Fibroma MRI

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Maneesha Nandimandalam, M.B.B.S.[2], Simrat Sarai, M.D. [3]

Overview

MRI may be helpful in the diagnosis of fibroma. On MRI, fibromas appear isointense or hypointense on T1 sequences and hyperintense on T2 sequences.

MRI Findings

MRI findings of ovarian fibroma include the following:[1][2][3][4][5][6]

MRI component Features
T1
  • Fibromas usually demonstrate homogeneous low signal intensity
T2
  • Fibromas appear as well-circumscribed masses with low signal intensity
  • May contain scattered hyperintense areas representing edema or cystic degeneration
  • A band of T2 hypointensity separating the tumor from the uterus on all imaging planes is also considered a characteristic feature
T1 contrast + gadolinium

Non-ossifying Fibroma

  • MRI appearances of non-ossifying fibroma are variable and depends on when along the development and healing phase the lesion is imaged. Initially, the lesion has high or intermediate T2 signal, with a peripheral low signal rim corresponding to the sclerotic border. As it matures and begins to ossify, the signal becomes low on all sequences.
  • Contrast enhancement is also variable.[7][8]

Ossifying Fibroma

  • MRI findings of ossifying fibroma includes the following:[9][10][11][12][13][14]
    • T1: low signal
    • T2: iso-high signal
    • T1 C+ (Gd): typically shows enhancement

Chondromyxoid Fibroma

  • MRI features of chondromyxoid fibromas are often not particularly specific. Signal characteristics include the following:[15][16][17][18][19]
    • T1: low signal
    • T1 C+ (Gd)
    • T2: high signal

Desmoplastic Fibroma

  • There is considerable overlap with other bony lesions on MRI appearances of desmoplastic fibroma. Signal characteristics include the following:[20][21][22][23]
    • T1: typically low signal
    • T2: has background intermediate to high signal with intrinsic low to intermediate intensity foci within 7
    • T1 C+ (Gd): often shows heterogeneous enhancement

Cardiac Fibromas

  • Because of their dense, fibrous nature, the tumors are usually homogeneous and hypointense on T2-weighted MR images and isointense relative to muscle on T1-weighted images. Cardiac fibroma often demonstrate little or no contrast material enhancement.

Pleural Fibromas

Cemento-ossifying Fibroma

  • Although cemento-ossifying fibroma are composed of a mixture of calcified and noncalcified soft-tissue, as the later is predominantly fibrous, the whole mass is largely of low intensity on MRI.[27][28][29]
    • T1:
      • Intermediate to low signal
      • Focal regions of higher signal may represent fatty marrow in ossified components
    • T2:
      • Low signal
    • T1 C+ (Gd)

Uterine Fibromas

  • MRI is not generally required for diagnosis, except for complex or problem-solving cases. It is, however, the most accurate modality for detecting, localizing and characterising fibroids. Size, location and signal intensity should be noted. Signal characteristics are variable and include the following:[30][31][32][33][34][35][36]
    • T1
      • Non-degenerated fibroids and calcification appear as low to intermediate signal intensity compared with the normal myometrium
      • Characteristic high signal intensity on T1 weighted images/an irregular, T1 hyperintense rim around a centrally located myoma suggests red degeneration, which is caused by venous thrombosis
    • T2
      • Non-degenerated fibroids and calcification appear as low signal intensity
      • As they are usually hypervascular, flow voids are often observed around them
      • Fibroids that have undergone cystic degeneration/necrosis can have a variable appearance, usually appearing high signal on T2 sequences.
      • Hyaline degeneration is demonstrated as low T2 signal intensity
      • Cystic degeneration, which is an advanced stage of intratumoral edema, also shows high signal intensity on T2 weighted images and does not enhance
    • T1 C+ (Gd)
      • Variable enhancement is seen with contrast administration
      • Marked high signal intensity with gradual enhancement suggests myxoid degeneration

