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Nonossifying fibroma: Characteristics at MR


imaging with pathologic correlation
ARTICLE in RADIOLOGY NOVEMBER 1998
Impact Factor: 6.87 DOI: 10.1148/radiology.209.1.9769832 Source: PubMed

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11 AUTHORS, INCLUDING:
Won-Hee Jee

Bo-Young Choe

Seoul St. Mary's Hospital, The Catholic Unive

Catholic University of Korea

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Jin-suck Suh

Kyung Nam Ryu

Yonsei University

Kyung Hee University Medical Center

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Available from: Jin-suck Suh


Retrieved on: 05 January 2016

Won-Hee

Jee, MD

Bo-Young

Choe,

Heung-Sik
Kyung-Jin

Kang, MD
Suh, MD

Nonossifying
Characteristics
with
Pathologic

PhD

Jin-Suck Suh, MD
Kyung-Nam
Ryu, MD
Yeon-Soo

Lee, MD

In-Young
Jung-Man

Ok, MD
Kim, MD

Kyu-Ho

Choi,

PURPOSE:
To correlate
the findings
of nonossifying
(MR) imaging
with those at pathologic
examination.

Shinn,

MATERIALS
years) with

MD

for

signal

and
Index terms:
Bone neoplasms,
in infants and
children,
40.31 31
Bone neoplasms,
MR. 40.121411,

From

1998;

the

of Radiology

Kyungpook
National
University,
Taegu,
South
Korea
(K.jS.);
Department
of
Radiology,
Yonsei
University,
Seoul,
South Korea (J.S.S.); and Department
of Radiology,
Kyung
Hee University,
Seoul, South Korea (K.N.R.).
From the
1997
RSNA
scientific
assembly.
Received
November
1 2, 1 997; revision
requested
December
31 ; final revision
received
March
1 7, 1998; accepted
April 23. Address
reprint
requests
to

W.H.J.

were

were

correlated.

hypointense

images,

all

nonossifying

fibromas

of skeletal
muscle.
On T2-weighted
and
four
(21%)
were
hyperintense.

had

low

signal

images,
1 5 lesions
On gadolinium-

CONCLUSION:
The distinguishing
features of nonossifying
fibroma
included
hypointensity
and septation
on T2-weighted
images.
Signal
intensity
on Ti
and T2weighted
MR images
and the patterns
of contrast
enhancement
were dependent
on
the amounts
of hypercellular
fibrous
tissue,
hemosiderin,
hemorrhage,
collagen,
foamy
histiocytes,
and bone trabeculae.
-

Nonossifying
fibroma
is the most
common
benign
bone
tumor
and is typically
encountered
during
childhood
and adolescence
(1). Most
lesions
are discovered
incidentally
and
show
classic
radiographic
features
within
the
long
bones
(2,3).
There
is no specific
indication
for magnetic
resonance
(MR) imaging
in cases of nonossifying
fibroma
unless
the radiographic
appearance
is atypical.
To our knowledge,
the appearance
of nonossifying
fibroma
at MR imaging,
with
pathologic
correlation,
has not
been
fully
illustrated
previously
(4,5).
The purpose
of this study
was to describe
the findings
at MR imaging
in patients
with
nonossifying
fibroma
and to correlate
them
with pathologic
findings.

1998

AND

MATERIALS

Author
contributions:
Guarantor
of integrity
of entire study,
W.H.j.;
study
concepts,
H.S.K.;
study
design,
W.H.J.;
definition
of intellectual content,
J.S.S., K.N.R.;
literature
research, W.H.J.; clinical studies, J.M.K.,
I.Y.O.;
experimental
studies,
Y.S.L.;
data
acquisition,
H.S.K.,
K.J.S.; data

analysis, W.H.J.; manuscript


tion, W.Hj.;
manuscript
review,

resonance

enhanced
images,
intense
contrast
enhancement
was seen throughout
1 5 lesions
(heterogeneous
pattern
in 1 2 and homogeneous
in three)
and in the margins
and
septa
in four. Extensive
hypercellular
fibrous tissue and hemosidenn
seen at pathologic
examination
were depicted
with low signal intensity
on T2-weighted
MR images.

