Bone or cartilage mass imaging: Difference between revisions

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==Overview==
==Overview==


Conventional radiography is the method of choice for the diagnosis of primary bone tumors. The evaluation of bone and cartilage tumors will depend on 7 characteristics: periosteal reaction, location, size, margins, cortical involvement, and soft-tissue component.<ref name="pmid18223119">{{cite journal |vauthors=Miller TT |title=Bone tumors and tumorlike conditions: analysis with conventional radiography |journal=Radiology |volume=246 |issue=3 |pages=662–74 |year=2008 |pmid=18223119 |doi=10.1148/radiol.2463061038 |url=}}</ref>
Conventional radiography is the method of choice for the diagnosis of bone and cartilage tumors. The evaluation of bone and cartilage tumors will depend on 7 characteristics: periosteal reaction, opacity and mineralization, location, size, margins, cortical involvement, and soft-tissue component.<ref name="pmid18223119">{{cite journal |vauthors=Miller TT |title=Bone tumors and tumorlike conditions: analysis with conventional radiography |journal=Radiology |volume=246 |issue=3 |pages=662–74 |year=2008 |pmid=18223119 |doi=10.1148/radiol.2463061038 |url=}}</ref>


==Imaging==
==Imaging==
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===Plain Radiograph===
===Plain Radiograph===


The evaluation of bone and cartilage tumors will depend on 7 characteristics: periosteal reaction, location, size, margins, cortical involvement, and soft-tissue component.<ref name="pmid18223119">{{cite journal |vauthors=Miller TT |title=Bone tumors and tumorlike conditions: analysis with conventional radiography |journal=Radiology |volume=246 |issue=3 |pages=662–74 |year=2008 |pmid=18223119 |doi=10.1148/radiol.2463061038 |url=}}</ref>  
Conventional radiography is the method of choice for the diagnosis of bone and cartilage tumors. The evaluation of bone and cartilage tumors will depend on 7 characteristics: location, margins, opacity and mineralization, size, [[periosteal reaction]], cortical involvement, and soft-tissue component.<ref name="pmid18223119">{{cite journal |vauthors=Miller TT |title=Bone tumors and tumorlike conditions: analysis with conventional radiography |journal=Radiology |volume=246 |issue=3 |pages=662–74 |year=2008 |pmid=18223119 |doi=10.1148/radiol.2463061038 |url=}}</ref>
 


