乳腺良恶性病变的磁共振T2*W首过灌注成像与血管生成相关性研究

Objective: To study the diagnostic value of T2*-weighted first-pass perfusion imaging in breast tumors. Methods:We analyzed the magnetic resonance imaging (MRI) information along with the pathological and immunohistochemistry results. Magnetic resonance imaging was performed in 28 patients with breast tumor. The time to signal intensity curves were generated according to the T2*-weighted first-pass perfusion imaging. The curve's maximal signal intensity drop rate and maximal signal intensity decrease time were analyzed and compared with the pathological diagnoses after surgery. Results:Malignant breast lesions showed higher maximal signal intensity drop rate (44.69% ± 17.07 vs. 17.22% ± 7.49, P ＜ 0.001)than benign lesions, but there was no significant difference of maximal signal decrease time between those two lesions (23.94 s ± 4.92 vs. 20.02 s ± 6.83, P ＞ 0.05). Conclusion: The T2*-weighted first-pass perfusion imaging has enough sensitivity and specificity in breast tumor diagnosis.     

颞叶放射性脑病磁共振成像的特征分析

Objective： To observe the magnetic resonance imaging （MRI） morphological features of radiation encephalopathy （REP） in nasopharyngeal carcinoma （NPC） and investigate their diagnostic value. Methods： The MRI data of 160 lesions from 104 NPC patients with the diagnosis of temporal lobe REP were retrospectively analyzed. The MRI was performed after radiation therapy of NPC with an interval ranged from 8 months to 13 years. The imaging sequences included T1-weighted imaging and T2-weighted imaging. Additionally T1-weighted imaging with injection of the contrast agent of Gd-DTPA was performed in 111 lesions and fluid attenuated inversion recovery （FLAIR） was performed on 37 lesions, and among them, 2 cases were subjected to MR perfusion weighted imaging （PWI）. Results： Unilateral temporal lobe was involved in 48 cases of REP, bilateral temporal lobe in 56 cases of REP respectively, with a total of 160 lesions. The REP in the white matter displayed hyper-intensity signal on T2-weighted imaging which could be homogenous, whereas areas with heterogeneous hypo-intensity signal could be seen in 59 of them otherwise with hyper-intensity signal, and 91 lesions of white matter were associated with gray matter lesions with an appearance of hypo-intensity signal on T1-weighted imaging and hyper-intensity signal on T2-weighted imaging. In 111 lesions with the Gd-DTPA enhanced T1-weigthed imaging, 91 showed the enhancement of brain parenchyma. Hemorrhage and hemosiderosis occurred in 5 lesions of REP. Conclusion： REP in NPC has a multiplicity of the imaging features on MRI, in addition to the common involvement of white matter, including other relatively frequent findings, such as the involvement of gray matter, hemorrhage, hemosiderosis and blood-brain barrier destruction, those could be clearly revealed on MRI.     

MRI Manifestions Correlate with Survival of Glioblastoma Multiforme Patients

Objective To identify the correlation between magnetic resonance manifestation and survival of patients with glioblastoma multiforme(GBM). Methods The magnetic resonance imaging(MRI) images of 30 glioblastoma patients were collected.Imaging features including degrees of contrasted area,edema surrounding the tumor,and intensity in T2-weighted imaging were selected to determine their correlation with patient survival.The relationship between imaging and survival time was studied using SPSS 19.0 software.KaplanMeier survival analysis and log-rank test were used to compare the survival curves. Results Patients with <5%contrasted enhancement area of tumor had longer overall survival(OS) than those with >5%contrasted enhancement area of tumor.Patients without edema surrounding the tumor had longer OS than those with edema.Patients with tumor of hyperintensity and/or isointensity in T2-weighted imaging had longer OS than those with hyperintensity and/or isointensity and hypointensity. Conclusions Some MR imaging features including degrees of contrasted area,edema surrounding the tumor,and intensity in T2- weighted imaging are correlated with the survival of patients with GBM.These features can serve as prognostic indicators for GBM patients.     

