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Imaging of Musculoskeletal Fibromatosis¹

¹ From the Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University School of Medicine, 10900 Euclid Ave, Cleveland, OH 44106 (M.R.R.); the Department of Radiologic Pathology, Armed Forces Institute of Pathology, Washington, DC (M.D.M., J.J.C.); the Departments of Radiology and Nuclear Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md (M.D.M.); the Department of Radiology, University of Maryland School of Medicine, Baltimore (M.D.M.); the Department of Orthopedic Surgery, University of Miami School of Medicine, Miami, Fla (H.T.T.); and the Department of Radiology, Mayo Clinic, Jacksonville, Fla (M.J.K.). Recipient of a Certificate of Merit award for a scientific exhibit at the 1997 RSNA scientific assembly. Received June 5, 2000; revision requested July 14; final revision received February 15, 2001; accepted February 15. Address correspondence to M.R.R. (e-mail: robbin@uhrad.com).

The musculoskeletal fibromatoses comprise a wide range of lesions with a common histopathologic appearance. They can be divided into two major groups: superficial and deep. The superficial fibromatoses are typically small, slow-growing lesions and include palmar fibromatosis, plantar fibromatosis, juvenile aponeurotic fibroma, and infantile digital fibroma. The deep fibromatoses are commonly large, may grow rapidly, and are more aggressive. They include infantile myofibromatosis, fibromatosis colli, extraabdominal desmoid tumor, and aggressive infantile fibromatosis. Radiographs typically reveal a nonspecific soft-tissue mass, and calcification is common only in juvenile aponeurotic fibroma. Advanced imaging (ultrasonography, computed tomography, and magnetic resonance [MR] imaging) demonstrates lesion extent. Involvement of adjacent structures is common, reflecting the infiltrative growth pattern often seen in these lesions. MR imaging may show characteristic features of prominent low to intermediate signal intensity and bands of low signal intensity representing highly collagenized tissue. However, fibromatoses with less collagen and more cellularity may have nonspecific high signal intensity on T2-weighted images. Local recurrence is frequent after surgical resection due to the aggressive lesion growth. It is important for radiologists to recognize the imaging characteristics of musculoskeletal fibromatoses to help guide the often difficult and protracted therapy and management of these lesions.

Index Terms: Bones, fibroma, 40.313 • Desmoid, 40.313 • Fibromatosis, 40.1544, 40.313, 40.3132 • Soft tissues, fibroma, 40.1544, 40.313

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