Objective:

Our purpose was to collect data that would allow differentiation of lesions arising from iliac wings that cause similar changes in this flat bone and surrounding muscle and soft tissues and to present them in conjunction with relevant cases.

Material and Methods:

34 cases (23 men and 11 women, mean age: 38 years) with the diagnosis of iliac wing lesions with various histopathological diagnoses were included in this retrospective study. All cases underwent spiral or multidetector computerised tomography (CT) or magnetic resonance imaging (MRI) at 1.5 Tesla. Intravenous contrast enhancement has been used in 29 out of a total of 34 cases; gadolinium-based contrast agents (0.1 mmol/kg) have been used in 10 MRI scanning (0.1 mmol/kg) and non-ionic contrast agent (1-1.5 ml/kg) has been used in CT scanning. Only MRI scans were available in 11 patients, only CT images in 19 patients and both CT and MRI images in 4 cases. Imaging findings of the cases were evaluated together with the review of published literature on histopathologic features of the lesions and findings that could provide a clue in differential diagnosis of iliac wing masses were recorded for each patient.

Results:

Data for each lesion group and features of the cases were tabulated. Discriminative features were summarised in a separate table.

Conclusion:

In patients with iliac wing lesions, history of a primary tumour or presence of an additional lesion in lumbosacral axis or other components of iliac bone similar to the original lesion (diffuse or multiple) should suggest metastasis. Lytic lesions with regular margins and multiple septa should suggest giant cell tumor if they show heterogeneous contrast enhancement and should suggest aneurysmal bone cyst if they show haemorrhagic levelling. Specific features such as characteristic contrast enhancement (haemangioma), specific density (lipoma, cyst) and increased sclerosis (bone islands, sclerotic response to treatment of metastasis) would aid differential diagnosis of individual lesions. It must also be realised that scintigraphy can be used as an adjuvant imaging modality in other pathologies such as metastatic lesions, Paget’s disease and osteoid osteoma.

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