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Neuromuscular choristoma: characteristic magnetic resonance imaging findings and association with post-biopsy fibromatosis
Objective To describe imaging characteristics of neuromuscular choristomas (NMC) and to differentiate them from fibrolipomatous hamartomas (FLH). Materials and methods Clinical and imaging characteristics of six patients with biopsy-proven NMC and six patients with FLH were reviewed by musculoskelet...
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| Published in: | Skeletal radiology 2013-04, Vol.42 (4), p.567-577 |
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| container_title | Skeletal radiology |
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| creator | Niederhauser, Blake D. Spinner, Robert J. Jentoft, Mark E. Everist, Brian M. Matsumoto, Jane M. Amrami, Kimberly K. |
| description | Objective
To describe imaging characteristics of neuromuscular choristomas (NMC) and to differentiate them from fibrolipomatous hamartomas (FLH).
Materials and methods
Clinical and imaging characteristics of six patients with biopsy-proven NMC and six patients with FLH were reviewed by musculoskeletal, a pediatric, and two in-training radiologists with a literature review to define typical magnetic resonance imaging features by consensus. Five radiology trainees blinded to cases and naive to the diagnosis of NMC and a musculoskeletal-trained radiologist rated each lesion as having more than or less than 50 % intralesional fat, as well as an overall impression using axial T1 images. Sensitivity, specificity, accuracy, and interobserver agreement kappa were determined.
Results
Typical features of NMC include smoothly tapering, fusiform enlargement of the sciatic nerve or brachial plexus elements with T1 and T2 signal characteristics closely following those of muscle. Longitudinal bands of intervening low T1 and T2 signal were often present and likely corresponded to fibrous tissue by pathology. Four of five patients with long-term follow-up (80 %) developed aggressive fibromatosis after percutaneous or surgical biopsy. Nerve fascicle thickening often resulted in a “coaxial cable” appearance similar to classic FLH, however, using a cutoff of |
| doi_str_mv | 10.1007/s00256-012-1546-7 |
| format | article |
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To describe imaging characteristics of neuromuscular choristomas (NMC) and to differentiate them from fibrolipomatous hamartomas (FLH).
Materials and methods
Clinical and imaging characteristics of six patients with biopsy-proven NMC and six patients with FLH were reviewed by musculoskeletal, a pediatric, and two in-training radiologists with a literature review to define typical magnetic resonance imaging features by consensus. Five radiology trainees blinded to cases and naive to the diagnosis of NMC and a musculoskeletal-trained radiologist rated each lesion as having more than or less than 50 % intralesional fat, as well as an overall impression using axial T1 images. Sensitivity, specificity, accuracy, and interobserver agreement kappa were determined.
Results
Typical features of NMC include smoothly tapering, fusiform enlargement of the sciatic nerve or brachial plexus elements with T1 and T2 signal characteristics closely following those of muscle. Longitudinal bands of intervening low T1 and T2 signal were often present and likely corresponded to fibrous tissue by pathology. Four of five patients with long-term follow-up (80 %) developed aggressive fibromatosis after percutaneous or surgical biopsy. Nerve fascicle thickening often resulted in a “coaxial cable” appearance similar to classic FLH, however, using a cutoff of <50 % intralesional fat allowed for differentiation with 100 % sensitivity by all reviewers and 100 % specificity when all imaging features were utilized for impressions. Agreement was excellent with all differentiating methods (kappa 0.861–1.0).
Conclusions
NMC can be confidently differentiated from FLH and malignancies using characteristic imaging and clinical features. When a diagnosis is made, biopsy should be avoided given frequent complication by aggressive fibromatosis.</description><identifier>ISSN: 0364-2348</identifier><identifier>EISSN: 1432-2161</identifier><identifier>DOI: 10.1007/s00256-012-1546-7</identifier><identifier>PMID: 23184268</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer-Verlag</publisher><subject>Adolescent ; Adult ; Biopsy ; Child ; Choristoma - pathology ; Diagnosis, Differential ; Female ; Fibroma - pathology ; Fibromatosis, Aggressive - pathology ; Humans ; Imaging ; Infant ; Magnetic resonance imaging ; Magnetic Resonance Imaging - methods ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Neuromuscular Diseases - pathology ; Nuclear Medicine ; Observer Variation ; Orthopedics ; Pathology ; Radiology ; Scientific Article ; Sensitivity and Specificity</subject><ispartof>Skeletal radiology, 2013-04, Vol.42 (4), p.567-577</ispartof><rights>ISS 2012</rights><rights>COPYRIGHT 2013 Springer</rights><rights>ISS 2013</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c439t-e2fe9bd84aa806d6133e0ff67145c1499cb018fcd7bcf842886b773b5df338743</citedby><cites>FETCH-LOGICAL-c439t-e2fe9bd84aa806d6133e0ff67145c1499cb018fcd7bcf842886b773b5df338743</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,778,782,27907,27908</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23184268$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Niederhauser, Blake D.</creatorcontrib><creatorcontrib>Spinner, Robert J.</creatorcontrib><creatorcontrib>Jentoft, Mark E.</creatorcontrib><creatorcontrib>Everist, Brian M.</creatorcontrib><creatorcontrib>Matsumoto, Jane M.</creatorcontrib><creatorcontrib>Amrami, Kimberly K.</creatorcontrib><title>Neuromuscular choristoma: characteristic magnetic resonance imaging findings and association with post-biopsy fibromatosis</title><title>Skeletal radiology</title><addtitle>Skeletal Radiol</addtitle><addtitle>Skeletal Radiol</addtitle><description>Objective
To describe imaging characteristics of neuromuscular choristomas (NMC) and to differentiate them from fibrolipomatous hamartomas (FLH).
