Radiology: Bone Tumors

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Aggressive lesions tend to grow (more/less) rapidly than less aggressive lesions
Lytic
Lytic or blastic?
Lytic
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Created by osteoclasts.

Charcterized by the presence of less bone.

Lytic lesions is created by what? What characterizes it?
Blastic
Lytic or Blastic?
Blastic
Created by osteoblast.

Characterized by less bone.

Blastic lesions are created by what? What is it characterized by?
Wide

It's an osteogenic sarcoma.
Wide or narrow zone of transition?
Wide

It’s an osteogenic sarcoma.

Narrow

It's a benign unicamal cyst
Wide or narrow zone of transition?
Narrow

It’s a benign unicamal cyst

It's a trick. Only applies to X-rays. 

Everything seems narrow in MRI and CT.
Zone of transition?
It’s a trick. Only applies to X-rays.

Everything seems narrow in MRI and CT.

Bone loss in one area

Bone more or less resembles a continent and has a narrow zone of transition

Characteristic of geographic zone of distruction
Geographic
Pattern of destruction?
Geographic
Multiple lytic areas

Wider zone of transition, more aggressive lesion

Characterization of moth eaten pattern of destruction?
Moth eaten
Pattern of destruction?
Moth eaten
Many tiny holes, perhaps pin size

Wide zone of transition

Characterization of permeative patten of destruction
Permeative
Pattern of destruction?
Permeative
Physiological stress; metatarsal fracture
What causes periostitis? Give an example.
Periostitis

(fusiform shape bone callus sign here)
Periostitis

(fusiform shape bone callus sign here)

Thick and uniform
What characterizes periostitis?
Periostitis: Sunburst pattern

Occuring here in osteosarcoma
Periostitis: Sunburst pattern

Occuring here in osteosarcoma

Any periostitis that is not thick with a smooth surface is associated with a more aggressive lesion until proven otherwise
What is the general rule of periostitis?
Periostitis: Hair on end
Periostitis: Hair on end
Periostitis: Onion skin
Periostitis: Onion skin
Occurs when the lesions rapid growth is intermittidly interrupted
What causes periostitis: onion skin?
Moth eaten pattern and wide zone of transition
What is seen in periostitis: onion skin?
Periostitis with Codman's Triangle
Periostitis with Codman’s Triangle
A rapidly expanding lesion effectively lifts the periostium from the bone’s surface
What happens in a periostitis lesion with Codman’s triangle?
Soft tissue involvement; yes 

Note it has a wide zone of transition
What’s seen here? Should it be considered aggressive until proven otherwise?
Soft tissue involvement; yes

Note it has a wide zone of transition

Even if it looks less aggressive, a lesion is considered aggressive if the patient is over 40

Use common sense when applying it. If a patient has OA and it’s next to an OA joint, it’s likely a geode or cyst without needing further action.

What is the over 40 rule?
Benign lesions with edge characteristics ranging from well defined to poorly defined
Lodwick Radiographic Tumor Staging: Grade 1A, 1B, and 1C
Low-grade malignant lesions with invasive features; applies particularly to lesions demonstrating total penetration of the cortex
Lodwick Radiographic Tumor Staging: Grade 2
High-grade malignant lesions with invasive, permeative, and destructive features
Lodwick Radiographic Tumor Staging: Grade 3
Radiographically benign lesions that do not require further investigation or treatment
Sundaram et al: Group 1
Lesions with a high likelihood of being benign but that should be confirmed as benign by means of clinical or radiographic follow-up examination
Sundaram et al: Group 2
Benign lesions that require surgical resection because of aggressive behavior or a risk of pathologic fracture
Sundaram et al: Group 3
Aggressive-appearing lesions that should be considered malignant but on which a biopsy should be performed to confirm the diagnosis and histologic grade
Sundaram et al: Group 4
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