Simple Stepwise Approach to Differentiate Cyst-Like Soft-Tissue Masses by Using Time-Resolved Magnetic Resonance Angiography

Ying-Chieh Lai,Yu-Jr Lin,Shu-Hang Ng,Wen-Yu Chuang,Tzu-Chin Lo,Chi-Ting Liau,Gigin Lin,Chun-Chieh Chen,Yu-Hsiang Juan,Yu-Ching Lin

doi:10.3390/diagnostics10121094

Abstract

This retrospective study aimed to differentiate cyst-like musculoskeletal soft-tissue masses by using time-resolved magnetic resonance angiography (MRA). During May 2015 to November 2019, patients with cyst-like soft-tissue masses examined through contrast-enhanced MRI followed by histologic diagnosis were included. The masses were classified into vascular lesions, solid lesions, and true cysts. Size, T1 hyperintensity, T2 composition, perilesional edema, time-resolved MRA, and static internal enhancement were assessed. The time-resolved MRA manifestations were classified into vascular pooling, solid stain, and occult lesion. Imaging predictors for each type of mass were identified through logistic regression and were used to develop a diagnostic flowchart. A total of 80 patients (47 men; median age, 42 years) were included, with 22 vascular lesions, 38 solid lesions, and 20 true cysts. The T2 composition, time-resolved MRA, and static internal enhancement were significantly different among the masses. Vascular pooling on time-resolved MRA was the sole predictor of vascular lesions (odds ratio = 722.0, p < 0.001). Solid stain on time-resolved MRA was the sole predictor of solid lesions (odds ratio = 73.6, p < 0.001). Occult lesion on time-resolved MRA (odds ratio = 7.4, p = 0.001) and absence of static internal enhancement (odds ratio = 80.0, p < 0.001) both predicted true cysts, while the latter was the sole predictor of true cysts after multivariate analysis. A diagnostic flowchart based on time-resolved MRA correctly classified 89% of the masses. In conclusion, time-resolved MRA accurately differentiates cyst-like soft-tissue masses and provides guidance for management.

Highlights

A cyst-like soft-tissue mass is defined as a lesion having bright signal intensity, equal to that of fluid, on T2-weighted or fluid-sensitive MRI sequences [1,2]
The vascular lesions consisted of 20 hemangiomas and 2 lymphatic malformations; the solid lesions consisted of 22 benign solid lesions and 16 malignant solid lesions
Vascular pooling on time-resolved magnetic resonance angiography (MRA) was the sole predictor of vascular lesions

Summary

Introduction

A cyst-like soft-tissue mass is defined as a lesion having bright signal intensity, equal to that of fluid, on T2-weighted or fluid-sensitive MRI sequences [1,2]. These lesions include true cysts and cyst-like masses (vascular lesions or solid lesions), and they could substantially overlap in images [1,3,4]. True cysts, such as ganglions or synovial cysts, may have a complex appearance and mimic solid lesions due to hemorrhage or infection [1] Vascular lesions, such as hemangiomas or vascular malformations, may be heterogeneously bright on T2-weighted images because of mixed slow and rapid blood flow within lesions [5,6,7]. Developing a practical imaging approach is crucial for clinical management

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