References

  1. ↑ R. K. Schwartz, D. Levine, H. Hatabu & R. R. Edelman (1997). "Ovarian fibroma: findings by contrast-enhanced MRI". Abdominal imaging. 22 (5): 535–537. PMID 9233896. Unknown parameter |month= ignored (help)
  2. ↑ J. Ueda, T. Furukawa, K. Higashino, K. Ueda, S. Kobayashi, K. Shimura, T. Tsujimura & Y. Araki (1998). "Ovarian fibroma of high signal intensity on T2-weighted MR image". Abdominal imaging. 23 (6): 657–658. PMID 9922206. Unknown parameter |month= ignored (help)
  3. ↑ Troiano, R N; Lazzarini, K M; Scoutt, L M; Lange, R C; Flynn, S D; McCarthy, S (1997). "Fibroma and fibrothecoma of the ovary: MR imaging findings". Radiology. 204 (3): 795–798. doi:10.1148/radiology.204.3.9280262. ISSN 0033-8419.
  4. ↑ Oh, S.N.; Rha, S.E.; Byun, J.Y.; Lee, Y.J.; Jung, S.E.; Jung, C.K.; Kim, M.R. (2008). "MRI features of ovarian fibromas: emphasis on their relationship to the ovary". Clinical Radiology. 63 (5): 529–535. doi:10.1016/j.crad.2007.10.006. ISSN 0009-9260.
  5. ↑ KITAJIMA, Kazuhiro; KAJI, Yasushi; SUGIMURA, Kazuro (2008). "Usual and Unusual MRI Findings of Ovarian Fibroma: Correlation with Pathologic Findings". Magnetic Resonance in Medical Sciences. 7 (1): 43–48. doi:10.2463/mrms.7.43. ISSN 1880-2206.
  6. ↑ Ohara, N.; Murao, S. (2009). "Magnetic resonance appearances of ovarian fibroma with myxomatous changes". Journal of Obstetrics and Gynaecology. 22 (5): 569–570. doi:10.1080/014436102760298980. ISSN 0144-3615.
  7. ↑ Katchy, AmechiUchenna; Eyesan, SamuelUwale; Idowu, OlukayodeOluseyi; Adesina, StephenAdesope; Ayandele, BabajideOladayo; Ano-Edward, U (2018). "Non-ossifying fibroma of the right clavicle". Nigerian Postgraduate Medical Journal. 25 (2): 126. doi:10.4103/npmj.npmj_60_18. ISSN 1117-1936.
  8. ↑ Rogozhin, D. V.; Konovalov, D. M.; Kozlov, A. S.; Talalaev, A. G.; Ektova, A. P. (2016). "Non-ossifying fibroma (metaphyseal fibrous defect)". Arkhiv patologii. 78 (2): 36. doi:10.17116/patol201678236-40. ISSN 0004-1955.
  9. ↑ Kawaguchi, Masaya; Kato, Hiroki; Miyazaki, Tatsuhiko; Kato, Keizo; Hatakeyama, Daijiro; Mizuta, Keisuke; Aoki, Mitsuhiro; Matsuo, Masayuki (2018). "CT and MR imaging characteristics of histological subtypes of head and neck ossifying fibroma". Dentomaxillofacial Radiology. 47 (6): 20180085. doi:10.1259/dmfr.20180085. ISSN 0250-832X.
  10. ↑ Owosho, Adepitan A.; Hughes, Marion A.; Prasad, Joanne L.; Potluri, Anitha; Costello, Bernard J.; Branstetter, Barton F. (2015). "Is Computed Tomography an Adequate Imaging Modality for the Evaluation of Juvenile Ossifying Fibroma? A Comparison of 2 Imaging Modalities (Computed Tomography and Magnetic Resonance Imaging)". Journal of Oral and Maxillofacial Surgery. 73 (7): 1304–1313. doi:10.1016/j.joms.2015.01.013. ISSN 0278-2391.
  11. ↑ Hara, Marina; Matsuzaki, Hidenobu; Katase, Naoki; Yanagi, Yoshinobu; Unetsubo, Teruhisa; Asaumi, Jun-ichi; Nagatsuka, Hitoshi (2012). "Ossifying fibroma of the maxilla: a case report including its imaging features and dynamic magnetic resonance imaging findings". Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology. 114 (4): e139–e146. doi:10.1016/j.oooo.2012.04.015. ISSN 2212-4403.
  12. ↑ Yang, B.T.; Wang, Y.Z.; Wang, X.Y.; Wang, Z.C. (2012). "Imaging study of ossifying fibroma with associated aneurysmal bone cyst in the paranasal sinus". European Journal of Radiology. 81 (11): 3450–3455. doi:10.1016/j.ejrad.2012.05.010. ISSN 0720-048X.
  13. ↑ Chaudhari, Swapnali; Umarji, Hemant R. (2011). "Peripheral Ossifying Fibroma in the Oral Cavity: MRI Findings". Case Reports in Dentistry. 2011: 1–3. doi:10.1155/2011/190592. ISSN 2090-6447.
