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Ultrasound and Magnetic Resonance Imaging Features of Calcifying Aponeurotic Fibromas
Author(s) -
Kang Ji Hee,
Lee Kyoungbun,
Yoo Hye Jin,
Chae Hee Dong,
Hong Sung Hwan,
Choi JaYoung
Publication year - 2020
Publication title -
journal of ultrasound in medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.574
H-Index - 91
eISSN - 1550-9613
pISSN - 0278-4297
DOI - 10.1002/jum.15222
Subject(s) - medicine , echogenicity , magnetic resonance imaging , soft tissue , calcification , ultrasound , radiography , radiology , anatomy , nuclear medicine
Objectives To report characteristic imaging findings of calcifying aponeurotic fibromas (CAFs) on ultrasound (US) and magnetic resonance imaging (MRI). Methods Eight patients with CAF based on our institutional pathology database from 2000 to 2019 were consecutively included. Images were assessed as follows: with plain radiographs for the presence of soft tissue calcifications; with US for the presence of microlithiasis (a nonshadowing hyperechoic focus <3 mm) and discrete calcifications, size, location, margin, echogenicity, and relationship with surrounding structures; and with MRI for the presence of MRI microlithiasis (scattered tiny signal‐void dots), margin, signal intensity, contrast enhancement pattern, and relationship with surrounding structures. Results Calcifying aponeurotic fibromas occurred most commonly in the foot (n = 5), followed by the hand, ankle, and knee, respectively. Half of the lesions (n = 4) showed intralesional calcifications on plain radiographs. On US, all lesions showed microlithiasis. They involved the subcutaneous (n = 5), perifascial (n = 2), and intermuscular (n = 1) layers. Margins were circumscribed (n = 3) or irregular (n = 5), whereas the echogenicity of the underlying tumor matrix was hyperechoic (n = 4), isoechoic (n = 2), or hypoechoic (n = 2). All lesions were abutting (n = 7) or encasing (n = 1) an adjacent tendon. On MRI, all CAFs showed tiny signal‐void dots and irregular margins. Signal intensity was mostly hyperintense (n = 5) on T2‐weighted images and all hypointense on T1‐weighted images. Three lesions showed heterogeneous contrast enhancement, and 3 showed uneven marginal enhancement. Conclusions A CAF should be considered a differential diagnosis if a soft tissue mass abutting or encasing the tendon or fascia shows US or MRI microlithiasis.