209:197-202

Departments

biopsy

(79%)

(W.H.J., B.Y.C., K.H.C., K.S.S.), Pathology (Y.S.L.), and Orthopedic


Surgery
(l.Y.O.,
J.M.K.),
Catholic
University
Medical
College,
Kangnam
St Marys
Hospital,
505 Banpo-Dong,
SeochoKu, Seoul,
1 37-040,
South
Korea;
Department of Radiology, Seoul National
University,
Seoul, South Korea
(H.S.K.);
Department
of Radiology,

RSNA,

at magnetic

AND METHODS:
In 1 9 patients (age range, 8-25 years; mean age, 14
pathologically
proved nonossifying
fibroma,
MR images were analyzed
intensity
and patterns of contrast
enhancement.
Findings
at MR imaging

RESULTS:
On Ti -weighted
intensity
compared
with that

40.12143,
40.1 21415
Bones, fibroma, 40.3131

fibroma

MD

Kyung-Sub

Radiology

Fibroma:
at MR Imaging
Correlation1

B.Y.C.,

K.H.C.,

prepara-

editing
K.S.S.

and

METHODS

From February
1993 through
March
1997,
19 patients
(10 female
and nine male patients;
age range,
8-25 years;
mean
age, 14 years)
with nonossifying
fibroma
participated
in this
study. The study
was approved
by the ethics
committee
at each
institution,
and written
informed
consent
was obtained
for each subject.
Each subject
underwent
plain
radiography, MR imaging,
and biopsy
of the nonossifying
fibroma.
Pathologic
findings
were based
on commonly
accepted
histologic
criteria
(3). MR imaging
and subsequent
biopsy
with
curettage
and
bone
grafting
were
performed
for the following
reasons:
prevention
of
pathologic
fracture
(ii =
1 1), pathologic
fracture
(ii =
3), persistent
pain (n = 3), and
atypical
findings
We reviewed

and

pattern

septation,
patterns

at radiography
the MR images

of

homogeneity;

on abnormal
of increased

signal
contrast.

(ii

and

the

2).
noted

sites

presence

intensity
Signal

of skeletal

of

involvement;

peripheral

of bone
marrow
intensity
lower
than

the

hypointense
and
or

signal

rim,

extraosseous
equal
to that

intensity

internal
areas;
and
of skeletal

197

Patient,

MR Imaging,

and Pathologic

Data in Cases of Nonosslfying

MR Imaging

Fibroma

Findings

Enhancement
Pattern on

Signal
Patient
No./

Intensity
on
12-weighted

Age (y)/Sex

Images

1/1 5/M

Low

Fat-suppressed,
Gadolinium-enhanced
Images
Heterogeneous,

Septation

Bone
Marrow
Change

SoftTissue
Change

Present

Present

Present

Marked

Present

Hypercellular
Fibrous Tissue

Hemosiderin

Pathologic

Features

Hemorrhage

Collagen

Foamy
Histiocytes

Slight

Slight

Absent

Absent

Bone
Trabeculae

intense
2/1 1/F

Low

Homogeneous,
intense

Present

Absent

Absent

Marked

Absent

Absent

Slight

Absent

Absent

3/8/M

High

Heterogeneous,

Present

Present

Absent

Slight

Absent

Absent

Slight

Marked

Slight

Present
Present

Absent
Absent

Absent
Absent

Marked
Moderate

Absent
Absent

Slight
Absent

Slight
Slight

Absent
Absent

Slight
Marked

Present

Absent

Absent

Marked

Absent

Absent

Slight

Slight

Slight

Present

Present

Present

Slight

Absent

Slight

Slight

Moderate

Absent

Absent

Present

Absent

Moderate

Absent

Slight

Moderate

Absent

Slight

Present

Absent

Absent

Marked

Absent

Absent

Slight

Absent

Slight

Present

Absent

Absent

Moderate

Absent

Slight

Moderate

Marked

Slight

intense

4/10/F

Low

Marginal,

5/25/M

Low

Homogeneous,
intense

septal

6/1 3/M

Low

Heterogeneous,
intense
Homogeneous,
intense
Heterogeneous,
intense
Heterogeneous,
intense
Heterogeneous,
intense
Marginal,
septal