VX2兔脑瘤模型三维放疗解剖学靶区灌注CT与增强CT对照研究

Objective To compare the accuracy of blood volume perfusion imaging (perfusion CT)with contrast enhanced 64-slice spiral computed tomography (CECT) in the evaluation of gross tumor volume (GTV) and clinical target volume (CTV) using rabbits with VX2 brain tumor. Methods Perfusion CT and CECT were performed in 20 rabbits with VX2 brain tumor. The GTV and CTV calculated with the maximal and minimal diameter of each tumor in the blood volume (BV) maps and CECT were measured and compared to those in pathological specimens. Results The mean value of the maximal and minimal diameter of GTV was (8.19 ± 2. 29) mm and (4.83 ± 1.31) mm in pathological specimens, (11.98 ±3.29) mmand (7.03±1.82) mm in BV maps, while (6.36±3.85) mm and (3.17±1.93) mm in CECT images, which were significantly different (pathological specimen vs. BV map, t = 7. 17,P =0. 000;pathological specimen vs. CECT, t = 8.37, P = 0. 000, respectively). The mean value of the maximal and minimal diameter of CTV in pathologic specimens was (12.87 ± 3.74) mm and (7.71 ± 2. 15) mm, which was significantly different from that of GTV and CTV in CECT (t = - 3. 18, P = 0. 005 and t = - 4. 24, P =0. 000;t= -11.59,P=0.000 and t= -9.39,P=0.000), while similar with that of GTV in BV maps (t = - 1.95,P = 0. 067; t = - 2. 06, P = 0. 054). For CECT, the margin from GTV to CTV was 81.83% ±40.33% for the maximal diameter and 276.73% ± 131.46% for the minimal. While for BV maps, the margin was 7.93% ± 17. 84% and 12.52% ± 27. 83%, which was significant different from that for CECT images (t=7.36,P=0. 000 and t= -8.78,P=0.000). Conclusions Compared with CECT, the BV map from 64-slice spiral CT peffusion imaging might have higher accuracy in target volume delineation for brain tumor.     

VX2兔脑瘤模型三维放疗解剖学靶区灌注CT与增强CT对照研究

Objective To compare the accuracy of blood volume perfusion imaging (perfusion CT)with contrast enhanced 64-slice spiral computed tomography (CECT) in the evaluation of gross tumor volume (GTV) and clinical target volume (CTV) using rabbits with VX2 brain tumor. Methods Perfusion CT and CECT were performed in 20 rabbits with VX2 brain tumor. The GTV and CTV calculated with the maximal and minimal diameter of each tumor in the blood volume (BV) maps and CECT were measured and compared to those in pathological specimens. Results The mean value of the maximal and minimal diameter of GTV was (8.19 ± 2. 29) mm and (4.83 ± 1.31) mm in pathological specimens, (11.98 ±3.29) mmand (7.03±1.82) mm in BV maps, while (6.36±3.85) mm and (3.17±1.93) mm in CECT images, which were significantly different (pathological specimen vs. BV map, t = 7. 17,P =0. 000;pathological specimen vs. CECT, t = 8.37, P = 0. 000, respectively). The mean value of the maximal and minimal diameter of CTV in pathologic specimens was (12.87 ± 3.74) mm and (7.71 ± 2. 15) mm, which was significantly different from that of GTV and CTV in CECT (t = - 3. 18, P = 0. 005 and t = - 4. 24, P =0. 000;t= -11.59,P=0.000 and t= -9.39,P=0.000), while similar with that of GTV in BV maps (t = - 1.95,P = 0. 067; t = - 2. 06, P = 0. 054). For CECT, the margin from GTV to CTV was 81.83% ±40.33% for the maximal diameter and 276.73% ± 131.46% for the minimal. While for BV maps, the margin was 7.93% ± 17. 84% and 12.52% ± 27. 83%, which was significant different from that for CECT images (t=7.36,P=0. 000 and t= -8.78,P=0.000). Conclusions Compared with CECT, the BV map from 64-slice spiral CT peffusion imaging might have higher accuracy in target volume delineation for brain tumor.     

声辐射力脉冲超声弹性成像对乳腺实质性病灶的诊断(英文)