<br>
<br>
{{familytree/start |summary= Imaging Evaluation Algorithm Bone or cartilage mass}}
{{familytree/start |summary= Imaging Evaluation Algorithm Bone or cartilage mass}}
{{familytree | | | | | | A02 | | | | | |A02=<div style="width: 10em; padding:0.2em;">'''Plain Radiograph'''</div>}}
{{familytree | | | | | | A02 | | | | | | A02=<div style="width: 10em; padding:0.2em;">'''Plain Radiograph'''</div>}}
{{familytree|boxstyle= border-top: 0px;| | | | | | A01 | |A01=<div style="width: 15em; padding:1em;">'''What type of bone is involved?''' <br> ❑ Long bone <br> ❑ Flat bone <br>'''Where is the lesion located?'''<br> ❑ Epiphysis<br> ❑ Diaphysis<br> ❑ Metaphysis<br> ❑ Apophysis  </div>}}
{{familytree | | | | | | |!| | | | | | | | }}
{{familytree | | | | | | |!| | | }}
{{familytree | | | | | | Z01 | | | | | | | Z01=What type of bone is involved?}}
{{familytree | | | | | | |!| | | }}
{{familytree | | | |,|-|-|^|-|-|.| | | | | }}
{{familytree | | | | | | A03 | |A03=<div style="width: 15em; padding:1em;">'''Imaging Evaluation'''</div>}}
{{familytree | | | B01 | | | | B02 | | | B01=Long bone|B02=Flat bone}}
{{familytree|boxstyle= border-top: 0px;| | | | | |A04 | | |A04=<div style="width: 15em; padding:1em;">'''What is the pattern involved?''' <br> ❑ Osteoblastic <br> ❑ Osteolytic <br> ❑ Mixed  <br>'''What is the transversal location? ''' <br> ❑ Medullary <br> ❑ Cortical<br> ❑ Yuxtacortical <br>'''What type of margin is involved? '''<br> ❑ Well defined <br> ❑ Ill-defined <br> ❑ Sclerotic <br> '''Is there a periosteal reaction?''' <br> ❑ Yes <br> ❑ No <br> '''What is the size? '''</div>}}
{{familytree | | | |!| | | | | |!| | | | | }}
{{familytree | | | | | | |!| | | | }}
{{familytree | | | C01 | | | | |!| | | | C01=<div style="width: 15em; padding:1em;">'''Where is the lesion located?''' <br>❑ Epiphysis<br> ❑ Diaphysis<br> ❑ Metaphysis<br> ❑ Apophysis  </div>}}
{{familytree | | | | | | |!| | | | }}
{{familytree | | | |`|-|-|v|-|-|'| | | | | }}
{{familytree | | | | |,|-|^|-|.| | }}
{{familytree | | | | | | D01 | | | | | | | D01=<div style="width: 15em; padding:1em;">'''What is the pattern involved?''' <br> ❑ Osteoblastic <br> ❑ Osteolytic <br> ❑ Mixed</div>}}
{{familytree | | | | B02 | |B01| | |B01=<div style="width: 10em; padding:1em;">'''Benign'''</div>|B02=<div style="width: 15em; padding:1em;">'''Malignant'''</div>}}
{{familytree | | | | | | |!| | | | | | | | }}
{{familytree | | | | | | E01 | | | | | | | E01=<div style="width: 15em; padding:1em;">'''What is the transversal location? ''' <br> ❑ Medullary <br> ❑ Cortical<br> ❑ Juxtacortical</div>}}
{{familytree | | | | | | |!| | | | | | | | }}
{{familytree | | | | | | X01 | | | | | | | X01=<div style="width: 15em; padding:1em;">'''What type of margin is involved? '''<br> ❑ Well defined <br> ❑ Ill-defined <br> ❑ Sclerotic</div>}}
{{familytree | | | | | | |!| | | | | | | | }}
{{familytree | | | | | | F01 | | | | | | | F01=<div style="width: 15em; padding:1em;">'''Is there a periosteal reaction?''' <br> ❑ Yes <br> ❑ No</div>}}
{{familytree | | | | | | |!| | | | | | | | }}
{{familytree | | | | | | G01 | | | | | | | G01=<div style="width: 15em; padding:1em;">'''What is the size? '''</div>}}
{{familytree | | | |,|-|-|^|-|-|.| | | | | }}
{{familytree | | | H01 | | | | H02 | | | | H01=<div style="width: 15em; padding:1em;">'''Likely benign? '''</div>|H02=<div style="width: 15em; padding:1em;">'''Likely malignant?'''</div>}}
{{familytree | | | |`|-|-|v|-|-|'| | | | | }}
{{familytree | | | | | | I01 | | | | | | | I01=<div style="width: 15em; padding:1em;">[[Bone or cartilage mass differential diagnosis|'''Differential diagnosis''']]</div>}}
{{familytree/end}}
{{familytree/end}}
<br>
<br>




'''Periosteal reaction'''  
'''Location'''
*Periosteal reaction is a non-specific radiographic feature, that occurs with periosteal irritation
*Bone and cartilage tumors can be divided by location into 3 different categories, such as:  
*Periosteal reactions may be broadly characterized by pattern and tumor nature (benign/malignant) 
:*Location in relation to the skeleton
*Useful to characterize a bone lesion
:*Location in relation to the physis ([[long bones]])
*Common periosteal reactions, include:  
:*Location in relation to the transverse bone
:*Single layer
:*Multilayered (onion-skin)
:*Solid
:*Spiculated
:*Perpendicular (hair-on-end)
:*Divergent (sunburst)
:*Sloping (velvet)
:*Disorganised/complex
:*Codman triangle


'''Location'''
Bone and cartilage tumors location by different parts of the skeleton, include:  
*Bone and cartilage tumors can be located in different parts of the skeleton, such as:  
*Axial skeleton
1.-Axial skeleton  
:*[[Skull]]
:*Skull
:*[[Rib cage]]
:*Rib cage
:*[[Hyoid bone]]
:*Hyoid bone
:*[[Vertebral column]]
:*Vertebral column  
*Appendicular skeleton
2.-Appendicular skeleton  
:*Long bones
:*Long bones
*Location in relation to the physis, includes:  
*Flat bones
:*Metaphysis
:*[[Pelvis|Pelvis bone]]
:*Diaphysis
:*[[Lacrimal bone]]
:*Epiphysis
:*Nasal bone
:*Apophysis
 
