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MRI characteristics of cysts and "cyst-like" lesions in and around the knee: what the radiologist needs to know.

Perdikakis E, Skiadas V - Insights Imaging (2013)

Bottom Line: A variety of benign cystic or "cyst-like" lesions may be encountered during a routine magnetic resonance imaging (MRI) of the knee.In addition, normal anatomic bursae and recesses may be misdiagnosed as an intra-articular cystic lesion when they are distended.However, the majority of the aforementioned lesions have characteristic MR appearances that allow a confident diagnosis, thus obviating the need for additional imaging or interventional procedures.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, 412 General Military Hospital-212 Mobile Army Surgical Hospital, Terma Lefkou Pyrgou, Xanthi, 67100, Greece, perdikakis_ev@yahoo.gr.

ABSTRACT

Objectives and methods: A variety of benign cystic or "cyst-like" lesions may be encountered during a routine magnetic resonance imaging (MRI) of the knee. These lesions comprise a diverse group of entities from benign cysts to complications of underlying diseases. In addition, normal anatomic bursae and recesses may be misdiagnosed as an intra-articular cystic lesion when they are distended. However, the majority of the aforementioned lesions have characteristic MR appearances that allow a confident diagnosis, thus obviating the need for additional imaging or interventional procedures.

Results: This article includes a comprehensive pictorial essay of the characteristic MRI features of common and uncommon benign cysts and "cyst-like" lesions in and around the knee joint.

Discussion: For accurate assessment of the "cystic structure", a radiologist should be able to identify typical MRI patterns that contribute in establishing the correct diagnosis and thus guiding specific therapy and avoiding unwarranted interventional procedures such as biopsy or arthroscopy.

Teaching points: • Cystic lesions are common in knee MRI and the commonest, the Baker's cyst, has an incidence of 38 %. • Synovial cysts, meniscal cysts, normal knee bursae and recesses have characteristic MR appearances. • Miscellaneous "cyst-like" lesions may require a more dedicated MR protocol for a correct diagnosis.

No MeSH data available.


Related in: MedlinePlus

Brodie’s abscess and lymph nodes in a patient with ACL reconstruction. (a) Axial and (b) sagittal fat saturated proton density weighted, (c) sagittal T1-weighted, (d) sagittal fat saturated contrast-enhanced T1-weighted and (e, f) sequential axial fat saturated contrast-enhanced T1-weighted images. A small cystic lesion (white arrow) at the anterior aspect of the tibia in contact with the ACL graft (black arrow) with marked peripheral enhancement (grey arrows) and a central non-enhancing portion is depicted. The abscess was draining via a sinus tract along the ACL graft to the anterior surface of the tibia. Three small cystic-like lesions (grey arrowheads) in the popliteal fossa, represent enlarged lymph nodes
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Fig25: Brodie’s abscess and lymph nodes in a patient with ACL reconstruction. (a) Axial and (b) sagittal fat saturated proton density weighted, (c) sagittal T1-weighted, (d) sagittal fat saturated contrast-enhanced T1-weighted and (e, f) sequential axial fat saturated contrast-enhanced T1-weighted images. A small cystic lesion (white arrow) at the anterior aspect of the tibia in contact with the ACL graft (black arrow) with marked peripheral enhancement (grey arrows) and a central non-enhancing portion is depicted. The abscess was draining via a sinus tract along the ACL graft to the anterior surface of the tibia. Three small cystic-like lesions (grey arrowheads) in the popliteal fossa, represent enlarged lymph nodes

Mentions: Popliteal artery aneurysms present on MR images with variable signal intensity depending on flow characteristics and pulse sequences [51, 52]. They are typically situated within the popliteal fossa. A laminated MR appearance consistent with multilayered thrombus and occasionally rim-like calcification may also be demonstrated. The lesion shows continuity with the popliteal artery, which is a hallmark in diagnosis. Popliteal vein varices are focal dilatations of the popliteal vein [1, 2, 6–11]. They present on MR images as lobulated masses in continuity with the popliteal vein. Lymph nodes located in and around the popliteal fossa may also manifest as cyst-like structures [1, 2, 6–11]. Knowledge of their location as well as of the normal MR appearance of the lymph node fatty hillum aids in the differential diagnosis. Haematomas may simulate a cyst but can be differentiated by its signal intensity which depends on blood products’ age (haemoglobin degradation products) [53–55]. Abscesses that can also mimic cysts are associated with infection and inflammation in the surrounding soft tissues and occasionally underlying osteomyelitis [55–57]. Contrast enhancement is necessary for the correct diagnosis and for unmasking a possible sinus tract (Figs. 23, 24 and 25).Fig. 23


MRI characteristics of cysts and "cyst-like" lesions in and around the knee: what the radiologist needs to know.

