieran J. Horgan
Received: 19 June 2007 / Revised: 15 September 2007 / Accepted: 20 October 2007 / Published online: 4 December 2007 # ISS 2007
Abstract Objective The objective was to evaluate ultrasound and MRI in clinical appendicular and truncal fat necrosis. Materials and methods Thirty-three patients (14 men, 19 women, median age 55, range 29–95) were retrospectively evaluated. Histologically, three groups were seen: Group 1 (n=18) consisted of patients with subcutaneous masses with septal and extrinsic oedema; in Group 2 (n=11) necrosis occurred within lipomatous tumours and little oedema; and in Group 3 (n=4) there were large complex masses consistent with Morel-Lavallée lesions. Two experienced radiologists reviewed MR (n=30) and ultrasound (n = 32) images with consensus agreement. MRI was performed on a 1.5T system with T1-weighted, T2weighted fat-suppressed and T1-weighted fat-suppressed
P. Robinson : J. M. Farrant : S. McKie Department of Radiology, Leeds Teaching Hospitals, Leeds LS1 3EX, UK G. Bourke Department of Plastic Surgery, Leeds Teaching Hospitals, Leeds LS1 3EX, UK W. Merchant Department of Pathology, Leeds Teaching Hospitals, Leeds LS1 3EX, UK K. J. Horgan Department of Surgery, Leeds Teaching Hospitals, Leeds LS1 3EX, UK P. Robinson (*) Musculoskeletal Centre, X-Ray Department, Chapel Allerton Hospital, Leeds Teaching Hospitals, Leeds LS7 4SA, UK e-mail: [email protected]
post-intravenous gadolinium sequences obtained in two orthogonal planes. Ultrasound (linear 5- to 13.5-MHz probe) was performed in the longitudinal and short axis. Anatomical position, size, shape (oval, linear, ill-defined), internal architecture (lobules, septi or stranding), intrinsic signal characteristics, presence of surrounding pseudocapsule, extrinsic linear stranding and vascularity (gadolinium enhancement or power Doppler) were recorded. Results Anatomical locations were buttock/thigh (n=17), leg (n=6), upper limb (n=5) and thoracic/abdominal wall (n=5) with the majority of lesions (30 out of 33) oval/linear in shape. On ultrasound and MRI most lesions showed internal fat lobules, intervening septi and a surrounding pseudocapsule. Conclusion Fat necrosis can usually be identified as containing multiple fat lobules on ultrasound and MRI despite a varying degree of inflammatory change surrounding and within the mass. Keywords Fat necrosis . Ultrasound . MRI . Appendicular
Introduction Fat necrosis is a benign process secondary to aseptic saponification of fat by lipase released from blood and tissue. The imaging features of fat necrosis of the breast have been documented in several studies demonstrating a wide variety of findings for both ultrasound and mammography [1, 2]. Ultrasound findings for fat necrosis of the breast include a simple cyst, a solid mass, a complex mass with mural nodules or just increased echogenicity of subcu
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