0:00

<v ->So let's start with that.

0:03

Now this last section is a little bit complicated.

0:07

Those bone tumor cases are more challenging.

0:11

So I'm gonna show some classic cases.

0:15

This first one,

0:19

it's a young 24 year-old female

0:25

presenting with mass

0:28

in the forearm.

0:32

And that we can see right away with MRI

0:42

T2 fat sat,

0:44

T1 and,

0:50

post gap imaging.

0:52

So we can see high signal bone lesion

0:58

with cortical destruction,

1:02

multilobular mass extending to the soft tissues.

1:07

We have a lot of enhancement of the lesion

1:11

and also of the soft tissues.

1:15

The axial imaging

1:19

we can see the insufflation

1:22

in a lot of soft tissue here, extension

1:29

and we lose the cortical bone here.

1:33

So this also, we did a CT of this patient

1:40

and with the CT, we can see the insufflation,

1:44

expansion of the lesion and a lot of cortical destruction.

1:52

We are searching for something inside the lesion

1:55

that can give us a clue.

1:59

Any hemosiderin or other stuff.

2:05

We also have findings at the wrist, the bones,

2:11

carpal bones, we have enhancement

2:16

and that's,

2:20

we can see some osteopenia here.

2:22

So probably we have a disuse osteoporosis going on

2:27

and responsible for those areas of increased vascular end

2:32

on the periphery of the carpal bones.

2:35

So this is reactional.

2:37

This is a classic case of Giant Cell Tumor.

2:43

Invasive.

2:45

It is a benign tumor

2:47

but this case is the aggressive type

2:51

with a lot of bone destruction.

2:53

We also did a TB CT scan

2:57

showing the multilobular appearance

3:01

of this tumor.

3:03

So we have some preservation

3:05

of tubercular bone in some regions here.

3:08

So it's a characteristic

3:10

of the Giant Cell Tumor

3:14

of the radius.

3:18

So I think this is a classic, Don.

3:20

Isn't it?

3:22

<v ->Yeah, it is a classic.

3:23

And, I just wanna make one comment

3:25

so that I'm sure every single person who's listening today

3:28

will come back tomorrow.

3:30

And that is that you pointed out beautifully

3:34

the changes in the carpal bones

3:36

and that peripheral rim, a bone within bone appearance

3:40

which is so characteristic of hyperemia.

3:44

Tomorrow, I'm gonna go into some detail

3:46

about some of the MR imaging characteristics

3:50

in the marrow that tell you whether

3:53

or not it is a reversible or irreversible condition

3:58

but that bone within bone appearance

4:00

in the carpal bones seen with osteoporosis

4:04

as you mentioned, is classic for hyperemia.

4:07

It's a beautiful demonstration.