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- Title
Imaging findings of intravascular papillary endothelial hyperplasia presenting in extremities: correlation with pathological findings.
- Authors
Lee, Sun; Choo, Hye; Park, Ji; Park, Yeong-Mi; Eun, Choong; Hong, Sung; Hwang, Ji; Lee, In; Lee, Jongmin; Jung, Soo-Jin; Lee, Sun Joo; Choo, Hye Jung; Park, Ji Sung; Eun, Choong Ki; Hong, Sung Hwan; Hwang, Ji Young; Lee, In Sook
- Abstract
<bold>Objective: </bold>To describe magnetic resonance imaging (MRI) and ultrasound (US) findings of intravascular papillary endothelial hyperplasia (IPEH) arising in extremities.<bold>Materials and Methods: </bold>Six patients with IPEH confirmed by surgical resection were reviewed retrospectively. Before resection, 3 patients underwent both MRI and US and 3 patients underwent only MRI. Two radiologists retrospectively reviewed MR/US imaging results and correlated them with pathological features.<bold>Results: </bold>The 6 IPEHs were diagnosed as 4 mixed forms and 2 pure forms. The pre-existing pathology of four mixed forms was intramuscular or intermuscular hemangioma. By MRI, the mixed form of IPEH (n = 4) revealed iso- to slightly high signal intensity containing nodule-like foci of high signal intensity on T1-weighted images (T1WI) and high signal intensity-containing nodule-like foci of low signal intensity on T2-weighted images (T2WI). The pure form of IPEH (n = 2) showed homogeneous iso- signal intensity on T1WI and high and low signal intensity containing nodule-like foci of low signal intensity on T2WI. On gadolinium-enhanced fat-suppressed T1WI, 50% of cases (n = 3: mixed forms) revealed peripheral, septal, and central enhancement. The other IPEHs (n = 3: 1 mixed and 2 pure forms) showed peripheral and septal enhancement or only peripheral enhancement. By US, two mixed forms of IPEH showed well-defined hypoechoic masses containing hyperechoic septa and central portion with vascularities. One pure form of IPEH was a homogeneous hypoechoic mass with septal and peripheral vascularities on color Doppler imaging. The foci of high signal intensity on T1WI, foci of low signal intensity on T2WI, and non-enhancing portions on MRI and the hypoechoic portion on US were histopathologically correlated with thrombi and the peripheral/septal or central enhancing areas on MRI, hyperechoic septa and the central portion on US, and septal/central or peripheral vascularities on color Doppler imaging corresponded to hypertrophic papillary epithelium and a fibrovascular core.<bold>Conclusions: </bold>Even though imaging findings of the pure form of IPEH are rather nonspecific, the mixed form of IPEH should be considered a possible diagnosis when a well-defined mass with T2 hyperintense signal containing nodule-like foci of low signal intensity, T1 iso- to slightly hyperintense signal containing nodule-like foci of high signal intensity, and peripheral/septal or central enhancement on MRI is seen in extremities, along with the US finding of a hypoechoic mass containing hyperechoic septa with vascularities.
- Subjects
HYPERPLASIA; MAGNETIC resonance imaging; DISEASES of the anatomical extremities; STATISTICAL correlation; SURGICAL excision; ANGIOSARCOMA; ANGIOMATOSIS; RETROSPECTIVE studies; ULTRASONIC imaging
- Publication
Skeletal Radiology, 2010, Vol 39, Issue 8, p783
- ISSN
0364-2348
- Publication type
journal article
- DOI
10.1007/s00256-010-0888-2