The clinical and pathologic features of 50 epithelioid hemangiomas of bone are analyzed. There were 29 males and 21 females who ranged in age from 10 to 75 (mean 35) years. The tumors arose in long tubular bones (40%), short tubular bones of the distal lower extremity (18%), flat bones (18%), vertebrae (16%), and small bones of the hands (8%). Nine patients (18%) had involvement of more than 1 bone. Radiographically, the lesions were lucent and well marginated. Microscopically, the neoplasms had a lobular architecture and were composed of epithelioid endothelial cells that formed obvious vascular lumina or grew in solid sheets. No hyalinized or solid appearing extracellular myxoid matrix was present. Thirty-five patients were treated with curettage, 13 patients had a local resection and 2 patients only had a biopsy. One patient had local lymph node involvement. Three patients were treated with surgery and radiation therapy. Follow-up information revealed that 4 patients experienced a local recurrence; and 1 patient developed limited involvement of a regional lymph node. Epithelioid hemangioma of bone is a benign lesion that may be multifocal and affect separate tissue and is successfully treated with curettage or marginal en bloc excision.

The study was undertaken to assess the diagnostic accuracy and clinical usefulness of computed tomography (CT)-guided biopsies and fine needle aspirates of musculoskeletal lesions. The analysis compared the accuracy according to anatomical location, size, type of lesion, and histology. On the basis of the information obtained by reviewing the report of the CT biopsy and comparing it with the final diagnosis for 359 cases, the overall accuracy was determined to be 71%. The accuracy for 101 fine needle aspirations was 63% and for 258 CT-guided core biopsies was 74%. It is of note that the biopsies of 81 pelvic lesions had higher rates of diagnostic accuracy (81%) than those of 278 non-pelvic sites (68%), and especially 94 lesions of the spine (61%). The lowest success rates occurred in 26 patients with infectious diseases (50%). We conclude that these procedures remain the logical and safe choice for diagnostic studies of patients with lesions of the musculoskeletal system.

Metabolic bone diseases are a diverse group of diseases that result in abnormalities of (a) bone mass, (b) structure mineral homeostasis, (c) bone turnover, or (d) growth. Osteoporosis, the most common metabolic bone disease, results in generalized loss of bone mass and deterioration in the bone microarchitecture. Impaired chondrocyte development and failure to mineralize growth plate cartilage in rickets lead to widened growth plates and frayed metaphyses at sites of greatest growth. Osteomalacia is the result of impaired mineralization of newly formed osteoid, which leads to characteristic Looser zones. Hypophosphatasia is a congenital condition of impaired bone mineralization with wide phenotypic variability. Findings of hyperparathyroidism are the result of bone resorption, most often manifesting as subperiosteal resorption in the hand. Renal osteodystrophy is the collection of skeletal findings observed in patients with chronic renal failure and associated secondary hyperparathyroidism and can include osteopenia, osteosclerosis, and "rugger jersey spine." Hypoparathyroidism is most commonly due to iatrogenic injury, and radiographic findings of hypoparathyroidism reflect an overall increase in bone mass. Thyroid hormone regulates endochondral bone formation; and congenital hypothyroidism, when untreated, leads to delayed bone age and absent, irregular, or fragmented distal femoral and proximal tibial epiphyses. Soft-tissue proliferation of thyroid acropachy is most often observed in the hands and feet. The findings of acromegaly are due to excess growth hormone secretion and therefore proliferation of the bones and soft tissues. Vitamin C deficiency, or scurvy, impairs posttranslational collagen modification, leading to subperiosteal hemorrhage and fractures. RSNA, 2016.

We believe that the constellation of imaging findings on T1- and T2-weighted images and post-gadolinium sequences is highly suggestive of muscle necrosis. We consider certain specific findings on gadolinium-enhanced images to be characteristic. The findings reported here should provide radiologists with useful information in making the diagnosis of skeletal muscle necrosis without resorting to invasive procedures.