Clinical Imaging xxx (2015) xxx–xxx
Contents lists available at ScienceDirect
Clinical Imaging journal homepage: http://www.clinicalimaging.org
Osteoid osteoma of the scaphoid: magnetic resonance imaging vessel sign☆,☆☆ Steven R. Kussman a,⁎, Michael Thompson b, Eric Y. Chang c,a a b c
Department of Radiology, University of California, San Diego Medical Center, San Diego, CA 92103 Scripps Healthcare, 10666 N. Torrey Pines Road, La Jolla, CA 92037 Radiology Service, VA San Diego Healthcare System, San Diego, CA 92161
a r t i c l e
i n f o
Article history: Received 23 December 2014 Received in revised form 27 January 2015 Accepted 5 February 2015 Available online xxxx Keywords: Scaphoid Osteoid osteoma MRI Vessel sign
a b s t r a c t Osteoid osteomas can be a challenging diagnosis, especially in smaller bones and, particularly, in the carpus. Clinical and imaging diagnosis may both be delayed due to other, more common, post-traumatic or inflammatory pathology in the same area. We present a case of a pathologically proven scaphoid osteoid osteoma with a feeding vessel sign on magnetic resonance imaging, previously described in long bones with computed tomography, as a helpful sign for accurate diagnosis in the scaphoid. © 2015 Elsevier Inc. All rights reserved.
1. Introduction Osteoid osteomas are the third most common bone tumor, accounting for 3% of primary bone tumors, and 11% of benign bone tumors [1]. The average age for an osteoid osteoma to develop is 20, and there is approximately a 3:1 male to female predominance [2]. The classic symptoms include night pain, relieved by nonsteroidal antiinflammatory drugs (NSAIDS). Because of the often confusing clinical picture, there is an average delay in diagnosis of up to 2 years [3,4]. Osteoid osteomas are usually a self-limited process, with eventual spontaneous resolution of symptoms years after onset. Surgery can be curative if the lesion is completely resected. Radiofrequency ablation has shown success rates from 76 to 100% [5]. The lesion is most common in the cortex of long bones, with the diaphysis more common than the metaphysis, while seldom occurring in the epiphysis [6]. More than half of the lesions occur in the lower extremity long bones, with the proximal femur the most common [7]. The characteristic central nidus is demonstrated in 85% of cases [8].
☆ Acknowledgement of Funding: Eric Y. Chang, MD, gratefully acknowledges grant support from the VA Clinical Science Research and Development Career Development Award (IK2CX000749). ☆☆ Conflict of Interest: No conflict of interest. ⁎ Corresponding author. UCSD Teleradiology & Education Center, 8899 University Center Lane, Suite 370. Tel.: +1-858-846-1011; fax: +1-888-960-5922. E-mail addresses: [email protected] (S.R. Kussman), [email protected] (M. Thompson), [email protected] (E.Y. Chang).
Osteoid osteomas occur occasionally in the hand, accounting for 8% of cases. Within the hand, the proximal phalanx is the most common site [9]. They are less frequent in the carpals and metacarpals. Of those in the carpus, the scaphoid is the most common site [10–12]. Because the wrist and hand bones are an infrequent site of osteoid osteomas, while a frequent site for many other pathologies, diagnosis may be difficult. Scaphoid osteoid osteomas can be confused with other pathologies such as DeQuervain's tenosynovitis [9,13]. We present a case of a surgically proven osteoid osteoma of the scaphoid with a “feeding vessel sign” on MRI of the scaphoid, previously only described in osteoid osteomas of long bones with computed tomographic (CT).
2. Case report A 42-year old right-hand dominant man presented to us with right wrist pain. Pain had begun about 8 months earlier without inciting event. Specifically, there was no history of trauma and no change in usual activity. In addition, the pain was unrelated to activities, worse at night and improved with NSAIDS. Physical exam demonstrated tenderness to palpation at the anatomic snuffbox. Passive range of motion, including extension, flexion, radial, and ulnar deviation, did not reproduce the pain. The patient initially underwent radiographic evaluation which did not show a fracture line or prospectively evident abnormality. Only in retrospect was a small amount of sclerosis appreciated near the dorsal ridge on the lateral radiograph. MRI was ordered which showed intense
http://dx.doi.org/10.1016/j.clinimag.2015.02.001 0899-7071/© 2015 Elsevier Inc. All rights reserved.