Materials and methods
Clinical and imaging characteristics of six patients with biopsy-proven NMC and six patients with FLH were reviewed by musculoskeletal, a pediatric, and two in-training radiologists with a literature review to define typical magnetic resonance imaging features by consensus. Five radiology trainees blinded to cases and naive to the diagnosis of NMC and a musculoskeletal-trained radiologist rated each lesion as having more than or less than 50 % intralesional fat, as well as an overall impression using axial T1 images. Sensitivity, specificity, accuracy, and interobserver agreement kappa were determined.
Results
Typical features of NMC include smoothly tapering, fusiform enlargement of the sciatic nerve or brachial plexus elements with T1 and T2 signal characteristics closely following those of muscle. Longitudinal bands of intervening low T1 and T2 signal were often present and likely corresponded to fibrous tissue by pathology. Four of five patients with long-term follow-up (80 %) developed aggressive fibromatosis after percutaneous or surgical biopsy. Nerve fascicle thickening often resulted in a “coaxial cable” appearance similar to classic FLH, however, using a cutoff of <50 % intralesional fat allowed for differentiation with 100 % sensitivity by all reviewers and 100 % specificity when all imaging features were utilized for impressions. Agreement was excellent with all differentiating methods (kappa 0.861–1.0).
Conclusions
NMC can be confidently differentiated from FLH and malignancies using characteristic imaging and clinical features. When a diagnosis is made, biopsy should be avoided given frequent complication by aggressive fibromatosis.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Biopsy</subject><subject>Child</subject><subject>Choristoma - pathology</subject><subject>Diagnosis, Differential</subject><subject>Female</subject><subject>Fibroma - pathology</subject><subject>Fibromatosis, Aggressive - pathology</subject><subject>Humans</subject><subject>Imaging</subject><subject>Infant</subject><subject>Magnetic resonance imaging</subject><subject>Magnetic Resonance Imaging - methods</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Neuromuscular Diseases - pathology</subject><subject>Nuclear Medicine</subject><subject>Observer Variation</subject><subject>Orthopedics</subject><subject>Pathology</subject><subject>Radiology</subject><subject>Scientific Article</subject><subject>Sensitivity and Specificity</subject><issn>0364-2348</issn><issn>1432-2161</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><recordid>eNp1kctu1TAQhi0EoofCA7BBkdh0k-JbbIddVVFAqmADa8tx7FNXiX3wJELl6ZnolKtAXow1_v7xzPyEPGf0nFGqXwGlvFMtZbxlnVStfkB2TArecqbYQ7KjQsmWC2lOyBOAW0qZ1p16TE64YEZyZXbk24ew1jKv4NfJ1cbflJpgKbN7jXdXnV_Clki-md0-h-1SA5Tssg9NwlzK-yamPGKExuWxcQDFJ7ekkpuvablpDgWWdkjlAHdIDvibWwokeEoeRTdBeHYfT8nnqzefLt-11x_fvr-8uG69FP3SBh5DP4xGOmeoGhUTItAYlWay80z2vR8oM9GPevARpzJGDVqLoRujEEZLcUrOjnUPtXxZAyx2TuDDNLkcygqWoUQwqkyH6Mu_0Nuy1ozdbZQ2Rvcd-0Xt3RRsyrEsuKitqL3QWInRznCkzv9B4RnDnHzJISbM_yFgR4GvBaCGaA8VN1zvLKN289se_bbot938tho1L-4bXoc5jD8VPwxGgB8BwKe8D_W3if5b9TsSDLZn</recordid><startdate>20130401</startdate><enddate>20130401</enddate><creator>Niederhauser, Blake D.</creator><creator>Spinner, Robert J.</creator><creator>Jentoft, Mark E.</creator><creator>Everist, Brian M.</creator><creator>Matsumoto, Jane M.</creator><creator>Amrami, Kimberly K.</creator><general>Springer-Verlag</general><general>Springer</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7P</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20130401</creationdate><title>Neuromuscular choristoma: characteristic magnetic resonance imaging findings and association with post-biopsy fibromatosis</title><author>Niederhauser, Blake D. ; Spinner, Robert J. ; Jentoft, Mark E. ; Everist, Brian M. ; Matsumoto, Jane M. ; Amrami, Kimberly K.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c439t-e2fe9bd84aa806d6133e0ff67145c1499cb018fcd7bcf842886b773b5df338743</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Biopsy</topic><topic>Child</topic><topic>Choristoma - pathology</topic><topic>Diagnosis, Differential</topic><topic>Female</topic><topic>Fibroma - pathology</topic><topic>Fibromatosis, Aggressive - pathology</topic><topic>Humans</topic><topic>Imaging</topic><topic>Infant</topic><topic>Magnetic resonance imaging</topic><topic>Magnetic Resonance Imaging - methods</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Neuromuscular Diseases - pathology</topic><topic>Nuclear Medicine</topic><topic>Observer Variation</topic><topic>Orthopedics</topic><topic>Pathology</topic><topic>Radiology</topic><topic>Scientific Article</topic><topic>Sensitivity and Specificity</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Niederhauser, Blake D.