MULTIFOCAL VASCULAR-LESIONS OF BONE IMAGING CHARACTERISTICS

Objective. Multifocal vascular processes which arise in bone are a ver y inhomogeneous class of diseases. Four of these processes are derived from endothelial precursors, however, and share a similar radiographi c spectrum. These four entities are reviewed in order to clarify their imaging patterns and the diagnostic utility of imaging modalities. Me thods. Eight cases of cystic angiomatosis, multifocal hemangioma, hema ngioendothelioma and angiosarcoma presenting to a tertiary referral ce nter over a 7-year period were reviewed. The medical literature was al so reviewed for information concerning the imaging of these processes. Results. All four diseases produced radiolucent defects on plain radi ographs with variable margination reflecting the aggressiveness of the lesions. Computed tomography was used to examine five patients and pr ovided supportive, though generally non-diagnostic, information in the five cases in which it was performed. Radionuclide bone scintigraphy, as reported in the literature, underestimated the extent of skeletal involvement in all eight cases, though some lesions were identified. R adionuclide imaging with labeled red blood cells, performed in three c ases, did not add any information, which is contrary to some reports i n the literature. Magnetic resonance imaging proved the most sensitive for identifying lesions, although the imaging characteristics were no t diagnostic. Conclusions. Plain radiographs are the mainstay for imag ing multifocal endothelial processes. Radiographs provide information on aggressiveness, multifocality and distribution of lesions. Computed tomography provides similar information. Magnetic resonance imaging o ften detects additional lesions. The insensitivity of radionuclide bon e scintigraphy is surprising. Reports of unique deposition of radionuc lide in tagged red blood cell scanning has been reported to support th e diagnosis of vascular lesions, but it did not do so in these cases.