3.-Flat bones
Bone and cartilage tumors location in relation to the physis, include:
*Pelvis bone
:*[[Metaphysis]]
*Lacrimal bone
:*[[Diaphysis]]
*Nasal bone
:*[[Epiphysis]]
:*[[Apophysis]]


*Bone and cartilage tumors can also be identified by the transverse location into different categories, such as:  
Bone and cartilage tumors location in relation to the transverse bone, include:  
:*Medullary  
:*Medullary
:*Cortical  
:*Cortical
:*Juxtacortical
:*Juxtacortical


'''Margin'''
'''Margin'''
* The margin evaluation of bone and cartilage tumors, is divided into 3 categories:
 
:*Transition zone
The margin evaluation of bone and cartilage tumors, is divided into 3 categories:
::* Narrow
*Transition zone
::* Wide  
:*Narrow
:*Margin characteristics
:*Wide
::* Well-defined  
*Margin characteristics
::* Ill-defined  
:*Well-defined
::* Sclerotic  
:*Ill-defined
:* Patterns of bone destruction (appearance)
:*Sclerotic
::*Moth-eaten
* Patterns of bone destruction (appearance)
:::*Examples) Myeloma, metastases, Ewing's sarcoma  
:*Moth-eaten (myeloma, metastases, Ewing's sarcoma)
::*Geographic
:*Geographic (non-ossifying fibroma, chondromyxoid fibroma, and eosinophilic granuloma)
:::*Examples) Non-ossifying fibroma, chondromyxoid fibroma, eosinophilic granuloma
:*Permeated (round cell lesions)
::*Permeated
:::*Examples) Round cell lesions  


'''Opacity and mineralization'''
'''Opacity and mineralization'''
*Bone and cartilage tumors opacity depends on the stimulation of osteoclasts or osteoblasts in the bone
*Bone and cartilage tumors opacity depends on the stimulation of osteoclasts or osteoblasts in the bone
*Bone and cartilage tumors can be characterized by the tumor opacity into 3 different categories, including:  
*Bone and cartilage tumors can be characterized by the tumor opacity into 3 different categories, including:
:*Lytic lesions
:*Lytic lesions
:*Sclerotic lesions
:*Sclerotic lesions
:*Mixed lesions  
:*Mixed lesions
*Bone and cartilage tumors can be characterized by 2 patterns of mineralization:
:*Osseous
::*Fluffy
::*Cloud-like
:*Chondral
::*Punctate
::*Flocculent
::*Arclike
 
'''Periosteal reaction'''
*Periosteal reaction is a non-specific radiographic feature, that occurs with periosteal irritation
*Periosteal reactions may be broadly characterized by pattern and tumor nature (benign/aggressive)
*Useful to characterize a bone lesion
*Common periosteal reactions, include:
:*Single layer
:*Multilayered (onion-skin)
:*Solid
:*Spiculated
:*Perpendicular (hair-on-end)
:*Divergent (sunburst)
:*Sloping (velvet)
:*Disorganised/complex
:*Codman triangle


'''Size '''
'''Size '''
*In some cases, bone tumor size may be helpful to establish the diagnosis.
*In some cases, bone tumor size may be helpful to establish the diagnosis (eg. osteoblastoma (>1.5 cm) vs osteoid osteoma (<1.5 cm))
:*Example) Osteoblastoma (>1.5cm) vs osteoid osteoma (<1.5cm)
*Size can range from 0.1 cm - 10 cm
*Size can range from 0.1 cm - 10cm
*In general, large size tumors are more likely to be malignant, whereas small size tumors tend to be related with benign origin.
*In general, large size tumors are more likely to be malignant, whereas small size tumors tend to be related with benign origin.  


