Radiologic evaluation of knee tumors in adults
- Shahla Modarresi, MD
Shahla Modarresi, MD
- Associate Clinical Professor of Radiology
- David Geffen School of Medicine at UCLA
- Cecilia Matilda Jude, MD
Cecilia Matilda Jude, MD
- Clinical Professor of Radiology
- David Geffen School of Medicine at UCLA
The knee is one of the largest and most complex joints in the body. It is lined by synovium and consists of two hinge-type joints between the femoral condyles and the medial and lateral tibial plateaus, and of a gliding-type joint between the patella and the trochlear groove of the anterior distal femur (figure 1) .
The radiographic evaluation of suspected or clinically apparent tumors of or near the knee is addressed here, including plain film, magnetic resonance imaging (MRI), and computed tomography (CT) features and the radiographic appearance of selected tumor-like intraarticular disorders.
The history and physical examination, which are necessary to develop a differential diagnosis prior to the selection of imaging tests, a general review of imaging tests that are used in the evaluation of bone and joint pain, and the use of imaging in the assessment of children and adolescents with knee pain are presented separately. (See "General evaluation of the adult with knee pain" and "Imaging techniques for evaluation of the painful joint" and "Approach to acute knee pain and injury in children and skeletally immature adolescents" and "Approach to chronic knee pain or injury in children or skeletally immature adolescents".)
IMAGING MODALITIES FOR MASS LESIONS OF THE KNEE
Plain film radiography, computed tomography (CT), and magnetic resonance imaging (MRI) are the mainstays of diagnostic imaging for patients with intraarticular or juxtaarticular bony or soft tissue mass lesions . The following is a brief discussion of the role of each of these modalities in assessing knee tumors and tumor-like disorders.
Plain film radiography — Plain film is the initial modality of choice for detection and assessment of the general features of the tumor. Accuracy of plain film for detection of soft tissue tumors is limited. Plain film is the most valuable method to evaluate the margin between normal bone and a neoplasm that is characteristic of bone tumor (zone of transition). Radiographic features of the zone of transition are important in distinguishing between benign and malignant bone lesions. Plain film radiography also demonstrates the extent of cortical destruction, periosteal reaction, matrix calcifications, and pathological fractures. Certain radiographic patterns, combined with the age of the patient, can be very suggestive of specific tumors.
- Frick MA, Wenger DE, Adkins M. MR imaging of synovial disorders of the knee: an update. Radiol Clin North Am 2007; 45:1017.
- http://www.acr.org/~/media/ACR/Documents/AppCriteria/Diagnostic/PrimaryBoneTumors.pdf (Accessed on March 12, 2014).
- Goldman AB, DiCarlo EF. Pigmented villonodular synovitis. Diagnosis and differential diagnosis. Radiol Clin North Am 1988; 26:1327.
- Beall DP, Ly JQ, Wolff JD, et al. Cystic masses of the knee: magnetic resonance imaging findings. Curr Probl Diagn Radiol 2005; 34:143.
- Norman A, Steiner GC. Bone erosion in synovial chondromatosis. Radiology 1986; 161:749.
- McKenzie G, Raby N, Ritchie D. A pictorial review of primary synovial osteochondromatosis. Eur Radiol 2008; 18:2662.
- Vilanova JC, Barceló J, Villalón M, et al. MR imaging of lipoma arborescens and the associated lesions. Skeletal Radiol 2003; 32:504.
- Subhas N, Bui KL, Sundaram M, et al. Incidental tumor and tumor-like lesions around the knee. Semin Musculoskelet Radiol 2009; 13:353.
- Kransdorf MJ, Peterson JJ, Bancroft LW. MR imaging of the knee: incidental osseous lesions. Radiol Clin North Am 2007; 45:943.
- Resnick D. Tumor and tumor-like lesions of bone: Imaging and pathology of specific lesions. In: Diagnosis of Bone and Joint Disorders, 4th, 2002. Vol 4, p.3763.
- Taylor JA, Hughes TH, Resnick D. Part III: Pelvis and lower extremities, knee. In: Skeletal Imaging: Atlas of the Spine and Extremities, 2009. p.547.
- Butler MG, Fuchigami KD, Chako A. MRI of posterior knee masses. Skeletal Radiol 1996; 25:309.
- Fletcher CDM, Chibon F, Mertens F. Undifferentiated/unclassified sarcomas. In: WHO classifiction of tumours of soft tissue and bone, 4th, Fletcher CDM, Bridge JA, Hogendoorn PCW, Mertens F. (Eds), IARC, Lyon 2013. p.236.
- van Vliet M, Kliffen M, Krestin GP, van Dijke CF. Soft tissue sarcomas at a glance: clinical, histological, and MR imaging features of malignant extremity soft tissue tumors. Eur Radiol 2009; 19:1499.
- IMAGING MODALITIES FOR MASS LESIONS OF THE KNEE
- Plain film radiography
- CT scanning
- MR imaging
- Radionuclide scan
- INTRAARTICULAR TUMORS AND TUMOR-LIKE LESIONS
- Tenosynovial giant cell tumor
- Synovial (osteo)chondromatosis
- Synovial hemangioma
- Lipoma arborescens
- Synovial sarcoma
- Synovial chondrosarcoma
- JUXTAARTICULAR BONE OR SOFT TISSUE TUMOR
- Nonossifying fibroma (NOF)
- Giant cell tumor
- Aneurysmal bone cyst (ABC)
- Osteosarcoma (conventional)
- Osteosarcoma (parosteal)
- Skeletal metastasis
- Multiple myeloma
- Soft tissue sarcomas