7/14/F

High

8/1 1/F

Low

9/15/F

Low

10/1 1/F

Low

1 1/1 3/F
12/1 3/M

Present

Present

Present

Marked

Present

High

Heterogeneous,
intense

Present

Absent

Absent

Slight

Absent

Slight
Moderate

Absent
Absent

Absent
Marked

Slight
Slight

1 3/1 7/M

Low

14/11/F

Low

Present
Present

Absent
Absent

Absent
Absent

Marked
Moderate

Present
Absent

Slight
Slight

Slight
Slight

Absent
Marked

Slight
Slight

1 5/16/F
16/10/M

Low
Low

Present
Present

Absent

Present

Absent
Present

Marked
Marked

Absent
Absent

Absent
Absent

Slight
Slight

Absent
Slight

Slight
Slight

1 7/20/M

Low

Marginal,
septal
Heterogeneous,
intense
Marginal,
septal
Heterogeneous,
intense
Heterogeneous,

Present

Absent

Absent

Moderate

Absent

Slight

Slight

Moderate

Slight

Present

Absent

Absent

Slight

Absent

Slight

Slight

Moderate

Slight

Present

Absent

Absent

Marked

Absent

Absent

Slight

Absent

Slight

Low

intense
18/19/M

High

19/14/F

Low

Heterogeneous,
intense
Heterogeneous,
intense

muscle
was considered
hypointense;
greater
than that of skeletal
muscle
but
less than that of fat, intermediate;
equal
to or greater
than that of fat, hyperintense.

MR imaging
was performed
with i.5-T
(Signa
Advantage,
GE Medical
Systems,
Milwaukee,
Wis; Magnetom
SP 4000, Siemens
Medical
Systems,
Isebin, NJ) and
1 .0-T (Magnetom;
Siemens
Medical
Systems, Erbangen,
Germany)
imagers,
with
the general-purpose,
circular,
14-cm-diameter

surface

coil

and

the

body

coil.

In all

cases, Ti-weighted
MR imaging
(repetition time msec/echo
time msec
350650/i 1-30) was performed.
In six cases,
=

proton-density-weighted

(1,800-2,700/

19-40)

and T2-weighted
(1,800-2,700/60100) imaging
were performed.
In 13 cases,
a fast spin-echo
pulse sequence
was used
to perform
proton-density-weighted
(2,500-4,000/i
(2,500-4,000/76-108)

5-40)

and
T2-weighted
imaging.
In

cases, imaging
was performed
suppression.
In all cases, axial,
198

Radiology

#{149}

October1998

#{149}

10

with fat
coronal,

and sagittab
fat-suppressed
Ti-weighted
imaging
was performed
after infusion
of
0.1 mmol per kilogram
of body weight of
gadopentetate
dimeglumine
(Magnevist;
Schering,
Berlin,
Germany).
Typical
MR
imaging
parameters
included
the following: field of view, 10-20 cm; two signals
acquired;
matrix
size, 256 x 192; section
thickness,
2.0 mm;

3-8 mm; intersection


and echo-train
length,

Histopathobogic
by a bone pathologist
of MR imaging
and

slides

were

(Y.S.L.).
pathologic

gap,
eight.

1.5-

reviewed
Correlation
findings

was performed
by a radiologist
(W.Hj.)
and the pathologist.
Correlation
was general rather than site to site because
curettage,
not complete
resection,
was the
method
of tumor removal.
Histologic
sections were evaluated
for relative
amounts
of hypercellular
fibrous
tissue, hemosidenin, hemorrhage,
collagen,
foamy histiocytes, and bone trabeculae.
Correlations
were performed
between
pathologic
and
MR imaging
findings
and radiographic
and MR imaging
findings.

RESULTS

All lesions
involved
the metaphysis
and
revealed
intramedulbary
extension,
with
the following
skeletal distribution:
proximal tibia (n
8), distal tibia (n
4), distal
femur
(n
3), proximal
fibula (n = 2),
proximal
femur (n
1), and distal fibula
(n = 1). Multiple
lesions
were not observed
in any case. Ti-weighted
MR images showed
homogeneous
decreased
signal intensity
throughout
the lesion; other
findings
are listed in the Table. On T2weighted
images,
iS of the 19 lesions
=

(79%)

four

were

(2i%)

hypointense

(Figs

1, 2) and

were

hypenntense
(Fig 3). The
hypointensity
on T2-weighted
images corresponded
to extensive
hypercellular
fibrous
tissue
at histologic
examination
(Fig 1) in all 15 lesions.
Four of these 15
lesions
were depicted
with
very low signab intensity
on T2-weighted
images, and
three of the four lesions
were found
to
contain
hemosidenin
at histologic
examination
(Fig 2). The hyperintensity
on
Jee

et

al

b.