'''Cortical involvement'''
'''Cortical involvement'''
*In some cases, bone and cartilage tumors lesions can specifically arise within the cortex, in such cases the evaluation will depend on:
*In some cases, bone and cartilage tumors lesions can specifically arise within the cortex, in such cases the evaluation will depend on:
:*Type of erosion
*Type of erosion
::*Endosteal scalloping
:*Endosteal scalloping
::*"Soap bubble” lesions
:*"Soap bubble” lesions


'''Soft-tissue component'''
'''Soft-tissue component'''
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===CT===
===CT===
*The majority of bone and cartilage tumors require further evaluation with CT scan.
*Bone CT scan may be helpful in the diagnosis of bone and cartilage tumors
*CT scan features for the evaluation bone tumors, include:
*The majority of bone and cartilage tumors require further evaluation with CT scan
*Useful for evaluating subtle mineralization in lytic lesions
*Features of bone CT scan, include:<ref name="’’arc”">American College of Radiology (2011) ACR Appropriateness Criteria. Follow-up of Malignant or Aggressive Musculoskeletal Tumors. Available via http://www.acr.org/~/media/ACR/Documents/AppCriteria/Diagnostic/FollowupMalignantOrAggressiveMusculoskeletalTumors.pdf.</ref>
*Demonstrate occult bone destruction
:*Characterization of sclerotic or mixed (lytic/sclerotic) lesions
:*Imaging method of choice for follow-up of malignant tumors
:*Characterization of occult bone destruction
 
===MRI===


===MRI===  
*Musculoskeletal MRI may be helpful in the diagnosis of bone and cartilage tumors, common features include:<ref name="pmid25005774">{{cite journal |vauthors=Nascimento D, Suchard G, Hatem M, de Abreu A |title=The role of magnetic resonance imaging in the evaluation of bone tumours and tumour-like lesions |journal=Insights Imaging |volume=5 |issue=4 |pages=419–40 |year=2014 |pmid=25005774 |pmc=4141345 |doi=10.1007/s13244-014-0339-z |url=}}</ref>
 
:*Evaluation of the local extent of a malignant process
:*Useful for tumor staging
:*Evaluation of  soft tissue extension
:*Extension within the bone marrow compartment and tumoral tissue infiltration
:*Soft-tissue edema
:*Narrow the differential diagnosis of bone and cartilage tumors, especially when there are signs of aggressiveness
:*Contrast-enhanced musculoskeletal MRI can help demonstrate vascularized parts of the tumor
:*Useful evaluating lesions involving the cortical or medullary region, and determine whether they penetrate or invade the region
:*Useful to assess the response of chemotherapy in malignant bone tumors
:*The use of FS/STIR sequences may be helpful to confirm the presence or absence of fat in a lesion (useful to differentiate hemangioma from lipoma)


==Gallery==
==Gallery==
Line 120: Line 156:
===Plain Radiograph===
===Plain Radiograph===


<gallery widths=200px>
<gallery widths="200px">
Codman Triangle.jpg | '''Osteosarcoma with Codman triangles''': the tumor is essentially lytic and destructive with irregular, permeative margins, and soft tissue extension. Codman triangles (reactive periosteal new bone formation around the edges) are very prominent<br> [https://www.flickr.com/photos/bc_the_path/4965296860/in/photolist-FbNmc-8yLrLy-5eeKc6-5ej82N-9jGwsP-9jGwhx-9jGw1g-5m8NmK-xvJ8PX-uTG3PW-9jKASs<font size="-2">''Adapted from Creative Commons 3.0''</font>]
Codman Triangle.jpg | '''Osteosarcoma with Codman triangles''': the tumor is essentially lytic and destructive with irregular, permeative margins, and soft tissue extension (red arrow). Codman triangles (reactive periosteal new bone formation around the edges) are very prominent<br> [https://www.flickr.com/photos/bc_the_path/4965296860/in/photolist-FbNmc-8yLrLy-5eeKc6-5ej82N-9jGwsP-9jGwhx-9jGw1g-5m8NmK-xvJ8PX-uTG3PW-9jKASs<font size="-2">''Adapted from Creative Commons 3.0''</font>]
Giant cell tumor.jpeg| '''Giant cell tumor''': located on distal radius <br>[http://radiopaedia.org/articles/giant-cell-tumour-of-bone <font size="-2">''Adapted from Radiopedia''</font>]
Giant cell tumor.jpeg| '''Giant cell tumor''': located on distal radius <br>[http://radiopaedia.org/articles/giant-cell-tumour-of-bone <font size="-2">''Adapted from Radiopedia''</font>]
Metaphyseal-pathological-fracture.jpg| '''Pathological fracture''': located in the metaphyseal region <br>[http://radiopaedia.org/articles/pathological-fracture<font size="-2">''Adapted from Radiopedia''</font>]
Metaphyseal-pathological-fracture.jpg| '''Pathological fracture''': located in the metaphyseal region <br>[http://radiopaedia.org/articles/pathological-fracture<font size="-2">''Adapted from Radiopedia''</font>]
Line 132: Line 168:


===CT===
===CT===
<gallery widths=200px>
<gallery widths="200px">
String sing ct osteosarcoma.jpeg | '''String sign ''': appearance a radiolucent cleavage plane between portions of the tumor and cortex of the affected bone<br>[http://radiopaedia.org/articles/string-sign-of-parosteal-osteosarcoma <font size="-2">''Adapted from Radiopedia''</font>]
String sing ct osteosarcoma.jpeg | '''String sign ''': appearance a radiolucent cleavage plane between portions of the tumor and cortex of the affected bone<br>[http://radiopaedia.org/articles/string-sign-of-parosteal-osteosarcoma <font size="-2">''Adapted from Radiopedia''</font>]
Osteoblastoma CT.jpeg |'''Osteoblastoma''': Internal matrix mineralisation is better appreciated on CT <br>[http://radiopaedia.org/articles/osteoblastoma<font size="-2">''Adapted from Radiopedia''</font>]
Osteoblastoma CT.jpeg |'''Osteoblastoma''': Internal matrix mineralisation is better appreciated on CT <br>[http://radiopaedia.org/articles/osteoblastoma<font size="-2">''Adapted from Radiopedia''</font>]
Line 138: Line 174:


===MRI===
===MRI===
<gallery widths=200px>
<gallery widths="200px">
ONIONSIGN MRI.jpg | '''MRI- Onion skin sign '''<br>[http://radiopaedia.org/articles/multilayered-periosteal-reaction <font size="-2">''Adapted from Radiopedia''</font>]
ONIONSIGN MRI.jpg | '''MRI- Onion skin sign '''<br>[http://radiopaedia.org/articles/multilayered-periosteal-reaction <font size="-2">''Adapted from Radiopedia''</font>]
Enchondroma MRI.jpeg|'''MRI-Enchondroma''' : Well circumscribed somewhat lobulated masses replacing marrow<br>[http://radiopaedia.org/articles/multilayered-periosteal-reaction <font size="-2">''Adapted from Radiopedia''</font>]
Enchondroma MRI.jpeg|'''MRI-Enchondroma''' : Well circumscribed somewhat lobulated masses replacing marrow<br>[http://radiopaedia.org/articles/multilayered-periosteal-reaction <font size="-2">''Adapted from Radiopedia''</font>]


</gallery>
</gallery>
Line 147: Line 182:
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


[[Category:Disease]]
[[Category:Disease]]

Latest revision as of 14:08, 22 February 2016

Bone or Cartilage Mass Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]

Overview

Conventional radiography is the method of choice for the diagnosis of bone and cartilage tumors. The evaluation of bone and cartilage tumors will depend on 7 characteristics: periosteal reaction, opacity and mineralization, location, size, margins, cortical involvement, and soft-tissue component.[1]

Imaging

Plain Radiograph

Conventional radiography is the method of choice for the diagnosis of bone and cartilage tumors. The evaluation of bone and cartilage tumors will depend on 7 characteristics: location, margins, opacity and mineralization, size, periosteal reaction, cortical involvement, and soft-tissue component.[1]


 
 
 
 
 
Plain Radiograph
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
What type of bone is involved?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Long bone
 
 
 
Flat bone
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Where is the lesion located?
❑ Epiphysis
❑ Diaphysis
❑ Metaphysis
❑ Apophysis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
What is the pattern involved?
❑ Osteoblastic
❑ Osteolytic
❑ Mixed
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
What is the transversal location?
❑ Medullary
❑ Cortical
❑ Juxtacortical
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
What type of margin is involved?
❑ Well defined
❑ Ill-defined
❑ Sclerotic
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Is there a periosteal reaction?
❑ Yes
❑ No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
What is the size?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Likely benign?
 