Please cite this article as: Kussman SR, et al, Osteoid osteoma of the scaphoid: magnetic resonance imaging vessel sign, Clin Imaging (2015), http://dx.doi.org/10.1016/j.clinimag.2015.02.001
2
S.R. Kussman et al. / Clinical Imaging xxx (2015) xxx–xxx
Fig. 1. Sagittal reconstructed CT image (A) shows a lytic lesion near the dorsal ridge of the scaphoid with central calcification (white arrow). 3D surface-rendered CT image (B) shows the central nidus within the dorsal sulcus of the scaphoid (black arrows). Technetium 99-m methylene diphosphonate bone scan image (C) shows intense focal activity within the scaphoid (thick arrow).
bone marrow edema at the dorsal aspect of the scaphoid and a linear, vertically oriented line, which was initially misinterpreted as a nondisplaced fracture line. The patient subsequently underwent CT and scintigraphic imaging, which showed a lytic lesion near the dorsal ridge with central calcification and intense radionuclide uptake, respectively, diagnostic of an osteoid osteoma (Fig. 1). The magnetic resonance images were rereviewed, which showed enlarged intraarticular arteries coursing along the dorsal ridge of the scaphoid near the osteoid osteoma lesion (Fig. 2). The vertically oriented hyperintense line was shown to represent an intraosseous vein coursing away from the hypointense nidus (Fig. 3). The corresponding CT vessel sign for this lesion is difficult since many trabecula in the scaphoid on CT are oriented in the proximal–distal direction and hard to distinguish between intraosseous vessels. In addition, there are typically many normal vascular grooves at the dorsal ridge of the scaphoid on CT. However, the intraarticular vessels are not typically visible unless enlarged, and MR allows for the contrast to visualize these vessels as well as the intraosseous vessel.
Fig. 2. Sagittal intermediate-weighted fat-suppressed images (A–B) show enlarged intraarticular arteries (small arrows) coursing along the dorsal ridge of the scaphoid (arrows). Also evident is abundant bone marrow edema in the dorsal aspect of the scaphoid.
The patient underwent surgical excision of the lesion. During surgery, the cherry-red tumor nidus was removed en bloc, and the cavity margins were cauterized to decrease the risk of residual tumor as well as achieve homeostasis. Morcellized cancellous allograft was used to backfill the cavity. Histologic evaluation of the lesion confirmed the preoperative diagnosis of an osteoid osteoma (Fig. 4). After surgery, the patient enjoyed immediate relief of his long-standing deep, aching pain. On last follow-up, after several months of physical therapy, the patient reported full recovery with no residual pain.
3. Discussion The pathogenesis of osteoid osteomas is still not completely clear. Some suggest that a vascular abnormality is the origin of these lesions. Pathologically, the nidus appears to contain numerous capillary channels, while the surrounding soft tissues contain prominent muscular arterial structures [14]. Others have also described prominent vessels near the nidus seen with ultrasound [15]. Imaging diagnosis can be a challenge. Radiographs show focal cortical thickening and solid periosteal reaction. CT shows similar findings, often with a central calcified nidus. MRI may show a low T2 signal nidus surrounded by an outer region of high T2 signal (target sign). There is often adjacent marrow, periosteal, and soft tissue edema. Contrast-enhanced studies show peak enhancement during arterial phase and early partial washout, with brisker enhancement than the adjacent bone marrow [16]. Bone scan will show increased uptake and a “double density” with a small focus of increased activity at the nidus surrounded by a larger area of intense activity, representing reactive sclerosis. More recently, the presence of a “feeding vessel” has been demonstrated on CT as a clue for diagnosis. In 80% of patients with osteoid osteomas in long bones, there was a blood vessel either entering the nidus itself or immediately adjacent to the nidus. This was significantly higher than nonosteoid osteoma bone lesions, such as nonossifying fibromas [17]. Another similar article described a “vascular groove sign” as a moderately sensitive and highly specific finding for osteoid osteoma identification on CT [18]. In this case, we show that a feeding vessel can also be seen on MRI and in smaller bones, such as the scaphoid. Given the often confusing clinical picture with carpal osteoid osteomas, this feeding vessel may be an important sign for correct early diagnosis and, importantly, should not be mistaken for other pathology such as a fracture.