  14. ↑ Salina, Andrea Carolina Inacio; Souza, Pedro Mansueto Melo de; Gadelha, Camila Maria da Costa; Aguiar, Lindenberg Barbosa; Castro, José Daniel Vieira de; Barreto, André Rodrigues Façanha (2017). "Ossifying fibroma: an uncommon differential diagnosis for T2-hypointense sinonasal masses". Radiology Case Reports. 12 (2): 313–317. doi:10.1016/j.radcr.2017.03.019. ISSN 1930-0433.
  15. ↑ Cappelle, Sarah; Pans, Steven; Sciot, Raf (2016). "Imaging features of chondromyxoid fibroma: report of 15 cases and literature review". The British Journal of Radiology. 89 (1064): 20160088. doi:10.1259/bjr.20160088. ISSN 0007-1285.
  16. ↑ Shen, Shuai; Chen, Miao; Jug, Rachel; Yu, Cheng-Qian; Zhang, Wan-Lin; Yang, Lian-He; Wang, Liang; Yu, Juan-Han; Lin, Xu-Yong; Xu, Hong-Tao; Ma, Shuang (2017). "Radiological presentation of chondromyxoid fibroma in the sellar region". Medicine. 96 (49): e9049. doi:10.1097/MD.0000000000009049. ISSN 0025-7974.
  17. ↑ Oh, Noeun; Khorsandi, Azita S.; Scherl, Sophie; Wang, Beverly; Wenig, Bruce M.; Manolidis, Spiros; Jacobson, Adam (2019). "Chondromyxoid Fibroma of the Mastoid Portion of the Temporal Bone: MRI and PET/CT Findings and Their Correlation with Histology". Ear, Nose & Throat Journal. 92 (4): 201–203. doi:10.1177/014556131309200412. ISSN 0145-5613.
  18. ↑ Kim, Hyun-Soo; Jee, Won-Hee; Ryu, Kyung-Nam; Cho, Kil-Ho; Suh, Jin-Suck; Cho, Jae-Hyun; Choi, Yun-Sun; Lee, Sung Moon; Lee, Jong-Min; Sung, Mi Sook; Kim, Jee Young; Jung, Eun Sun; Chung, Yang-Guk; Ok, In-Young (2011). "MRI of chondromyxoid fibroma". Acta Radiologica. 52 (8): 875–880. doi:10.1258/ar.2011.110180. ISSN 0284-1851.
  19. ↑ Tarhan, N. C.; Yologlu, Z.; Tutar, N. U.; Coskun, M.; Agildere, A. M.; Arikan, U. (2000). "Chondromyxoid fibroma of the temporal bone: CT and MRI findings". European Radiology. 10 (10): 1678–1680. doi:10.1007/s003300000323. ISSN 0938-7994.
  20. ↑ Frick, Matthew A.; Sundaram, Murali; Unni, Krishnan K.; Inwards, Carrie Y.; Fabbri, Nicola; Trentani, Federico; Baccini, Patrizia; Bertoni, Franco (2005). "Imaging Findings in Desmoplastic Fibroma of Bone: Distinctive T2 Characteristics". American Journal of Roentgenology. 184 (6): 1762–1767. doi:10.2214/ajr.184.6.01841762. ISSN 0361-803X.
  21. ↑ Kim, Ok Hwa; Kim, Seon Jeong; Kim, Ji Yeon; Ryu, Ji Hwa; Choo, Hye Jung; Lee, Sun Joo; Lee, In Sook; Suh, Kyung Jin (2013). "Desmoplastic Fibroma of Bone in a Toe: Radiographic and MRI Findings". Korean Journal of Radiology. 14 (6): 963. doi:10.3348/kjr.2013.14.6.963. ISSN 1229-6929.
  22. ↑ Shuto, Rieko; Kiyosue, Hiro; Hori, Yuko; Miyake, Hidetoshi; Kawano, Katsunori; Mori, Hiromu (2001). "CT and MR imaging of desmoplastic fibroblastoma". European Radiology. 12 (10): 2474–2476. doi:10.1007/s00330-001-1217-x. ISSN 0938-7994.
  23. ↑ Gong, Li-Hua; Liu, Wei-Feng; Ding, Yi; Geng, Yue-Hang; Sun, Xiao-Qi; Huang, Xiao-Yuan (2018). "Diagnosis and Differential Diagnosis of Desmoplastic Fibroblastoma by Clinical, Radiological, and Histopathological Analyses". Chinese Medical Journal. 131 (1): 32–36. doi:10.4103/0366-6999.221274. ISSN 0366-6999.
  24. ↑ Carter, Brett W.; Betancourt, Sonia L.; Shroff, Girish S.; Lichtenberger, John P. (2018). "MR Imaging of Pleural Neoplasms". Topics in Magnetic Resonance Imaging. 27 (2): 73–82. doi:10.1097/RMR.0000000000000162. ISSN 0899-3459.
  25. ↑ Bickelhaupt, S.; Shah, R.; Schneider, S.; Wrazidlo, W.; Schlemmer, H.; Lederer, W. (2015). "Computer- und magnetresonanztomografische Charakterisierung eines solitären fibrösen Tumors der Pleura". RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren. 187 (06): 489–491. doi:10.1055/s-0034-1385819. ISSN 1438-9029.