 
 
Likely malignant?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 



Location

  • Bone and cartilage tumors can be divided by location into 3 different categories, such as:
  • Location in relation to the skeleton
  • Location in relation to the physis (long bones)
  • Location in relation to the transverse bone

Bone and cartilage tumors location by different parts of the skeleton, include:

  • Axial skeleton
  • Appendicular skeleton
  • Long bones
  • Flat bones

Bone and cartilage tumors location in relation to the physis, include:

Bone and cartilage tumors location in relation to the transverse bone, include:

  • Medullary
  • Cortical
  • Juxtacortical

Margin

The margin evaluation of bone and cartilage tumors, is divided into 3 categories:

  • Transition zone
  • Narrow
  • Wide
  • Margin characteristics
  • Well-defined
  • Ill-defined
  • Sclerotic
  • Patterns of bone destruction (appearance)
  • Moth-eaten (myeloma, metastases, Ewing's sarcoma)
  • Geographic (non-ossifying fibroma, chondromyxoid fibroma, and eosinophilic granuloma)
  • Permeated (round cell lesions)

Opacity and mineralization

  • Bone and cartilage tumors opacity depends on the stimulation of osteoclasts or osteoblasts in the bone
  • Bone and cartilage tumors can be characterized by the tumor opacity into 3 different categories, including:
  • Lytic lesions
  • Sclerotic lesions
  • Mixed lesions
  • Bone and cartilage tumors can be characterized by 2 patterns of mineralization:
  • Osseous
  • Fluffy
  • Cloud-like
  • Chondral
  • Punctate
  • Flocculent
  • Arclike

Periosteal reaction

  • Periosteal reaction is a non-specific radiographic feature, that occurs with periosteal irritation
  • Periosteal reactions may be broadly characterized by pattern and tumor nature (benign/aggressive)
  • Useful to characterize a bone lesion
  • Common periosteal reactions, include:
  • Single layer
  • Multilayered (onion-skin)
  • Solid
  • Spiculated
  • Perpendicular (hair-on-end)
  • Divergent (sunburst)
  • Sloping (velvet)
  • Disorganised/complex
  • Codman triangle

Size

  • In some cases, bone tumor size may be helpful to establish the diagnosis (eg. osteoblastoma (>1.5 cm) vs osteoid osteoma (<1.5 cm))
  • Size can range from 0.1 cm - 10 cm
  • In general, large size tumors are more likely to be malignant, whereas small size tumors tend to be related with benign origin.

Cortical involvement

  • In some cases, bone and cartilage tumors lesions can specifically arise within the cortex, in such cases the evaluation will depend on:
  • Type of erosion
  • Endosteal scalloping
  • "Soap bubble” lesions

Soft-tissue component

  • Involvement of the soft-tissue is suggestive of a malignant process.

CT

  • Bone CT scan may be helpful in the diagnosis of bone and cartilage tumors
  • The majority of bone and cartilage tumors require further evaluation with CT scan
  • Features of bone CT scan, include:[2]
  • Characterization of sclerotic or mixed (lytic/sclerotic) lesions
  • Imaging method of choice for follow-up of malignant tumors
  • Characterization of occult bone destruction

MRI

  • Musculoskeletal MRI may be helpful in the diagnosis of bone and cartilage tumors, common features include:[3]
  • Evaluation of the local extent of a malignant process
  • Useful for tumor staging
  • Evaluation of soft tissue extension
  • Extension within the bone marrow compartment and tumoral tissue infiltration
  • Soft-tissue edema
  • Narrow the differential diagnosis of bone and cartilage tumors, especially when there are signs of aggressiveness
  • Contrast-enhanced musculoskeletal MRI can help demonstrate vascularized parts of the tumor
  • Useful evaluating lesions involving the cortical or medullary region, and determine whether they penetrate or invade the region
  • Useful to assess the response of chemotherapy in malignant bone tumors
  • The use of FS/STIR sequences may be helpful to confirm the presence or absence of fat in a lesion (useful to differentiate hemangioma from lipoma)

Gallery

Plain Radiograph

  • Osteosarcoma with Codman triangles: the tumor is essentially lytic and destructive with irregular, permeative margins, and soft tissue extension (red arrow). Codman triangles (reactive periosteal new bone formation around the edges) are very prominent Adapted from Creative Commons 3.0