Please cite this article as: Kussman SR, et al, Osteoid osteoma of the scaphoid: magnetic resonance imaging vessel sign, Clin Imaging (2015), http://dx.doi.org/10.1016/j.clinimag.2015.02.001
S.R. Kussman et al. / Clinical Imaging xxx (2015) xxx–xxx
3
Fig. 3. Axial Short tau inversion recovery image (A) shows the hypointense, centrally calcified osteoid osteoma nidus (thick arrow) with abundant, surrounding bone marrow edema. Coronal intermediate-weighted fat-suppressed (A) and T2*-weighted multiecho data image combination images (B) show a vertically oriented, linear hyperintense intraosseous vein (thin arrow) which coursed away from the nidus.
Fig. 4. Photomicrographs of the decalcified nidus after hematoxylin and eosin staining (A and B) show characteristic anastomosing trabecular and woven bone rimmed by osteoclasts and osteoblasts on a background of highly vascular cellular stroma, consistent with an osteoid osteoma.
References [1] Frassica FJ, Waltrip RL, Sponseller PD, Ma LD, McCarthy EF. Clinicopathologic features and treatment of osteoid osteoma and osteoblastoma in children and adolescents. Orthop Clin North Am 1996;27(3):559–74. [2] Kransdorf MJ, Stull MA, Gilkey FW, Moser RP. Osteoid osteoma. Radiographics 1991; 11:671–96. [3] Bednar MS, Weiland AJ, Light TR. Osteoid osteoma of the upper extremity. Hand Clin 1995;11:211–21. [4] Ghiam GF, Bora FW. Osteoid osteoma of the carpal bones. J Hand Surg [Am] 1978;3: 280–3. [5] Cantwell CP, Obyrne J, Eustace S. Current trends in treatment of osteoid osteoma with an emphasis on radiofrequency ablation. Eur Radiol 2004;14(4):607–17. [6] Brody JM, Brower AC, Shannon FB. An unusual epiphyseal osteoid osteoma. AJR Am J Roentgenol 1992;158(3):609–11. [7] Lee EH, Shafi M, Hui JH. Osteoid osteoma: a current review. J Pediatr Orthop 2006;26 (5):695–700. [8] Yildiz Y, Bayrakci K, Altay M, Saglik Y. Osteoid osteoma: the results of surgical treatment. Int Orthop 2001;25(2):119–22. [9] Severo AL, Arujo R, Puentes R. Osteoid osteoma of the scaphoid bone: a case report. J Hand Surg Eur Vol 2012;37(8):797–9.
[10] Themistocleous GS, Chloros GD, Mavrogenis AF, Khaldi L, Papagelopoulos PJ, Efstathopoulos DG. Unusual presentation of osteoid osteoma of the scaphoid. Arch Orthop Trauma Surg 2005;125:482–5. [11] Bednar MS, McCormack RR, Glasser D, Weiland AJ. Osteoid osteoma of the upper extremity. J Hand Surg [Am] 1993;18:1019–25. [12] De Smet L. Osteoid osteoma of the wrist and hand. J Am Soc Surg Hand 2001;1: 267–74. [13] Ozalp T, Yercan H, Okcu G. Osteoid osteoma of the scaphoid bone: a case report. Firat Tip Dergisi 2008;13:59–61. [14] de Chadarevian JP, Katsetos CD, Pascasio JM, Geller E, Herman MJ. Histological study of osteoid osteoma’s blood supply. Pediatr Dev Pathol 2007;10(5): 358–68. [15] Gil S, Marco SF, Arenas J, Irurzun J, Agullo T, Alonso S, et al. Doppler duplex color localization of osteoid osteomas. Skelet Radiol 1999;28:107–10. [16] Liu PT, Chivers FS, Roberts CC, Schultz CJ, Beauchamp CP. Imaging of osteoid osteoma with dynamic gadolinium-enhanced MR imaging. Radiology 2003; 227(3):691–700. [17] Yaniv G, Shabshin N, Sharon M, Liberman B, Garniack A, Rimon U, et al. Osteoid osteoma–the CT vessel sign. Skelet Radiol 2011;40(10):1311–4. [18] Liu PT, Kujak JL, Roberts CC, de Chadarevian JP. The vascular groove sign: a new CT finding associated with osteoid osteomas. AJR 2011;196:168–73.
