(Fig 5-B.05) Subchondral Cyst-like Lesion in Bone

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📌 Subchondral Cyst-like Lesion

✅ Definition and Characteristics

• Subchondral cystlike lesions are well-defined rounded areas of fluid signal intensity. 
• The terms "cystlike changes" or "cystlike lesion" should be used more accurately to describe histopathologic findings. 

 

✅ Histopathologic Consistency

• They may contain various materials including necrotic bone debris, myxoid and adipose tissue, fibrous elements, or proteinaceous material, and are lined by a nonepithelial fibrous wall.
• Unlike true cysts, which are fluid-filled and lined by an epithelial membrane, these subchondral lesions are typically lined by a connective tissue membrane, such as collagen, and filled with a combination of inflammatory cells, mucoid or myxoid material, bone or fat necrosis, and even solid, vascularized tissue.

 

✅  Associated Conditions

• Subchondral cystlike lesions can be prominent in various conditions, including osteoarthritis, rheumatoid arthritis, and calcium pyrophosphate deposition disease. Additionally, cysts may be observed alongside avascular necrosis (AVN) and subchondral insufficiency fractures (SIF).

 

✅  Development and Chronicity

• The edemalike marrow signal intensity on MR images can be associated with the subsequent development of subchondral cystlike lesions in the same location. 
• Subchondral cystic change often indicates a chronic condition.

 

✅  Localization and Inference

• Reporting the specific location of cystlike lesions within the bone can help infer potential causes. 
• For instance, lesions described as "subarticular" and "subchondral" often relate to processes occurring adjacent to cartilage abnormalities. 
• In contrast, "subcortical" abnormalities, such as those at the tibial spines and the humeral greater tuberosity, are more often associated with the insertion of a ligament or tendon.

 

References

• RadioGraphics 2018; 38:1478–1495
• AJR 2019; 213:963–982

 

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#Radiology, #SubchondralCyst, #BoneLesions, #Osteoarthritis, #RheumatoidArthritis, #CalciumPyrophosphate, #AvascularNecrosis, #SubchondralBone, #MedicalImaging, #Histopathology