  26. ↑ Mittal, MaheshKumar; Mittal, Aliza; Sinha, Mukul; Sureka, Binit; Thukral, BrijBhushan (2013). "Radiological review of pleural tumors". Indian Journal of Radiology and Imaging. 23 (4): 313. doi:10.4103/0971-3026.125577. ISSN 0971-3026.
  27. ↑ Chadwick, JW; Alsufyani, NA; Lam, EWN (2011). "Clinical and radiographic features of solitary and cemento-osseous dysplasia-associated simple bone cysts". Dentomaxillofacial Radiology. 40 (4): 230–235. doi:10.1259/dmfr/16355120. ISSN 0250-832X.
  28. ↑ Cavalcanti, Paulo Henrique Pereira; Nascimento, Eduarda Helena Leandro; Pontual, Maria Luiza dos Anjos; Pontual, Andréa dos Anjos; Marcelos, Priscylla Gonçalves Correia Leite de; Perez, Danyel Elias da Cruz; Ramos-Perez, Flávia Maria de Moraes (2018). "Cemento-Osseous Dysplasias: Imaging Features Based on Cone Beam Computed Tomography Scans". Brazilian Dental Journal. 29 (1): 99–104. doi:10.1590/0103-6440201801621. ISSN 1806-4760.
  29. ↑ Bala, Tapas; Soni, Sarmeshta; Dayal, Prakriti; Ghosh, Indrajeet (2017). "Cemento-ossifying fibroma of the mandible. A clinicopathological report". Saudi Medical Journal. 38 (5): 541–545. doi:10.15537/smj.2017.5.15643. ISSN 0379-5284.
  30. ↑ Nakai, Go; Yamada, Takashi; Hamada, Takamitsu; Atsukawa, Natsuko; Tanaka, Yoshikazu; Yamamoto, Kiyohito; Higashiyama, Akira; Juri, Hiroshi; Nakamoto, Atsushi; Yamamoto, Kazuhiro; Hirose, Yoshinobu; Ohmichi, Masahide; Narumi, Yoshifumi (2017). "Pathological findings of uterine tumors preoperatively diagnosed as red degeneration of leiomyoma by MRI". Abdominal Radiology. 42 (7): 1825–1831. doi:10.1007/s00261-017-1126-3. ISSN 2366-004X.
  31. ↑ Maciel, Cristina; Tang, Yen Zhi; Sahdev, Anju; Madureira, António Miguel; Vilares Morgado, Paulo (2017). "Preprocedural MRI and MRA in planning fibroid embolization". Diagnostic and Interventional Radiology. 23 (2): 163–171. doi:10.5152/dir.2016.16623. ISSN 1305-3825.
  32. ↑ Cassar Scalia, Ambra; Farulla, Antonino; Fiocchi, Federica; Alboni, Carlo; Torricelli, Pietro (2018). "Imaging features of uterine and ovarian fibromatosis in Nevoid Basal Cell Carcinoma Syndrome". Journal of Radiology Case Reports. 12 (9). doi:10.3941/jrcr.v12i9.3390. ISSN 1943-0922.
  33. ↑ Takeuchi, Mayumi; Matsuzaki, Kenji; Bando, Yoshimi; Harada, Masafumi (2019). "Evaluation of Red Degeneration of Uterine Leiomyoma with Susceptibility-weighted MR Imaging". Magnetic Resonance in Medical Sciences. 18 (2): 158–162. doi:10.2463/mrms.mp.2018-0074. ISSN 1347-3182.
  34. ↑ Rowland, Fauniel; Call, Catherine; Mujtaba, Bilal; Amini, Behrang; Wang, Wei-Lien (2018). "Calcified leiomyoma of the deltoid: pathophysiology and imaging review". Skeletal Radiology. 48 (4): 625–628. doi:10.1007/s00256-018-3053-y. ISSN 0364-2348.
  35. ↑ Gupta, Avantika; Gupta, Purnima; Manaktala, Usha (2018). "Varied Clinical Presentations, the Role of Magnetic Resonance Imaging in the Diagnosis, and Successful Management of Cervical Leiomyomas: A Case-Series and Review of Literature". Cureus. doi:10.7759/cureus.2653. ISSN 2168-8184.
  36. ↑ Stoelinga, Barbara; Hehenkamp, Wouter J.K.; Nieuwenhuis, Lotte L.; Conijn, Mandy M.A.; van Waesberghe, JanHein H.T.M.; Brölmann, Hans A.M.; Huirne, Judith A.F. (2018). "Accuracy and Reproducibility of Sonoelastography for the Assessment of Fibroids and Adenomyosis, with Magnetic Resonance Imaging as Reference Standard". Ultrasound in Medicine & Biology. 44 (8): 1654–1663. doi:10.1016/j.ultrasmedbio.2018.03.027. ISSN 0301-5629.


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