Please cite this article as: Kussman SR, et al, Osteoid osteoma of the scaphoid: magnetic resonance imaging vessel sign, Clin Imaging (2015), http://dx.doi.org/10.1016/j.clinimag.2015.02.001
Contents lists available at ScienceDirect
Clinical Imaging journal homepage: http://www.clinicalimaging.org
Osteoid osteoma of the scaphoid: magnetic resonance imaging vessel sign☆,☆☆ Steven R. Kussman a,⁎, Michael Thompson b, Eric Y. Chang c,a a b c
Department of Radiology, University of California, San Diego Medical Center, San Diego, CA 92103 Scripps Healthcare, 10666 N. Torrey Pines Road, La Jolla, CA 92037 Radiology Service, VA San Diego Healthcare System, San Diego, CA 92161
a r t i c l e
i n f o
Article history: Received 23 December 2014 Received in revised form 27 January 2015 Accepted 5 February 2015 Available online xxxx Keywords: Scaphoid Osteoid osteoma MRI Vessel sign
a b s t r a c t Osteoid osteomas can be a challenging diagnosis, especially in smaller bones and, particularly, in the carpus. Clinical and imaging diagnosis may both be delayed due to other, more common, post-traumatic or inflammatory pathology in the same area. We present a case of a pathologically proven scaphoid osteoid osteoma with a feeding vessel sign on magnetic resonance imaging, previously described in long bones with computed tomography, as a helpful sign for accurate diagnosis in the scaphoid. © 2015 Elsevier Inc. All rights reserved.
1. Introduction Osteoid osteomas are the third most common bone tumor, accounting for 3% of primary bone tumors, and 11% of benign bone tumors [1]. The average age for an osteoid osteoma to develop is 20, and there is approximately a 3:1 male to female predominance [2]. The classic symptoms include night pain, relieved by nonsteroidal antiinflammatory drugs (NSAIDS). Because of the often confusing clinical picture, there is an average delay in diagnosis of up to 2 years [3,4]. Osteoid osteomas are usually a self-limited process, with eventual spontaneous resolution of symptoms years after onset. Surgery can be curative if the lesion is completely resected. Radiofrequency ablation has shown success rates from 76 to 100% [5]. The lesion is most common in the cortex of long bones, with the diaphysis more common than the metaphysis, while seldom occurring in the epiphysis [6]. More than half of the lesions occur in the lower extremity long bones, with the proximal femur the most common [7]. The characteristic central nidus is demonstrated in 85% of cases [8].
☆ Acknowledgement of Funding: Eric Y. Chang, MD, gratefully acknowledges grant support from the VA Clinical Science Research and Development Career Development Award (IK2CX000749). ☆☆ Conflict of Interest: No conflict of interest. ⁎ Corresponding author. UCSD Teleradiology & Education Center, 8899 University Center Lane, Suite 370. Tel.: +1-858-846-1011; fax: +1-888-960-5922. E-mail addresses: [email protected] (S.R. Kussman), [email protected] (M. Thompson), [email protected] (E.Y. Chang).
Osteoid osteomas occur occasionally in the hand, accounting for 8% of cases. Within the hand, the proximal phalanx is the most common site [9]. They are less frequent in the carpals and metacarpals. Of those in the carpus, the scaphoid is the most common site [10–12]. Because the wrist and hand bones are an infrequent site of osteoid osteomas, while a frequent site for many other pathologies, diagnosis may be difficult. Scaphoid osteoid osteomas can be confused with other pathologies such as DeQuervain's tenosynovitis [9,13]. We present a case of a surgically proven osteoid osteoma of the scaphoid with a “feeding vessel sign” on MRI of the scaphoid, previously only described in osteoid osteomas of long bones with computed tomographic (CT).
2. Case report A 42-year old right-hand dominant man presented to us with right wrist pain. Pain had begun about 8 months earlier without inciting event. Specifically, there was no history of trauma and no change in usual activity. In addition, the pain was unrelated to activities, worse at night and improved with NSAIDS. Physical exam demonstrated tenderness to palpation at the anatomic snuffbox. Passive range of motion, including extension, flexion, radial, and ulnar deviation, did not reproduce the pain. The patient initially underwent radiographic evaluation which did not show a fracture line or prospectively evident abnormality. Only in retrospect was a small amount of sclerosis appreciated near the dorsal ridge on the lateral radiograph. MRI was ordered which showed intense
http://dx.doi.org/10.1016/j.clinimag.2015.02.001 0899-7071/© 2015 Elsevier Inc. All rights reserved.