Objective:The aim of our study was to make the qualitative and quantitative analysis to breast lesions using acoustic radiation force impulses (ARFI), and assess the diagnostic value of ARFI for differentiation between benign and malignant solid breast masses, meanwhile evaluate the influences of ARFI with breast imaging reporting and data system (BI-RADS) of suspicious masses. Methods:Seventy-five women with 86 breast lesions underwent conventional breast ultrasound examination. Then B-mode BI-RADS features and assessments were recorded and standard breast US supplemented by ARFI elastographic examination were repeated. The data were recorded and analyzed as following:area ratio of breast lesion, the shear-wave velocity, the ratio of the shear-wave velocity between lesions and surrounding normal tissues, and according to the elastographic data reconsidered the BI-RADS category, all the results have been correlated with pathological results and make statistical evaluations of ARFI for differentiation between benign and malignant solid breast masses. Meantime our study has correlated the adjusted BI-RADS category of suspicious breast lesions with the pathological results and made assessment. Results:Thirty-eight patients were malignant breast carcinoma (31 invasive ductal carcinoma, 5 intraductal carcinoma in situ, 2 medullary carcinoma, 2 invasive lobular carcinoma), 48 patients were benign breast lesions (23 fibroadenoma, 12 benign nodular hyperplasia, 5 phyllodes tumor, 6 adenosis, 2 intraductal papilloma). Underwent conventional breast ultrasound exam, 42 cases were BI-RADS category 3, 23 cases were BI-RADS category 4. When adding elastographic data, 46 cases were BI-RADS category 3 and 20 cases were BI-RADS category 4. Compared with pathological results showed for both the specificity of BIRADS features and the area under ROC curve has risen. Virtual touch tissue imaging (VTI) and virtual touch tissue quantification (VTQ) data showed the area ratio (AR) between elastographic lesions area and B-mode lesions area, SWV (maximal shear-wave velocity of lesions), R-SWV (shear-wave velocity ratio between lesions and surrounding normal tissues) in benign breast lesions were lower than those in malignant lesions which has statistical significance and the cut-off point were 1.1, 4.65 m/s, 5.18 respectively. Conclusion:The ARFI elastography can provide the reliable qualitative and quantitative analysis about hardness of breast lesions, supply the new BI-RADS category features to suspicious breast masses and serve as an effective diagnostic tool for differentiation between benign and malignant solid masses.     

MR imaging features of solitary plasmacytoma of the spine

OBJECTIVE To evaluate the MR imaging features of solitary plasmacytomas of the spine. METHODS The MR images of 7 patients with histologically proven solitary plasmacytomas of the spine were reviewed. RESULTS All tumors showed predominantly isoto hypointensity relative to muscle on Tl-weighted MR images and intermediate signal intensity between muscle and fat on T2- weighted images. Curvilinear low signal intensity structures were seen within the lesions on T1 and T2-weighted images in five tumors. Moderate to strong enhancement was seen in all 6 tumors that underwent contrast enhanced MR examination. All tumors showed areas of high signal intensity on T2-weighted images and heterogeneous enhancement, except the 2 largest tumors without pathologic fracture in the sacrum. Intervertebral discs were preserved in all tumors. CONCLUSION The MR imaging features that suggest plasmacytorna of the spine include predominant intermediate signal intensity on T2-weighted images, curvilinear low signal intensity structures, moderate to strong enhancement, relatively homogeneous appearance if there are no pathologic fracture and preservation of the intervertebral discs.     

Comparative Study of Images with Pathology： Superparamagnetic Iron Oxide-enhanced Magnetic Resonance Image （MRI） of Splenic VX2 Tumor in Rats

Objective： To establish a rodent model of VX2 tumor of the spleen, to analyze relationship between the change of the signal intensity on superparamagnetic iron oxide enhanced magnetic resonance image （MRI） and pathologic change to evaluate the ability of superparamagnetic iron oxide enhanced MRI for detection of splenic metastases. Methods： 8 rodent models of VX2 tumor of spleen were established successfully. The images were obtained before and after administration of superparamagnetic iron oxide. T1-weighted spin-echo （SE） pulse sequence with a repetition time （TR） of 450 msec, and echo time （TE） of 12 msec （TR/TE=450/12） was used. The imaging parameters of T2-weighted SE pulse sequence were as follows： TR/TE=4000/128. Results： On plain MR scanning T1-weighted splenic VX2 tumor showed hypointensity or isointensity which approximated to the SI of splenic parenchyma. Therefore all lesions were not displayed clearly. On superparamagnetic iron oxide enhancement T2WI sequence the SI of splenic parenchyma decreased obviously with percentage of signal intensity loss （PSIL） of 55.04%, But the SI of tumor was not evidently changed with PSIL of 0.87%. Nevertheless the SNR of normal splenic parenchyma around the lesions had obvious difference （P〈0.001） comparatively. Therefore the contrast between tumor and spleen increased, and tumor displayed more clearly. Moreover the contrast-to-noise （CNR） between VX2 tumor and splenic parenchyma had an evident difference before and after admininstration of superparamagnetic iron oxide （P〈0.001）. Conclusion： On superparamagnetic iron oxide enhancement T1WI sequence the contrast of tumor-to-spleen is poor. Therefore it is not sensitive to characterize the lesions in spleen. On superparamagnetic iron oxide enhanced T2WI the contrast degree of lesions increases obviously. Consequently, superparamagnetic iron oxide -enhanced T2WI MRI scanning can improve the rate of detection and characterization for lesions of spleen.     

