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Multimodality imaging of intraosseous ganglia of the wrist and their differential diagnosis

Imaging integrato e diagnosi differenziale dei gangli intraossei del polso

  • Musculoskeletal Radiology / Radiologia Muscolo-Scheletrica
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Intraosseous ganglion (IOG) is the most frequently occurring bone lesion within the carpus and is often an incidental finding on radiographs obtained for other reasons. Two types of IOG have been described: an “idiopathic” form (or type I), the pathogenesis of which has not been completely clarified, and a “penetrating” form (or type II), caused by the intrusion of juxtacortical material (often a ganglion cyst of the dorsal soft tissue) into the cancellous bone compartment. The differential diagnosis for IOG is wide-ranging and complex, including lesions of posttraumatic (posttraumatic cystlike defects), degenerative (subchondral degenerative cysts), inflammatory [cystic rheumatoid arthritis, chronic tophaceous gout (CTG)], neoplastic (benign primary bone tumours and synovial proliferative lesions), ischaemic (Kienböck’s disease or avascular osteonecrosis of the lunate) and metabolic (amyloidosis) origin. Multimodality imaging of IOGs is a useful diagnostic tool that provides complete morphological characterisation and differentiation from other intraosseous cystic abnormalities of the carpus. Thin-slice multidetector computed tomography (MDCT) can provide high-spatial-resolution images of the cortical and cancellous bone compartments, allowing detection of morphological findings helpful in characterising bone lesions, whereas magnetic resonance (MR) imaging can simultaneously visualise bone, articular surfaces, hyaline cartilage, fibrocartilage, capsules and ligaments, along with intra- and periarticular soft tissues.

Riassunto

Il ganglio intraosseo (IOG) è la lesione ossea del carpo di più frequente riscontro e spesso rappresenta un reperto occasionale in esami radiografici eseguiti per altri motivi. I IOG vengono distinti in due forme: la forma idiopatica (o tipo I), la cui patogenesi non è stata ancora completamente chiarita, e quella penetrante (o tipo II), determinata dall’intrusione nel compartimento spongioso di materiale juxtacorticale, spesso rappresentato da un ganglio dei tessuti molli dorsali del carpo. La diagnosi differenziale dei IOG è ampia ed articolata, includendo lesioni di origine post-traumatica (difetti simil-cistici post-traumatici, PTCD), degenerativa (cisti subcondrali degenerative, SDC), infiammatoria (artrite reumatoide cistica e gotta cronica tofacea), neoplastica (tumori ossei primitivi e lesioni proliferative sinoviali benigne), ischemica (morbo di Kienbock od osteonecrosi avascolare del semilunare) e metabolica (amiloidosi). L’imaging integrato dei IOG è fondamentale per la loro completa caratterizzazione morfologica e per distinguerli dalle altre lesioni pseudocistiche intraspongiose che si possono sviluppare nelle ossa del carpo. La tomografia computerizzata multi-detettore (MDCT) consente di ottenere immagini ad elevata risoluzione spaziale dei compartimenti ossei corticale e spongioso, permettendo di rilevare elementi morfologici utili ad una precisa caratterizzazione delle lesioni ossee, mentre la risonanza magnetica (RM) offre il vantaggio di visualizzare simultaneamente la componente ossea, le superfici articolari, gli spessori condrali, le strutture fibrocartilaginee, capsulo-legamentose ed i tessuti molli intra- e peri-articolari.

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Authors and Affiliations

  1. S.C. Radiodiagnostica, Dipartimento Area Radiologica, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128, Genova, Italy

    F. Paparo, E. Fabbro, R. Piccazzo, M. Revelli, G. Ferrero, A. Muda & G. Garlaschi

  2. Clinica Reumatologica, Dipartimento di Medicina Interna (DIMI), Università di Genova, Viale Benedetto XV 6, 16132, Genoa, Italy

    M. A. Cimmino

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  1. F. Paparo
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  2. E. Fabbro
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  3. R. Piccazzo
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  4. M. Revelli
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Correspondence to F. Paparo.

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Paparo, F., Fabbro, E., Piccazzo, R. et al. Multimodality imaging of intraosseous ganglia of the wrist and their differential diagnosis. Radiol med 117, 1355–1373 (2012). https://doi.org/10.1007/s11547-012-0875-x

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  • DOI: https://doi.org/10.1007/s11547-012-0875-x

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