Fibrolipomatous hamartoma: pathognomonic on MR imaging

Purpose. To assess the MR imaging characteristics, presenting symptoms, age and nerve distribution of fibrolipomatous hamartoma. Design. A computer search was performed of the term fibrolipomatous hamarto ma through the musculoskeletal section MR imaging results at our institutio n from June 7, 1996 to January 21. 1998 followed by a search of the terms l ipomatous hamartoma, median nerve, surrounding Fat, increased fatty signal, coaxial, and neuroma. MR images and medical files were retrospectively rev iewed by two experienced musculoskeletal radiologists for imaging character istics. nerve and age distribution as well as for history of trauma. In add ition three consultation cases from outside institutions were added for det ermination of image characteristics. Results. Ten fibrolipomatous hamartomas were identified: eight in the media n nerve, one in the ulnar nerve and one in the sciatic nerve. Mean age was 32.3 years (range 4-75 years, SD 21 years). Imaging characteristics were se rpiginous low-intensity structures representing thickened nerve fascicles, surrounded by evenly distributed fat, high signal intensity on T1-weighted sequences and low signal intensity on T2-weighted sequences. The amount of fat varied; however, distribution in eight cases (80%) was predominantly be tween nerve fibers rather than surrounding them peripherally. All had a coa xial-cable-like appearance on axial planes and a spaghetti-like appearance on coronal planes that was not seen in any other type of median nerve abnor mality imaged during the study period. Conclusion. The MR imaging characteristics of fibrolipomatous hamartoma are pathognomonic, obviating the need for biopsy for diagnosis.