Perdikakis E, Skiadas V - Insights Imaging (2013)

Brodie’s abscess and lymph nodes in a patient with ACL reconstruction. (a) Axial and (b) sagittal fat saturated proton density weighted, (c) sagittal T1-weighted, (d) sagittal fat saturated contrast-enhanced T1-weighted and (e, f) sequential axial fat saturated contrast-enhanced T1-weighted images. A small cystic lesion (white arrow) at the anterior aspect of the tibia in contact with the ACL graft (black arrow) with marked peripheral enhancement (grey arrows) and a central non-enhancing portion is depicted. The abscess was draining via a sinus tract along the ACL graft to the anterior surface of the tibia. Three small cystic-like lesions (grey arrowheads) in the popliteal fossa, represent enlarged lymph nodes
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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Fig25: Brodie’s abscess and lymph nodes in a patient with ACL reconstruction. (a) Axial and (b) sagittal fat saturated proton density weighted, (c) sagittal T1-weighted, (d) sagittal fat saturated contrast-enhanced T1-weighted and (e, f) sequential axial fat saturated contrast-enhanced T1-weighted images. A small cystic lesion (white arrow) at the anterior aspect of the tibia in contact with the ACL graft (black arrow) with marked peripheral enhancement (grey arrows) and a central non-enhancing portion is depicted. The abscess was draining via a sinus tract along the ACL graft to the anterior surface of the tibia. Three small cystic-like lesions (grey arrowheads) in the popliteal fossa, represent enlarged lymph nodes
Mentions: Popliteal artery aneurysms present on MR images with variable signal intensity depending on flow characteristics and pulse sequences [51, 52]. They are typically situated within the popliteal fossa. A laminated MR appearance consistent with multilayered thrombus and occasionally rim-like calcification may also be demonstrated. The lesion shows continuity with the popliteal artery, which is a hallmark in diagnosis. Popliteal vein varices are focal dilatations of the popliteal vein [1, 2, 6–11]. They present on MR images as lobulated masses in continuity with the popliteal vein. Lymph nodes located in and around the popliteal fossa may also manifest as cyst-like structures [1, 2, 6–11]. Knowledge of their location as well as of the normal MR appearance of the lymph node fatty hillum aids in the differential diagnosis. Haematomas may simulate a cyst but can be differentiated by its signal intensity which depends on blood products’ age (haemoglobin degradation products) [53–55]. Abscesses that can also mimic cysts are associated with infection and inflammation in the surrounding soft tissues and occasionally underlying osteomyelitis [55–57]. Contrast enhancement is necessary for the correct diagnosis and for unmasking a possible sinus tract (Figs. 23, 24 and 25).Fig. 23

Bottom Line: A variety of benign cystic or "cyst-like" lesions may be encountered during a routine magnetic resonance imaging (MRI) of the knee.In addition, normal anatomic bursae and recesses may be misdiagnosed as an intra-articular cystic lesion when they are distended.However, the majority of the aforementioned lesions have characteristic MR appearances that allow a confident diagnosis, thus obviating the need for additional imaging or interventional procedures.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, 412 General Military Hospital-212 Mobile Army Surgical Hospital, Terma Lefkou Pyrgou, Xanthi, 67100, Greece, perdikakis_ev@yahoo.gr.

ABSTRACT

Objectives and methods: A variety of benign cystic or "cyst-like" lesions may be encountered during a routine magnetic resonance imaging (MRI) of the knee. These lesions comprise a diverse group of entities from benign cysts to complications of underlying diseases. In addition, normal anatomic bursae and recesses may be misdiagnosed as an intra-articular cystic lesion when they are distended. However, the majority of the aforementioned lesions have characteristic MR appearances that allow a confident diagnosis, thus obviating the need for additional imaging or interventional procedures.

Results: This article includes a comprehensive pictorial essay of the characteristic MRI features of common and uncommon benign cysts and "cyst-like" lesions in and around the knee joint.

Discussion: For accurate assessment of the "cystic structure", a radiologist should be able to identify typical MRI patterns that contribute in establishing the correct diagnosis and thus guiding specific therapy and avoiding unwarranted interventional procedures such as biopsy or arthroscopy.

Teaching points: • Cystic lesions are common in knee MRI and the commonest, the Baker's cyst, has an incidence of 38 %. • Synovial cysts, meniscal cysts, normal knee bursae and recesses have characteristic MR appearances. • Miscellaneous "cyst-like" lesions may require a more dedicated MR protocol for a correct diagnosis.

No MeSH data available.


Related in: MedlinePlus