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All issues Volume 3 (2017) SICOT-J, 3 (2017) 34 Full HTML

Table 2.

Summary of the sonographic, CT and MRI findings of musculoskeletal fat-containing lesions.

Lesion Ultrasound CT MRI
Lipoma

  • Well defined

  • Oblong or round

  • Echogenic

  • No posterior acoustic enhancement

  • Circumscribed

  • Hypodense (−120 to −65 HU)

  • Non-enhancing, thin septa (<2 mm)

  • Circumscribed

  • Fat signal intensity on all sequences

  • Non-enhancing, thin septa (<2 mm)
Well-differentiated liposarcoma

  • Similar appearance to lipoma

  • Deep soft tissues/retroperitoneum

  • Similar to lipoma except septa may be irregular or thicker (>2 mm)

  • Similar to lipoma except septa may be irregular or thicker (>2 mm), with enhancement
Dedifferentiated liposarcoma

  • Similar to well-differentiated liposarcoma, plus a soft tissue nodule >1 cm

  • Similar to well-differentiated liposarcoma, plus a soft tissue nodule >1 cm
Myxoid liposarcoma

  • Low T1 signal with internal linear/nodular high T1 signal

  • High T2 signal in myxoid portions

  • Occasionally, entirely cystic (high T2)
Pleomorphic liposarcoma

  • Large

  • Well-defined

  • Heterogeneous

  • Heterogeneous related to internal hemorrhage and necrosis

  • Heterogeneous related to internal hemorrhage and necrosis
Elastofibroma dorsi

  • Infrascapular

  • Bilateral (60%)

  • Echogenic

  • Internal curvilinear hypoechoic streaks

  • Infrascapular

  • Bilateral (60%)

  • Poorly defined

  • Soft tissue density (isodense to muscle) with internal fat striations

  • Infrascapular

  • Bilateral (60%)

  • Poorly defined

  • Soft tissue intensity (isointense to muscle) with internal fat striations
Angiolipoma

  • Circumscribed or infiltrative

  • Small (<2 cm)

  • Similar to liposarcoma

  • May have mild internal vascularity

  • Circumscribed or infiltrative

  • Small (<2 cm)

  • Heterogeneous soft tissue and fat density lesion

  • Circumscribed or infiltrative

  • Small (<2 cm)

  • Heterogeneous lesion with soft tissue and fat signal intensity
Lipoblastoma/lipoblastomatosis

  • Circumscribed or infiltrative

  • May appear similar to liposarcoma

  • Avidly enhancing

  • Circumscribed or infiltrative

  • Variable appearance based upon myxoid component

  • Myxoid components demonstrate high T2 signal

  • Avidly enhancing
Hibernoma

  • Similar to lipoma except prominent vascularity on color Doppler imaging

  • Variable appearance depending on fat contentAvid FDG uptake on PET/CT

  • Variable appearance depending on fat content

  • Low T1 and T2 signal septa

  • Avid enhancement
Parosteal lipoma Radiographically:

  • Radiopaque soft tissue mass

  • Adjacent cortical thickening, sclerosis, periosteal reaction, osseous excrescence formation or smooth cortical scalloping

  • Identical to soft tissue lipoma

  • Adjacent cortical thickening, sclerosis, periosteal reaction, osseous excrescence formation or smooth cortical scalloping

  • Identical to soft tissue lipoma

  • Adjacent cortical thickening, sclerosis, periosteal reaction, osseous excrescence formation or smooth cortical scalloping

  • Hyaline cartilage (intermediate T1/high T2 signal intensity) may be seen along the osseous excrescence

  • Fibrous tissue (intermediate T1/low T2 signal intensity) may also be present
Intraosseous lipoma Radiographically:

  • Lucent intramedullary lesion

  • Partial or complete sclerotic rim

  • Dystrophic calcification (>50%)

  • Fat density intraosseous lesion

  • Partial or complete sclerotic rim

  • May be expansile

  • Isointense to subcutaneous fat

  • Signal loss on fat suppression sequences

  • Signal void in calcified regions

  • If necrosis, low T1/high T2 signal

  • If cystic, low T1/high T2 signal with peripheral enhancement
Fibrolipomatous hamartoma

  • Hypoechoic coaxial nerve bundles encased by echogenic fat

  • Increased fat density along a nerve

  • Mass effect on nearby structures

  • Low T1 signal nerve fascicles engulfed by high T1 fat intensity

  • Nerve within regions with restricted expansion (e.g. carpal and cubital tunnels) may be spared

  • Nerve bundles, but not surrounding fat, will enhance
Lipoma arborescens

  • Fat density synovial mass

  • Frond-like appearance

  • High T1 signal matches subcutaneous fat

  • Signal loss with fat suppression

  • Synovium will enhance, but fat will not

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