::

#{149}

#{149}.

C.

.:

_\.

-$

.-:
:

:::,.

..

I:

d.
Figure

1. Patient

(arrows).
(3,000/84;

4.

Nonossifying

(b)

Sagittal
echo-train

TI-weighted
length,

uniform,
tibia

benign-appearing,
reveals

of the distal

(Hematoxylin-eosin

reactive

sclerosis

(arrows)

stain;
that

Number

#{149}

original

surrounds

T2-weigh
ted
i mages
corresponded
to
scanty
hypercellular
fibrous
tissue
and
massive
aggregation
of foamy
histiocytes
(Fig 3) in the four remaining
lesions.
At
histologic
examination,
nonossifying
fibroma
showed
variable
amounts
of hemo-

VoIume2O9

tibia.

(a) Lateral

radiograph

image
(450/16)
shows
a hypointense
demonstrates
a hypointense
mass
fat-suppressed
Ti-weighted
MR image
(350/16)
of nonossifying
fibroma
that
involves
the distal
tibia
spindle-shaped
fibroblasts
arranged
in intersecting

(d) Gadolinium-enhanced,
(e) Photomicrograph
cells do not appear.

fibroma
MR
eight)

magnification,
the

tumor

component.

x 150.)

shows

an eccentric,

radiolucent

lesion

with

a sclerotic

margin

mass
(arrows).
(c) Sagittal,
fast spin-echo,
T2-weighted
MR image
with
marginal
(arrows)
and
septal
(arrowheads)
hyperintensity.
reveals
marginal
(arrows)
and
septal
(arrowheads)
enhancement.
shows
a large area of hypercellular
fibrotic
lesions
( * ) composed
of
fascicles.
Multinucleated
giant
cells (arrows)
are scattered,
hut foam

(f) Photomicrograph
(Hematoxylin-eosin

siderin,
hemorrhage,
collagen,
foamy
histiocytes,
and bone tnabecubae.
In all 19 cases,
a peripheral
hypointense rim on MR images
corresponded
to
marginal
sclerosis
on plain
radiographs
and
to peripheral
reactive
sclerosis
at

of nonossifying
stain;

original

fibroma
magnification,

that

involves

the distal

x40.)

(Fig
If). In 18
internal
septation
was seen
on MR images
that
correlated
with
trabeculation
on plain radiographs
(Figs 1-3).
All five lesions
(26%)
with
hyperintense
septa on TI-weighted
images
were hyperhistologic

cases

examination

(95%),

Nonossifying

Fibroma

at MR Imaging

199

#{149}

1i

-;t

I
b.

a.

C.

,,
,

#{149}1

r::

d.

Figure

2. Patient

1.

..

f.

e.
Nonossifying

fibroma
of the proximal
fibular
metaphysis.
(a) Anteroposterior
radiograph
shows
a centrally
located
osteolytic
erosion
and a pathologic
fracture.
(b) Sagittal
Ti-weighted
MR image
(400/i
1) shows
a hypointense
mass (arrows)
with
marrow
(arrowheads).
(c) Sagittal,
fat-suppressed,
fast spin-echo,
T2-weighted
MR image
(3,000/84;
echo-train
length,
hypointense
mass
(black
arrows)
with
adjacent
abnormal
high
signal
intensity
of the bone
marrow
(white
arrows).
(d) Sagittal gadolinium-enhanced,
fat-suppressed
Ti-weighted
MR image (350/11)
shows
heterogeneously
intense
enhancement
(arrows).
(e) Axial
gadolinium-enhanced,
fat-suppressed
Ti-weighted
MR image
(550/i2)
demonstrates
adjacent,
extraosseous
hyperintensity
(arrows).
(f) Photomicrograph of nonossifying
fibroma
in the proximal
fibula reveals fibrotic stromal
cells in which
hemosiderin
pigment
(arrows)
is deposited.
(Prussian
blue
stain; original
magnification,
X400.)
lesion
(arrows)
intratumoral
eight)
reveals

intense
showed

with endosteal
remaining
bone
a septate,
very

on
T2-weighted
contrast
enhancement

binium-enhanced

1). Among
ointense

200

TI-weighted

the
septa

Radiology

#{149}

images
on

14 lesions
on

TI-weighted

October

#{149}

(74%)

