Age / Sex : 30 / M

Chief complaint : right hip pain


What is your diagnosis?

Two weeks later, you can see the final diagonosis with a brief discussion of this case (Please submit only one answer)

Courtesy :  이슬기 (Seul Ki Lee), 성빈센트병원 (St. Vincent’s Hospital)

Giant cell tumor of bone

Discussion

Findings
1. CT shows well-defined osteolytic lesion in Rt. Femoral head.
2. Coronal proton-density, axial T1-weighted, axial T1-weighted enhanced MRIs show a well-circumscribed mass with proton-density high and T1 intermediate signal intensity, as well as heterogeneous enhancement in the femoral head, accompanied by extensive peritumoral edema
3. DWI with b-values of 50 and 800 s/mm2 exhibit persistent low signal with different b-values, while the ADC map shows a signal drop, indicating a T2 “black-out” effect, which could be attributed to susceptibility artifacts of hemosiderin.


References
Khoo, M.M.; Tyler, P.A.; Saifuddin, A.; Padhani, A.R. Diffusion-weighted imaging (DWI) in musculoskeletal MRI: A critical review. Skelet. Radiol. 2011, 40, 665–681