What causes Bowl of Grapes Sign in extremities on MRI?
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Answer:
Bowl of Grapes Sign represents a mass with multiple fluid-fluid levels and cystic spaces separated by septa, seen in synovial sarcoma (most commonly) or telangiectatic osteosarcoma, reflecting hemorrhage, cystic degeneration, and necrosis within these aggressive soft tissue or bone tumors.
Why is it called so?
The sign is named for its resemblance to a bowl of grapes, due to multiple rounded hyperintense cystic areas of varying fluid intensities with intervening hypointense septa on T2-weighted or fluid-sensitive MRI sequences.
Pathophysiology
Tumor hemorrhage and cystic/necrotic degeneration create fluid-fluid levels within multicystic compartments; thin fibrous septa remain hypointense on T2, producing the clustered grape-like appearance amid hyperintense fluid collections.
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