1998

and
gado-

images

(Fig

with

hyp-

images,

three

(16%)

were

depicted

septa on T2-weighted
contrast
enhancement
enhanced
Ti-weighted
1 1 (58%) were depicted

as hyperintense

images
and showed
on gadoliniumimages
(Fig 2) and
as hypointense
septa

on T2-weighted
images
and showed
no
contrast
enhancement
on gadoliniumenhanced
TI-weighted
images
(Fig 3). In
four cases (21%),
abnormal
signal
intensity

was

depicted

in

both

bone

marrow

Jeeet

al

b.

a.

c.

#{231}

..-..

I#{149}.(

Figure

#{149}
.#{149}

:.

.#{149}

p.

#{149} ,

k
#{149}

.#{149}.
#{149}

.:.#{149}:
. .1

:.

12.

Nonossifying

fibroma

tibia. (a) Anteroposterior


radiograph shows an eccentric,
well-defined,
radiolucent lesion (arrows)
with a sclerotic
border.
0,) Coronal
Ti-weighted
MR image (633/i i)

3. Patient

of the proximal

#{149}

shows

a heterogeneously

(arrows).

(c) Coronal,

echo,

T2-weighted

train

length,

hyperintense
linium-enhanced,

hypointense

fat-suppressed,
MR image

eight)
mass

reveals

mass

fast spin-

(3,000/108;

echo-

a heterogeneously

(arrows).
(d) Sagittal,
gadofat-suppressed
Ti -weighted
1) shows
heterogeneously

MR image
(400/i
intense
enhancement
(arrows).
(e) Photomicrograph
of nonossifying
fibroma in the proximal tibia demonstrates
a massive aggregation
of benign-appearing
foam cells (arrows).
(Hematoxylin-eosin
stain; original magnification,
xiOO.)

d.

e.

and extraosseous
areas,
with a pathologic
fracture
depicted
in three
(16%)
(Fig 2).
In two cases (1 1%), abnormal
signal
inten-

DISCUSSION

sity

brous
cortical
fibrous
lesions
nonossifying
tinct
in most

was depicted
in only bone
marrow.
After infusion
of gadopentetate
dimeglumine,
intense
contrast
enhancement
was seen in 15 cases (79%),
in a heterogeneous
(ii
=
12) (Figs 2, 3) or homogeneous
(ti = 3) pattern.
In the remaining
four
cases
(21%),
marginal
and
septab
enhancement
(Fig 1) were
depicted.
Penipheral
margins
of all lesions
showed
enhancement,
consistent
with thin hypervascular
zones
at the periphery.

Volume2O9

Number

Nonossifying

intracortical
and subpeniosteal
lesions
(6).
Nonossifying
fibroma
is an evolutionary
form
of fibrous
cortical
defect
that
extends
from the cortex
into the medullary
substance
of the
bone
(7). The
terms
fibroma

defect
are
of bones.
fibroma
is
cases.
In

and

the

related

fi-

common
benign
In the long bones,
radiologically
disa child
or adoles-

cent,
an eccentric,
well-defined,
radiolucent lesion
that arises
in the metaphysis
of a tubular
bone,
a short
distance
from
the physis,
is almost
diagnostic
of nonossifying
fibroma
or fibrous
cortical
defect
(1-3).
Nonossifying
fibroma
should
be
included
in the differential
diagnosis
of

nonossifying

fibroma

and

thoma
are sometimes
used
ably (4). Most
nonossifying
cur in the
especially

bones
about

nonossifying

pain
and
may
fracture
(1 1).
tion,
interlacing
make
up most
larly distributed
and hemosiderin

Nonossifylng

fibroxan-

interchangefibromas

oc-

of the lower
extremity,
the knee
(8-10).
Large

fibromas

frequently

cause

predispose
to pathologic
At microscopic
examinawhorls
of fibrous
tissue
of the lesion,
with
irregumultinucleated
giant cells
of variable
degree.
Non-