    Osteosarcoma with Codman triangles: the tumor is essentially lytic and destructive with irregular, permeative margins, and soft tissue extension (red arrow). Codman triangles (reactive periosteal new bone formation around the edges) are very prominent
    Adapted from Creative Commons 3.0

  • Giant cell tumor: located on distal radius Adapted from Radiopedia

    Giant cell tumor: located on distal radius
    Adapted from Radiopedia

  • Pathological fracture: located in the metaphyseal region Adapted from Radiopedia

    Pathological fracture: located in the metaphyseal region
    Adapted from Radiopedia

  • Rind sign: a lesion surrounded by a layer of thick, sclerotic reactive bone (rind) and is suggestive of fibrous dysplasia Adapted from Radiopedia

    Rind sign: a lesion surrounded by a layer of thick, sclerotic reactive bone (rind) and is suggestive of fibrous dysplasia
    Adapted from Radiopedia

  • Sunburst appearance: a type of periosteal reaction giving the appearance of a sunburst secondary to an aggressive periostitis. Present in aggresive tumors, such as: osteosarcoma, Ewing sarcoma, and osteoblastic metastases (e.g. prostate, lung or breast cancer) Adapted from Radiopedia

    Sunburst appearance: a type of periosteal reaction giving the appearance of a sunburst secondary to an aggressive periostitis. Present in aggresive tumors, such as: osteosarcoma, Ewing sarcoma, and osteoblastic metastases (e.g. prostate, lung or breast cancer)
    Adapted from Radiopedia

  • Onion skin sign : Also known as "multilayered periosteal reaction" demonstrates multiple concentric parallel layers of new bone adjacent to the cortex, reminiscent of the layers on an onion. Associated with osteosarcoma,Ewing sarcoma, and acute osteomyelitis (*) Parallel layers of new bone Adapted from Radiopedia

    Onion skin sign : Also known as "multilayered periosteal reaction" demonstrates multiple concentric parallel layers of new bone adjacent to the cortex, reminiscent of the layers on an onion. Associated with osteosarcoma,Ewing sarcoma, and acute osteomyelitis (*) Parallel layers of new bone
    Adapted from Radiopedia

  • Cockade sign: Classic appearance of an intraosseous lipoma of the calcaneus which presents as a well-defined lytic lesion with a central calcification resembling a cockade Adapted from Radiopedia

    Cockade sign: Classic appearance of an intraosseous lipoma of the calcaneus which presents as a well-defined lytic lesion with a central calcification resembling a cockade
    Adapted from Radiopedia

  • Geographic skull sign: radiographic appearance which is seen at eosinophilic granuloma. Destructive lytic bone lesion, edges of which may be bevelled, scalloped or confluent Adapted from Radiopedia

    Geographic skull sign: radiographic appearance which is seen at eosinophilic granuloma. Destructive lytic bone lesion, edges of which may be bevelled, scalloped or confluent
    Adapted from Radiopedia

CT

  • String sign : appearance a radiolucent cleavage plane between portions of the tumor and cortex of the affected bone Adapted from Radiopedia

    String sign : appearance a radiolucent cleavage plane between portions of the tumor and cortex of the affected bone
    Adapted from Radiopedia

  • Osteoblastoma: Internal matrix mineralisation is better appreciated on CT Adapted from Radiopedia

    Osteoblastoma: Internal matrix mineralisation is better appreciated on CT
    Adapted from Radiopedia

MRI

References

  1. ↑ 1.0 1.1 Miller TT (2008). "Bone tumors and tumorlike conditions: analysis with conventional radiography". Radiology. 246 (3): 662–74. doi:10.1148/radiol.2463061038. PMID 18223119.
  2. ↑ American College of Radiology (2011) ACR Appropriateness Criteria. Follow-up of Malignant or Aggressive Musculoskeletal Tumors. Available via http://www.acr.org/~/media/ACR/Documents/AppCriteria/Diagnostic/FollowupMalignantOrAggressiveMusculoskeletalTumors.pdf.
  3. ↑ Nascimento D, Suchard G, Hatem M, de Abreu A (2014). "The role of magnetic resonance imaging in the evaluation of bone tumours and tumour-like lesions". Insights Imaging. 5 (4): 419–40. doi:10.1007/s13244-014-0339-z. PMC 4141345. PMID 25005774.


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