磁共振动态增强乳腺扫描及时间信号曲线结合在早期乳腺癌诊断中的应用价值(英文)

Objective: The aim of this study was to investigate the application value of breast dynamic contrast-enhanced magnetic resonance imaging combined with time signal curve in diagnosis of early breast cancer. Methods: Conducted dynamic contrast-enhanced MRI and drew the time signal curves of breast lesions in 60 patients with breast disease (malignant 46, benign 14). Results: Morphological features of malignant tumors mostly showed blurred or thin spiculate outlines, irregular shape or lobular signs, signal heterogeneity or peripheral enhancement in dynamic contrast-enhanced MRI. Time signal curve showed type Ⅲ or Ⅱ. Morphologic features of benign tumors mostly showed clear edge, regular shape and homogeneous signal, or diffuse spot enhancement. Time signal curve showed type Ⅰ or Ⅱ. Conclusion: breast dynamic contrast enhanced scan in MRI can provide morphology and functional diagnosis information of the breast tissues. Dynamic contrast-enhanced MRI combined with time signal curve can further improve the accuracy of diagnosis of early breast cancer.     

Efficacy of volume navigation in assessment of extent of breast cancer

Objective Volume navigation (Vnav) combines real-time ultrasound (US) with previously acquired volume data from magnetic resonance imaging (MRI) data into a single display. The efficacy of Vnav for preoperative assessment of the extent of breast cancer lesions was evaluated in the present study.Methods Twenty-nine breast cancer patients were evaluated using Vnav during second-look US or preoperative mapping. Retrospective chart review was performed. Correlation detection rates and pathological results were evaluated.Results Vnav identified lesions that were initially detected on MRI in 23 of 29 patients (79.3%). Of the 23 patients who had US correlated lesions, pathological diagnoses of the corresponding lesions were as follows: benign (n=9) and malignant (n=14).Conclusion Vnav may be a useful technique for identification of the extent of breast cancer lesions.     

A Prospective Evaluation of T2-Weighted First-Pass Perfusion MR Imaging In Diagnosing Breast Neoplasms

Objective To compare the results from breast cancer patients who undergo T2-weighted first-pass perfusion imaging after dynamic contrast-enhanced T1-weighted imaging during the same examination, and to evaluate if T2-weighted imaging can provide additional diagnostic information over that obtained with T1-weighted imaging. Methods Twenty-nine patients with breast lesions verified by pathology (benign 12, malignant 17.) underwent MR imaging with dynamic contrast-enhanced T1-weighted imaging of the entire breasts, immediately followed by 6-sections of T2-weighted first-pass perfusion imaging of the lesions. The diagnostic indices were acquired by individual 3D T1-weighted enhancement rate criterion and the T2 signalintensity loss rate criterion. The sensitivity and specificity were calculated and the 2 methods were compared. Results With the dynamic.contrast-enhanced T1-weighted imaging, there was a significant differences between the benign and malignant breast lesions (t =2.563,P=0.016). However we found a considerable overlap between the signal intensity increase in the carcinomas and that in the benign lesions, for a sensitivity of 94% and a specificity of 25%. With T2-weighted first-pass perfusion imaging, there was a very significant difference between the benign and malignant breast lesions(t =4.777,P< 0.001), and the overlap between the signal intensity decrease in the carcinomas and that of the benign lesions on the T2-weighted images was less pronounced than the overlap in the T1-weighted images, for a sensitivity of 88% and a specificity of 75%. Conclusion T2-weighted first-pass perfusion imaging may help differentiate between benign and malignant breast lesions with a higher level of specificity. The combination of T1-weighted and T2-weighted imaging is feasible in a single patient examination and may improve breast MR imaging.     