Please cite this article as: Kussman SR, et al, Osteoid osteoma of the scaphoid: magnetic resonance imaging vessel sign, Clin Imaging (2015), http://dx.doi.org/10.1016/j.clinimag.2015.02.001
2
S.R. Kussman et al. / Clinical Imaging xxx (2015) xxx–xxx
Fig. 1. Sagittal reconstructed CT image (A) shows a lytic lesion near the dorsal ridge of the scaphoid with central calcification (white arrow). 3D surface-rendered CT image (B) shows the central nidus within the dorsal sulcus of the scaphoid (black arrows). Technetium 99-m methylene diphosphonate bone scan image (C) shows intense focal activity within the scaphoid (thick arrow).
bone marrow edema at the dorsal aspect of the scaphoid and a linear, vertically oriented line, which was initially misinterpreted as a nondisplaced fracture line. The patient subsequently underwent CT and scintigraphic imaging, which showed a lytic lesion near the dorsal ridge with central calcification and intense radionuclide uptake, respectively, diagnostic of an osteoid osteoma (Fig. 1). The magnetic resonance images were rereviewed, which showed enlarged intraarticular arteries coursing along the dorsal ridge of the scaphoid near the osteoid osteoma lesion (Fig. 2). The vertically oriented hyperintense line was shown to represent an intraosseous vein coursing away from the hypointense nidus (Fig. 3). The corresponding CT vessel sign for this lesion is difficult since many trabecula in the scaphoid on CT are oriented in the proximal–distal direction and hard to distinguish between intraosseous vessels. In addition, there are typically many normal vascular grooves at the dorsal ridge of the scaphoid on CT. However, the intraarticular vessels are not typically visible unless enlarged, and MR allows for the contrast to visualize these vessels as well as the intraosseous vessel.
Fig. 2. Sagittal intermediate-weighted fat-suppressed images (A–B) show enlarged intraarticular arteries (small arrows) coursing along the dorsal ridge of the scaphoid (arrows). Also evident is abundant bone marrow edema in the dorsal aspect of the scaphoid.
The patient underwent surgical excision of the lesion. During surgery, the cherry-red tumor nidus was removed en bloc, and the cavity margins were cauterized to decrease the risk of residual tumor as well as achieve homeostasis. Morcellized cancellous allograft was used to backfill the cavity. Histologic evaluation of the lesion confirmed the preoperative diagnosis of an osteoid osteoma (Fig. 4). After surgery, the patient enjoyed immediate relief of his long-standing deep, aching pain. On last follow-up, after several months of physical therapy, the patient reported full recovery with no residual pain.
3. Discussion The pathogenesis of osteoid osteomas is still not completely clear. Some suggest that a vascular abnormality is the origin of these lesions. Pathologically, the nidus appears to contain numerous capillary channels, while the surrounding soft tissues contain prominent muscular arterial structures [14]. Others have also described prominent vessels near the nidus seen with ultrasound [15]. Imaging diagnosis can be a challenge. Radiographs show focal cortical thickening and solid periosteal reaction. CT shows similar findings, often with a central calcified nidus. MRI may show a low T2 signal nidus surrounded by an outer region of high T2 signal (target sign). There is often adjacent marrow, periosteal, and soft tissue edema. Contrast-enhanced studies show peak enhancement during arterial phase and early partial washout, with brisker enhancement than the adjacent bone marrow [16]. Bone scan will show increased uptake and a “double density” with a small focus of increased activity at the nidus surrounded by a larger area of intense activity, representing reactive sclerosis. More recently, the presence of a “feeding vessel” has been demonstrated on CT as a clue for diagnosis. In 80% of patients with osteoid osteomas in long bones, there was a blood vessel either entering the nidus itself or immediately adjacent to the nidus. This was significantly higher than nonosteoid osteoma bone lesions, such as nonossifying fibromas [17]. Another similar article described a “vascular groove sign” as a moderately sensitive and highly specific finding for osteoid osteoma identification on CT [18]. In this case, we show that a feeding vessel can also be seen on MRI and in smaller bones, such as the scaphoid. Given the often confusing clinical picture with carpal osteoid osteomas, this feeding vessel may be an important sign for correct early diagnosis and, importantly, should not be mistaken for other pathology such as a fracture.