Fibroma

at MR Imaging

201

#{149}

ossifying

fibroma

is usually

cellular,

only small amounts


of collagen
Treatment
of nonossifying
required
only if the diagnosis

with

(4,12).
fibroma
is
is in doubt

and if the defect is large enough


to weaken
the bone appreciably.
Lesions in the fibula
usually
bone,

involve
the entire
often
appear
atypical,

width
and

of the
must
be

sampled
at biopsy
to rube out malignant
disease
(13). Lesions
more
than
33 mm
long that involve
more
than
50% of the
transverse
diameter
of the bone should
be
observed
carefully.
Prophylactic
curettage

and

autobogous

bone

grafting

of barge

lesions
may
be considered
if there
is a
reasonable
chance
of impending
fracture
(14).
Fibrous
tissue was known
to be hypointense
on both
Ti- and T2-weighted
MR
images
(1). Fibrous
dysplasia,
one of the
benign
fibrous
bone
lesions,
recently
was

reported
to be hypenintense
60% of cases on T2-weighted
(15,16).
scnibed
weighted
intensity

the

in more than
MR images

Nonossifying
fibroma
was
dewith
low signal
intensity
on TiMR images
and
mixed
signal
on T2-weighted
images
(5). On

basis

of our

experience

with

fibrous

dyspbasia,
nonossifying
pected
to be depicted

fibroma
was
as hypenintense

rather than
MR images.

on T2-weighted
however,
79% of

hypointense
In our study,

ex-

lesions
were hypointense
on Ti- and T2weighted
images
and 21% were hypointense
on Ti-weighted
MR images
and
hypenintense
on T2-weighted
images.
These
results
are consistent
with those
of
Kransdorf
et al (4), who reported
hypointense
nonossifying
fibroma
on
T2weighted
images
in eight
of 10 (80%)
patients.
In the study
by Kransdorf
et al (4), only
nonenhanced
MR images
were reviewed
of 10 nonossifying
fibromas
in nine
patients,
and
pathologic
results
were
obtamed
by means
of biopsy
in only
four
cases.
In our
study,
however,
nonen-

hanced

and

images

Radiology

#{149}

reviewed

MR

of 19 biopsy-proved
nonossifying
fibromas.
Among
the four
lesions
with findings
confirmed
at biopsy
in their
study,
two had unusually
barge
amounts
of hemosidenin
pigment
present
and
one
had
an increased
amount
of
collagen.
In our study,
all 15 lesions
depicted
with diffuse
hypointensity
on T2weighted
MR images
contained
extensive
hypercellular
fibrous
tissue.
Three
of our
four lesions
depicted
with very low signal
intensity
on T2-weighted
images
contamed
hemosidenin
pigment.
In a study
of another
hemosidenin-baden
bone
tumor
such
as giant
cell tumor,
hemosiderin was depicted
in 63#{176}A
at MR imaging

202

were

gadolinium-enhanced

October1998

#{149}

(1 7). In our
fibrous tissue
foamy

and

study,
scanty
with massive

histiocytes

was

was depicted

noted

in four

as hypenintense

weighted
MR
and trabeculation
were correlated
tense
rim and
tively,
intense

hyperceblubar
aggregation
of

enin,

cytes,

images.

Marginal
sclerosis
on plain
nadiographs
with a peripheral
hypoininternal
septation,
nespec-

with

peripheral

reactive

1.

2.

tiated
been

with

a thick

fibroma

sclerotic
rim,
be diffenen-

should

from
fibrous
dysplasia,
associated
with a peripheral

tense
rim on Tiimages
in 77% of
rounding
layer of
(16). On the basis

nal septation
MR images
of our
dysplasia

19

Abnormal
row and

which
has
hypoin-

and
T2-weighted
MR
cases owing
to a sunsclerotic
reactive
bone
of our findings,
inter-

is more frequently
seen on
of nonossifying
fibroma
(i8
cases
(three

[95%])
than
of fibrous
of 13 cases
[23%])
(16).

signal intensity
extnaosseous
areas

and

intraosseous

ganglion

hypenintense.
On gadolinium-enhanced
tense
contrast
enhancement
79%
of our cases
and

images,
inwas seen in
marginal
septab

enhancement

in 21%. These

contradictory

to those

et al (5) that
not depicted
sity
on
weighted

is also

findings

reported

nonossifying
with increased

gadolinium-enhanced
MR images.
We

were

3.

were
inten-

supposed

Tithis

contradiction

could

fat-suppressed
fat suppression

sequence
used in our study;
was not employed
in their

study.
In
conspicuous

our

be partly

due

6.

and

the patterns

in nonossifying
on the amounts
tissue,
hemosid-

MirraJM.

