8th Baltic Congress of Radiology

MSK Radiology

poster abstract

1.To review the whole-body MRI protocol for fibrous dysplasia (FD) evaluation. 2.To show the different patterns of bone lesions in FD and their distribution. 3.To discuss the list of FD’s differential diagnosis

Whole-body MRI is a useful diagnostic tool that allows to examine to have a visual of the whole body within a matter of minutes.Therefore, it is a great substitute for CT and scintigraphy starting from diagnosis to staging and monitoring of pediatric patients who require frequent follow-ups.

Whole-body examination revealed dominant lesions in the metaphysis of the long bones and pelvis. These lesions were determined as foci of fibrous conversion of the bone tissue, which were hypointense in T1w,hyperintense in STIR and GRE T2*w.The lesions in the superior extremity were distributed in the proximal metaphysis of the humeral bones, distal metaphysis of the ulna, radius and metacarpal bones (Fig. 1).The lesions in the inferior extremity were located in the metaphysis of the proximal and distal femur, tibia, fibula and also distal metatarsal bones (Fig. 2, 3).Pelvic lesions were present bilaterally surrounding the triradiate cartilage – at the level of ilio-ischio-pubic junction (Fig. 4).

Our conclusion is that the signal intensity of FD is highly variable and thus indicates that the diagnosis of FD cannot be based on MRI alone. FD lesions may show evidence of cortical destruction and/or soft tissue extension and still be benign. In conclusion, the facts of this case report indicate that whole-body MRI may be a promising method for the evaluation of systemic diseases with diffuse involvement of the musculoskeletal system. In our case, whole-body MRI revealed the skeletal lesions evidenced by radiographic examinations, but was also capable of detecting additional abnormalities in the ovary. To establish the diagnosis of polyostotic fibrous dysplasia with relative specificity, an initial skeletal radiographic examination would still be required. However, whole-body MRI is a fast and safe diagnostic tool without ionizing radiation that could replace radiographic examinations during follow-up assessments of patients with fibrous dysplasia. This radiation-free evaluative method creates images that can be used as baseline assessments for longitudinal monitoring. The potential role of this new diagnostic tool in the evaluation of children with McCune-Albright syndrome should be investigated in future studies with larger sample sizes. There are some limitations to the use of whole-body MRI compared to conventional radiography and bone scintigraphy (the common methods of evaluation in these cases). Whole-body MRI has a higher cost per use and poor availability. Furthermore, additional lesions detected by MRI in this case have little added clinical value. Although these limitations exist, we feel that the benefits of improved detection of skeletal and soft tissue abnormalities outweigh the negatives of this technique, especially for the follow-up assessments.

Whole-body MRI is a useful diagnostic tool that allows to examine to have a visual of the whole body within a matter of minutes. We wanted to review the whole-body MRI protocol for fibrous dysplasia (FD) evaluation, to show the different patterns of bone lesions in FD and their distribution and to discuss the list of FD’s differential diagnosis. Whole-body examination revealed dominant lesions in the metaphysis of the long bones and pelvis.

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