Bone or cartilage mass imaging
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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
Imaging
Plain Radiograph
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/malignant)
- 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
Location
- Bone and cartilage tumors can be located in different parts of the skeleton, such as:
1.-Axial skeleton
- Skull
- Rib cage
- Hyoid bone
- Vertebral column
2.-Appendicular skeleton
- Long bones
- Location in relation to the physis, includes:
- Metaphysis
- Diaphysis
- Epiphysis
- Apophysis
3.-Flat bones
- Pelvis bone
- Lacrimal bone
- Nasal bone
- Bone and cartilage tumors can also be identified by the transverse location into different categories, such as:
- 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
- Examples) Myeloma, metastases, Ewing's sarcoma
- Geographic
- Examples) Non-ossifying fibroma, chondromyxoid fibroma, eosinophilic granuloma
- Permeated
- Examples) 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
Size
Cortical involvement
Soft-tissue component
CT
MRI
Gallery
Plain Radiograph
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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
Adapted from Creative Commons 3.0 -
Giant cell tumor: located on distal radius
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 -
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 -
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
CT
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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
MRI
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MRI- Onion skin sign
Adapted from Radiopedia -
MRI-Enchondroma : Well circumscribed somewhat lobulated masses replacing marrow
Adapted from Radiopedia
