Imaging features of nodular fasciitis: a review of 89 cases

To review the spectrum of clinical and imaging features of nodular fasciitis, emphasizing those most characteristic of this diagnosis.

A retrospective review of our institutional pathology and imaging databases from 2006 to 2024 identified 89 patients with confirmed nodular fasciitis pathology and imaging evaluation. For the purpose of analysis, lesions were subdivided into 2 basic groups: superficial and deep. Superficial lesions were defined as those involving the skin, superficial fascia, subcutaneous fat, and/or extending to the deep fascia. Deep lesions were defined as those localized to the deep fascia or extending deep to the deep fascia, as well as those that were intermuscular or intramuscular.

There were 45 females and 44 males with an overall average age of 37.3 years (range 1.5-84 years; 68.5% between 20 and 60 years). There were 30 superficial lesions (33.7%) and 59 (66.3%) deep lesions. Deep lesions were on average 65% larger than those located superficially and patients with deep lesions were on average 7.2 years older than those with superficial lesions. While there are no pathognomonic imaging features, careful attention to the relationship of the lesion to the adjacent fascia, as well as to the identification of characteristic time-dependent lesional MR signal changes can be useful aids in identifying this lesion.

While nodular fasciitis is often considered to be an uncommon soft tissue tumor, it is recognized as the third most common benign soft tissue lesion. Knowledge of the spectrum of lesion characteristic locations and appearances will facilitate definitive diagnosis.