Magnetic resonance imaging of brain tumors

Magnetic resonance imaging (MRI) has been applied to the diagnosis of brain tumors very widely and MRI is now replacing computed tomography (CT). One of the most important advantages of MRI is influence of multiple tissue and machine parameters on the signal intensities. In addition, capability of imaging in various planes and multislices is another advantage for the brain tumor diagnosis. The coronal image is important when the abnormal side can be compared with the normal side and midline lesions can be easily diagnosed with sagittal imaging. Transverse imaging is important when comparison is made with CT. Many brain tumors show increased signal intensity on T2-weighted images and decreased signal intensity on T1-weighted images and decreased signal intensity on T1-weighted images. The difference of signal intensity in various brain tumors including glioma, meningioma and other important tumors are discussed. MRI is superior to CT in many brain tumors, but poor delineation of calcification and hemorrhage is a disadvantage of MRI.     

Neuroradiological follow-up of the growth of papillary tumor of the pineal region: a case report

Papillary tumor of the pineal region (PTPR) is a recently described distinct clinicopathological entity. The purpose of this case report is to increase the knowledge of its neuroradiological findings and natural history by describing the long-term clinical and neuroradiological follow-up of a PTPR occurring in a 56-year-old Italian male patient. At magnetic resonance imaging (MRI) obtained at diagnosis, the lesion showed a subtle high signal intensity on T1-weighted imaging. Twenty-nine months later, MRI showed clearcut enlargement of the lesion, which had only a small area of high signal intensity on T1-weighted images, and a minimum apparent diffusion coefficient of 0.854 × 10⁻³ mm²/s. Treatment included surgery followed by irradiation. Three-month MRI follow-up did not show disease relapse.     

59例软组织肉瘤的MRI特征与组织病理分级的关系

背景与目的:软组织肉瘤的边缘部生长方式是影响肿瘤局部复发、转移的重要影响因子。本研究采用MRI检查探讨软组织肉瘤边缘表现与肿瘤病理分级之间的相关关系,以便在术前能对软组织肉瘤的生物学特性进行评估。方法:对59例软组织肉瘤患者进行MRI检查,应用自旋回波(SE)序列,采集T1加权(T1W)、T2加权(T2W)图像。在MRI图像上对软组织肉瘤的肿瘤边界、T2W图像上瘤周高信号征象、瘤周低信号包膜征象进行分析。59例软组织肉瘤均经手术病理证实,根据组织切片表现对软组织肉瘤进行病理分级。结果:软组织肉瘤的病理分级与肿瘤边界的清晰程度有关(P<0.05),60.0%Ⅰ级肿瘤其边界清晰,而60.0%Ⅲ级肿瘤其边界不清楚。Ⅱ级与Ⅲ级肿瘤的瘤周高信号征象、瘤周包膜样低信号征象的出现率差异均无统计学意义(P>0.05)。Ⅰ级肿瘤的瘤周高信号征象、瘤周包膜样低信号征象的出现率均明显不同于Ⅱ、Ⅲ级肿瘤,两者之间差异均具有显著性(P<0.05),Ⅰ级肿瘤瘤周高信号征象、包膜样低信号征象的出现率分别为10.0%、80.0%,而Ⅱ及Ⅲ级肿瘤瘤周高信号征象、包膜样低信号征象的出现率分别为74.4%、15.4%。结论:软组织肉瘤的边缘形态特点与组织病理学分级有关,可在一定程度上反映肿瘤组织的生物学特性。     

Spontaneous regression of multicentric pilocytic astrocytoma with CSF dissemination in an adult

We present a case of spontaneous regression of multicentric pilocytic astrocytoma with cerebrospinal fluid (CSF) dissemination without neurofibromatosis type 1 (NF1) in an adult, the first such case reported. Magnetic resonance imaging (MRI) showed multiple low signal intensity lesions on T1-weighted images and high signal intensity areas on T2-weighted images in the bilateral thalamus, basal ganglia and midbrain. Contrast-enhanced MRI revealed that small, enhanced lesions were seen in the basal ganglia and the pineal region. Neuroendoscopic biopsy and third ventriculostomy were performed. Intraoperative findings demonstrated CSF dissemination. Histologically, the specimens showed pilocytic astrocytoma. Serial MRIs showed regression of the tumor without any additional treatment. The clinical features of spontaneous regression of pilocytic astrocytoma are discussed.     