</creatorcontrib><creatorcontrib>Spinner, Robert J.</creatorcontrib><creatorcontrib>Jentoft, Mark E.</creatorcontrib><creatorcontrib>Everist, Brian M.</creatorcontrib><creatorcontrib>Matsumoto, Jane M.</creatorcontrib><creatorcontrib>Amrami, Kimberly K.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biological Science Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Advanced Technologies & Aerospace Database</collection><collection>ProQuest Advanced Technologies & Aerospace Collection</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Skeletal radiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Niederhauser, Blake D.</au><au>Spinner, Robert J.</au><au>Jentoft, Mark E.</au><au>Everist, Brian M.</au><au>Matsumoto, Jane M.</au><au>Amrami, Kimberly K.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Neuromuscular choristoma: characteristic magnetic resonance imaging findings and association with post-biopsy fibromatosis</atitle><jtitle>Skeletal radiology</jtitle><stitle>Skeletal Radiol</stitle><addtitle>Skeletal Radiol</addtitle><date>2013-04-01</date><risdate>2013</risdate><volume>42</volume><issue>4</issue><spage>567</spage><epage>577</epage><pages>567-577</pages><issn>0364-2348</issn><eissn>1432-2161</eissn><abstract>Objective
To describe imaging characteristics of neuromuscular choristomas (NMC) and to differentiate them from fibrolipomatous hamartomas (FLH).
Materials and methods
Clinical and imaging characteristics of six patients with biopsy-proven NMC and six patients with FLH were reviewed by musculoskeletal, a pediatric, and two in-training radiologists with a literature review to define typical magnetic resonance imaging features by consensus. Five radiology trainees blinded to cases and naive to the diagnosis of NMC and a musculoskeletal-trained radiologist rated each lesion as having more than or less than 50 % intralesional fat, as well as an overall impression using axial T1 images. Sensitivity, specificity, accuracy, and interobserver agreement kappa were determined.
Results
Typical features of NMC include smoothly tapering, fusiform enlargement of the sciatic nerve or brachial plexus elements with T1 and T2 signal characteristics closely following those of muscle. Longitudinal bands of intervening low T1 and T2 signal were often present and likely corresponded to fibrous tissue by pathology. Four of five patients with long-term follow-up (80 %) developed aggressive fibromatosis after percutaneous or surgical biopsy. Nerve fascicle thickening often resulted in a “coaxial cable” appearance similar to classic FLH, however, using a cutoff of <50 % intralesional fat allowed for differentiation with 100 % sensitivity by all reviewers and 100 % specificity when all imaging features were utilized for impressions. Agreement was excellent with all differentiating methods (kappa 0.861–1.0).
Conclusions
NMC can be confidently differentiated from FLH and malignancies using characteristic imaging and clinical features. When a diagnosis is made, biopsy should be avoided given frequent complication by aggressive fibromatosis.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer-Verlag</pub><pmid>23184268</pmid><doi>10.1007/s00256-012-1546-7</doi><tpages>11</tpages></addata></record> |
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| identifier | ISSN: 0364-2348 |
| ispartof | Skeletal radiology, 2013-04, Vol.42 (4), p.567-577 |
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| language | eng |
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| source | Springer Nature |
| subjects | Adolescent Adult Biopsy Child Choristoma - pathology Diagnosis, Differential Female Fibroma - pathology Fibromatosis, Aggressive - pathology Humans Imaging Infant Magnetic resonance imaging Magnetic Resonance Imaging - methods Male Medicine Medicine & Public Health Middle Aged Neuromuscular Diseases - pathology Nuclear Medicine Observer Variation Orthopedics Pathology Radiology Scientific Article Sensitivity and Specificity |
| title | Neuromuscular choristoma: characteristic magnetic resonance imaging findings and association with post-biopsy fibromatosis |
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