Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany.
Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Frankfurt am Main, Germany.
Br J Radiol. 2023 Mar 1;96(1144):20220849. doi: 10.1259/bjr.20220849. Epub 2023 Feb 14.
The objective of this work was to evaluate the incremental value of MR angiography over plain radiographs and MRI for the differentiation of aneurysmal bone cysts (ABCs) from unicameral bone cysts (UBCs).
Thirty-six juvenile patients with histologically secured primary ABCs or UBCs were included in this retrospective study. Two radiologists assessed all obtained images in a blinded fashion using a catalog of previously suggested imaging findings. A second readout with supplementary MR angiography images was performed after 8 weeks to prevent observer recall bias. Diagnostic accuracy parameters were calculated for individual imaging findings, and overall diagnostic accuracy and diagnostic confidence were assessed for all readouts. Receiver operating characteristic (ROC) curve comparison was used to determine the incremental value of MR angiography.
Of 16 imaging features, only abnormal vascularization in MR angiography provided sufficient diagnostic accuracy for the identification of ABCs. Other imaging features such as fluid-fluid levels and internal septations were insufficient for the differentiation of UBCs from ABCs. Availability of MR angiography images significantly increased diagnostic accuracy (94.4 75.0% and 83.3 69.4%, respectively, < 0.05) and diagnostic confidence (4.5 3.7, < 0.05) of reading radiologists.
The presence of arterial feeders in MR angiography can accurately discriminate primary ABCs from UBCs and increases the diagnostic accuracy and diagnostic confidence of reporting radiologists.
Radiographic differentiation of cystic bone lesions such as ABCs and UBCs remains challenging. We demonstrate that MR angiography provides incremental value and suggest inclusion in standard examination protocols.
本研究旨在评估磁共振血管造影（MRA）相对于平片和 MRI 在鉴别动脉瘤样骨囊肿（ABC）和单纯性骨囊肿（UBC）中的作用。
本回顾性研究纳入了 36 例经组织学证实的原发性 ABC 或 UBC 患者。两名放射科医生以盲法方式使用先前提出的影像学表现目录评估所有获得的图像。8 周后进行第二次阅读，增加 MRA 图像以防止观察者回忆偏倚。计算单个影像学表现的诊断准确性参数，并评估所有读片的总体诊断准确性和诊断信心。采用接受者操作特征（ROC）曲线比较来确定 MRA 的附加价值。
在 16 种影像学特征中，只有 MRA 中的异常血管化对 ABC 的识别具有足够的诊断准确性。其他影像学特征，如液-液平面和内部分隔，不足以区分 UBC 和 ABC。MRA 图像的可用性显著提高了诊断准确性（94.4%比 75.0%，83.3%比 69.4%，均<0.05）和读片放射科医生的诊断信心（4.5 比 3.7，均<0.05）。
MRA 中动脉供血的存在可以准确地区分原发性 ABC 和 UBC，并提高报告放射科医生的诊断准确性和诊断信心。
囊性骨病变（如 ABC 和 UBC）的影像学鉴别仍然具有挑战性。我们证明 MRA 具有附加价值，并建议将其纳入标准检查方案。
