Imaging features of intraosseous ganglia: a report of 45 cases

Abstract

The aim of this study is to report the spectrum of imaging findings of intraosseous ganglia (IG) with particular emphasis on the radiographic and magnetic resonance (MR) features. Forty-five patients with a final diagnosis of IG were referred to a specialist orthopaedic oncology service with the presumptive diagnosis of either a primary or secondary bone tumour. The diagnosis was established by histology in 25 cases. In the remainder, the imaging features were considered characteristic and the lesion was stable on follow-up radiographic examination. Radiographs were available for retrospective review in all cases and MR imaging in 29. There was a minor male preponderance with a wide adult age range. Three quarters were found in relation to the weight-bearing long bones of the lower limb, particularly round the knee. On radiographs all were juxta-articular and osteolytic; 74% were eccentric in location, 80% had a sclerotic endosteal margin and 60% of cases showed a degree of trabeculation. Periosteal new bone formation and matrix mineralization were not present. Of the 29 cases that underwent MR imaging, 66% were multiloculated. On T1-weighted images the IG contents were isointense or mildly hypointense in 90% cases. Forty-one per cent of the cases showed a slightly hyperintense rim lining that enhanced with a gadolinium chelate. Thirty-eight per cent were associated with soft tissue extension and 17% with a defect of the adjacent articular cortex. Fifty-five per cent showed surrounding marrow oedema on T2-weighted or STIR images and two cases (7%) a fluid-fluid level prior to any surgical intervention. The authors contend that it is semantics to differentiate between an IG and a degenerate subchondral cyst as, while the initial pathogenesis may vary, the histological endpoint is identical, as are the imaging features apart from the degree of associated degenerative joint disease. IGs, particularly when large, may be mistaken for a bone tumour. Correlation of the typical radiographic and MR imaging features will indicate the correct diagnosis and obviate the need for biopsy.

Therapeutic effect of bone cement injection in the treatment of intraosseous ganglion of the carpal bones

“…Ganglia may be classified as intraosseous, subperiosteal, intraarticular or soft tissue ganglia. Soft tissue ganglia are commonly observed, occasionally presenting with superficial erosion and close proximity to the bone; however, their intraosseous counterparts have been rarely reported (18,19). In the majority of patient cohorts, intraosseous ganglia are most commonly detected in the lower extremities, particularly in the tibia and femur, and predominantly occur in the epiphyseal-metaphyseal area of the long tubular bones (20).…”

Frequency of Baker’s Cysts in Cases of Meniscal Injury

“…This difference was found to not be statistically significant (p= 0.93). In MRI, Baker's cyst appears as a well-defined unilocular or multilocular cystic mass, located posteromedially between the tendon of the semimembranosus and the medial head of gastrocnemius [7][8][9][10][11][12][13]. Baker's cyst can be effectively diagnosed with MRI since the fluid-distented gastrocnemiussemimembranosus bursa is easily depicted on T 2 -weighted MR images, especially in the axial plane.…”

“…Fluid signal intensity is seen in all sequences in cases of popliteal cysts [11,12]. Nevertheless, complications such as hemorrhage, rupture, the presence of intra-articular loose bodies and synovial proliferative reaction-diseases may produce a more heterogeneous appearance.…”

Tumours and Tumour-Like Lesions of Bone

“…The terms intraosseous ganglion, subchondral cyst or geode are often applied interchangeably, although the latter are more frequently used to describe juxta-articular lesions associated with degenerative or inflammatory joint disease (Williams et al 2004). They appear as well-defined subarticular lytic lesions.…”