Please cite this article as: Kussman SR, et al, Osteoid osteoma of the scaphoid: magnetic resonance imaging vessel sign, Clin Imaging (2015), http://dx.doi.org/10.1016/j.clinimag.2015.02.001
S.R. Kussman et al. / Clinical Imaging xxx (2015) xxx–xxx
3
Fig. 3. Axial Short tau inversion recovery image (A) shows the hypointense, centrally calcified osteoid osteoma nidus (thick arrow) with abundant, surrounding bone marrow edema. Coronal intermediate-weighted fat-suppressed (A) and T2*-weighted multiecho data image combination images (B) show a vertically oriented, linear hyperintense intraosseous vein (thin arrow) which coursed away from the nidus.
Fig. 4. Photomicrographs of the decalcified nidus after hematoxylin and eosin staining (A and B) show characteristic anastomosing trabecular and woven bone rimmed by osteoclasts and osteoblasts on a background of highly vascular cellular stroma, consistent with an osteoid osteoma.
References [1] Frassica FJ, Waltrip RL, Sponseller PD, Ma LD, McCarthy EF. Clinicopathologic features and treatment of osteoid osteoma and osteoblastoma in children and adolescents. Orthop Clin North Am 1996;27(3):559–74. [2] Kransdorf MJ, Stull MA, Gilkey FW, Moser RP. Osteoid osteoma. Radiographics 1991; 11:671–96. [3] Bednar MS, Weiland AJ, Light TR. Osteoid osteoma of the upper extremity. Hand Clin 1995;11:211–21. [4] Ghiam GF, Bora FW. Osteoid osteoma of the carpal bones. J Hand Surg [Am] 1978;3: 280–3. [5] Cantwell CP, Obyrne J, Eustace S. Current trends in treatment of osteoid osteoma with an emphasis on radiofrequency ablation. Eur Radiol 2004;14(4):607–17. [6] Brody JM, Brower AC, Shannon FB. An unusual epiphyseal osteoid osteoma. AJR Am J Roentgenol 1992;158(3):609–11. [7] Lee EH, Shafi M, Hui JH. Osteoid osteoma: a current review. J Pediatr Orthop 2006;26 (5):695–700. [8] Yildiz Y, Bayrakci K, Altay M, Saglik Y. Osteoid osteoma: the results of surgical treatment. Int Orthop 2001;25(2):119–22. [9] Severo AL, Arujo R, Puentes R. Osteoid osteoma of the scaphoid bone: a case report. J Hand Surg Eur Vol 2012;37(8):797–9.
[10] Themistocleous GS, Chloros GD, Mavrogenis AF, Khaldi L, Papagelopoulos PJ, Efstathopoulos DG. Unusual presentation of osteoid osteoma of the scaphoid. Arch Orthop Trauma Surg 2005;125:482–5. [11] Bednar MS, McCormack RR, Glasser D, Weiland AJ. Osteoid osteoma of the upper extremity. J Hand Surg [Am] 1993;18:1019–25. [12] De Smet L. Osteoid osteoma of the wrist and hand. J Am Soc Surg Hand 2001;1: 267–74. [13] Ozalp T, Yercan H, Okcu G. Osteoid osteoma of the scaphoid bone: a case report. Firat Tip Dergisi 2008;13:59–61. [14] de Chadarevian JP, Katsetos CD, Pascasio JM, Geller E, Herman MJ. Histological study of osteoid osteoma’s blood supply. Pediatr Dev Pathol 2007;10(5): 358–68. [15] Gil S, Marco SF, Arenas J, Irurzun J, Agullo T, Alonso S, et al. Doppler duplex color localization of osteoid osteomas. Skelet Radiol 1999;28:107–10. [16] Liu PT, Chivers FS, Roberts CC, Schultz CJ, Beauchamp CP. Imaging of osteoid osteoma with dynamic gadolinium-enhanced MR imaging. Radiology 2003; 227(3):691–700. [17] Yaniv G, Shabshin N, Sharon M, Liberman B, Garniack A, Rimon U, et al. Osteoid osteoma–the CT vessel sign. Skelet Radiol 2011;40(10):1311–4. [18] Liu PT, Kujak JL, Roberts CC, de Chadarevian JP. The vascular groove sign: a new CT finding associated with osteoid osteomas. AJR 2011;196:168–73.
Please cite this article as: Kussman SR, et al, Osteoid osteoma of the scaphoid: magnetic resonance imaging vessel sign, Clin Imaging (2015), http://dx.doi.org/10.1016/j.clinimag.2015.02.001
