Focal hand lesions: review and radiological approach

Focal hand lesions are commonly encountered in clinical practice and are often benign. Magnetic resonance (MR) imaging is the imaging modality of choice in evaluating these lesions as it can accurately determine the nature of the lesion, enhancement pattern and exact location in relation to surrounding tissues. However, while MR features of various soft tissue lesions in the hand have been well described, it is often still difficult to differentiate between benign and malignant lesions. We review the MR imaging features of a variety of focal hand lesions presenting at our institution and propose a classification into "benign", "intermediate grade" (histologically benign but locally aggressive with potential for recurrence) and frankly "malignant" lesions based on MR findings. This aims to narrow down differential diagnoses and helps in further management of the lesion, preoperative planning and, in cases of primary malignancy, local staging. Teaching Points • Hand lesions are often benign and MR is essential as part of the workup. • MR features of various hand lesions are well described but are often non-specific. • Certain MR features may help for the diagnosis but histological examination is usually required. • We aim to classify hand lesions based on MR features such as margin, enhancement and bony involvement. • Classifying these lesions can help narrow down differential diagnoses and aid management.