Fluid-fluid levels in bone tumours is a commonly encountered finding, both in benign as well as malignant bone tumours, and can be used to differentiate between the two.
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Measurement
On the sagittal T2W image:
measure the length of the largest fluid-fluid level (A)
measure the maximum length of the tumour (B)
calculate A/B ratio
Interpretation
an A/B ratio >41.5 means the tumour is more likely to be benign
an A/B ratio <41.5 means the tumour is more likely to be malignant
The rationale behind this method of assessment is that areas of necrosis in a malignant tumour are more likely to result in multiple small fluid-fluid levels as compared to a benign tumour.
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