Magnetic resonance imaging is appropriate for determining the osteotomy plane for appendicular osteosarcoma after neoadjuvant chemotherapy

There are no standard criteria for determining a sufficient resection margin in the treatment of osteosarcoma. The purposes of this study are to evaluate clinical outcomes using T1-weighted magnetic resonance imaging (MRI) for determining the margin of resection and to compare that with the results of different imaging modalities. Seventeen patients diagnosed with osteosarcoma who underwent en bloc resection with a margin of 2–3 cm based on T1-weighted MRI following chemotherapy were studied. Imaging modalities including conventional radiography, MRI, computed tomography (CT), visual assessment, and histopathological examination were performed and compared. Survival rates were determined. After follow-up of 45.5 ± 13.8 months, no local tumor recurrence was observed in any patient. The 1-, 3-, and 5-year survival rates were 94.1, 82.3, and 76.5%, respectively. The differences in the measurement errors among the five methods were analyzed using pathology as the gold standard. Errors were smallest using T1-weighted and fat-suppressed MRI. There were no significant differences between the measurement results of postoperative histopathological examination and that of T1-weighted imaging or T2 fat-suppressed imaging. The measurement results of radiography and CT were significantly different from that of postoperative pathological findings (P < 0.05). Thus, MRI examination is superior to radiography and CT for determining tumor invasion in patients with osteosarcoma. A resection margin of 2–3 cm determined by MRI provides adequate treatment, while minimizing tissue removal.     

颞叶放射性脑病磁共振成像的特征分析

背景与目的：鼻咽癌(nasopharyngeal carcinoma,NPC)放疗后放射性脑病(radiation encephalopathy,REP)的表现形式多样,对其多样性表现的报道并不多,本研究观察NPC放射性脑病的磁共振成像(magnetic resonance imaging,MRI)形态学表现特征并探讨其诊断价值。方法：对104例NPC患者共160处病灶经MRI诊断为颞叶REP的MRI资料进行回顾性分析。在NPC放射治疗8个月～13年进行MRI检查,成像序列包括T1WI,T2WI,111处病灶作了T1WI Gd—DTPA增强,37处病灶有水抑制反转恢复(fluid attented inversion recovery FLAIR)检查,其中2例有磁共振脑血流灌注成像(MR perfusion weighted imaging,MR PWI)。结果：104例REP中累及单侧颞叶48例,双侧颞叶56例,共160个病灶。脑白质病变在T2WI为高信号,信号可均匀一致,但其中59个病灶在高信号区内出现不均匀低信号影;有91个病灶同时伴有灰质病变,表现为T1WI低信号,T2WI高信号;在111个病灶T1WI Gd—DTPA检查中91个病灶出现强化灶;有5个病灶出现出血及含铁血黄素沉着。结论：鼻咽癌放射性脑病表现具有多样性,除了常见的脑白质病变外,脑灰质病变、脑出血及含铁血黄素沉着及血脑屏障破坏等均比较常见;MRI能清楚地显示这些病变。     

Neurotized Free Muscle Flaps can Produce MRI Changes Mimicking Tumour Recurrence

Soft tissue sarcomas are investigated by magnetic resonance imaging (MRI) both for initial staging and follow-up. We describe the presence of increased signal on T2-weighted images caused by a neurotized muscle flap following reconstructive surgery. This raised concern about possible sarcoma recurrence that was not clinically evident. On post-operative imaging of sarcomas the presence of recurrent tumour is indicated by a mass and high signal intensity on T2-weighted images. However, high signal changes in skeletal muscle on T2-weighted images are not specific. In this case, the free functioning muscle transfer with neurotization of the flap mimicked recurrence on MR scan. High signal intensity on T2-weighted images in muscle is an indication of either a physiological change or a pathological condition and must be taken in context of the clinical picture.     

MRI findings of large low-grade angiosarcoma of the breast with subsequent bone metastases: a case report

We describe the magnetic resonance imaging (MRI) findings of 13 cm-sized low-grade angiosarcoma of the breast that occurred in a 23-year-old woman. Magnetic resonance examination revealed an ill-defined mass with marked high-signal intensity on T2-weighted images and persistent heterogeneous enhancement. Thirty months later she developed bone metastases, incidentally found on an MRI performed to evaluate the pelvis. There were well-defined bone lesions with high-signal intensity on T2-weighted images and persistent contrast enhancement on delayed phases. The metastases were not detected on previous computed tomography and fluoro-deoxyglucose positron emission tomography scans because the lesions were subtle osteoblastic type with a low proliferative index.