Intraosseous migration of tendinous calcifications: two case reports

Area of Science:

• Radiology
• Orthopedics
• Pathology

Background:

• Calcific tendinopathy of the rotator cuff is a frequent cause of shoulder pain.
• Complications include bone erosion and intraosseous migration of calcific deposits, leading to marrow inflammation.
• Conventional imaging like X-ray and ultrasound (US) often fail to visualize bone marrow involvement.

Observation:

• Magnetic resonance imaging (MRI) can detect focal bone T1 and T2-weighted hypointensity, bone marrow edema-like signal, and cortical erosion.
• These MRI findings can mimic infectious or neoplastic lesions, necessitating further investigation.
• Two cases illustrate how MRI findings guided diagnosis, with one case requiring computed tomography (CT) and biopsy, while the other was diagnosed with MRI alone.

Findings:

• MRI is highly sensitive for detecting intraosseous migration of calcific deposits.
• Specific MRI signals (T1/T2 hypointensity, edema-like signal, cortical erosion) are key indicators.
• Accurate MRI interpretation can narrow the differential diagnosis for bone lesions in calcific tendinopathy.

Implications:

• Recognizing characteristic MRI signs can help differentiate intraosseous calcific migration from infection or tumors.
• This may obviate the need for additional costly and invasive procedures like CT and biopsy.
• Improved diagnostic accuracy through MRI can lead to more efficient patient management for shoulder pain.