Fibrohistiocytic
origin.

tumors

In:

Mirra

JM,

Pa:

of intraPiero

P,

I, Hajek

PC, Pechmann

U. Fibrous

metaphyseal
defects: magnetic
resonance
imaging appearances.
Skeletal Radiol 1989;
18:253-259.
Jackson RP, Reckling FW. Intracortical
and
subperiosteal
lesion of unknown
etiology.
Clin Orthop
1978; 130:260-262.
Blau PA, Zwick
DL, Westphal
RA. Multiple
nonossifying
fibroma.
J Bone Joint Surg
[Am] 1988;
70:299-304.

8.

Kumar
R, Madewell
JE, Lindell
MM,
Swischuk
LE. Fibrous
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RadioGraphics
1990; 10:237-256.
Gross ML, Soberman
N, Dorfman
HD,
Seimon LP. Case report 556: multiple
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Skeletal

9.

Radiol 1989; 18:389-391.

10.

1 1.

12.

13.
14.

15.

Marks KE, Bauer TW. Fibrous tumors


of
bone. Orthop
Clin North Am 1989; 20:
377-393.
Drennan
DB, Maylahn
Di, Fahey JJ. Fractures through
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fibroma.
Clin Orthop
1974; 103:82-88.
Mubarak

S, Saltzstein

SL, Daniel

DM.

Non-

ossifying
fibroma:
report of an intact lesion. AmJ Clin Pathol 1974; 61:697-701.
Berkin CR. Nonossifying
fibroma
of bone.
BrJ Radiol 1966; 39:469-471.
Arata MA, Peterson HA, Dahlin DC. Pathological fractures through nonossifying
fibromas: review of the Mayo Clinic experience.J
BoneJoint
Surg [Ami 1981; 63:980-988.
UtzJA, Kransdorf
MJ, JelinekJS,
Moser RP
Jr, Berry BM. MR appearance
of fibrous
dysplasia.
J Comput
Assist Tomogr
1989;
13:845-85i.

16.

17.

19.

MR images

GD.

7.

that
logic

of contrast
enhancement
fibroma
were dependent
of hyperceblulan
fibrous

Greenway

Ritschl

18.

T2-weighted

M,

5.

to the

histopathoon Ti- and

Kyriakos

4.

study,
the lesion
became
when
the signal
intensity
on

well with
the
Signal
intensity

D,

Gold RH, eds. Bone tumors.


Philadelphia,
Pa: Lea & Febiger, 1989; 691-799.
Kransdorf
MJ, Utz JA, Gilkey FW, Berrey
BH. MR appearance
of fibroxanthoma.
J
Comput
Assist Tomogr 1988; 12:612-615.

fat-suppressed
images was rescaled
(19).
In conclusion,
nonossifying
fibroma
has characteristic
findings
at MR imaging
correlate
features.

Resnick

medublary

by Ritschl

fibromas
signal

Stark DD, Bradley


WG. Musculoskeletal
tumors.
In: Harms SE, Greenway
G, eds.
Magnetic
resonance
imaging.
2nd ed. St
Louis, Mo: Mosby, 1988; 2107-2222.

joint
disorders.
3rd ed. Philadelphia,
Saunders, 1995; 3628-3938.

of bone marwas observed

in four
of our 19 cases
(21%)
and was
thought
to result
from fracture
in all but
one case. In contrast
to the hypointensity
of nonossifying
fibroma
on T2-weighted
images,
chondromyxoid
fibroma
is hyperintense,
aneunysmal
bone cyst is heterogeneously
hypenintense
with
a fluid-fluid

level,

histio-

Tumors
and tumor-like
lesions of bone:
imaging
and pathology
of specific lesions.
In: Resnick D, ed. Diagnosis
of bone and

mal bone cyst, and intraosseous


ganglion
could be included
in the differential
diagnonossifying

foamy

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Jee et al