Bone Tumor NM + pictures

Question 1

Osteosarcoma

Answer 1

painful mass rising at metaphyseal regions
most common knee (the end of long bones)
Conventional type 80% – 10-20 years
Parosteal sarcoma – posterior distal metaphysis of femur

Question 2

Osteosarcoma T

Answer 2

T1 < 8 cm long
T2 > 8 cm long
T3 2 lesions in one bone

Question 3

Osteosarcoma risk

Answer 3

Polyostotic Paget long term – secondary
Previous radio
Familial retinoblastoma
Rothmund-Thomson sy (skin)
Bone infarct

Question 4

Osteosarcoma M

Answer 4

lung
bone
LN

Question 5

Osteosarcoma X-ray

Answer 5

Medullary and cortical bone destruction, wide zone of transition (permeative or moth-eaten appearance), aggressive periosteal reaction

Question 6

Osteosarcoma CT

Answer 6

Staging, lytic lesions
Chest – MTS
Osteoid matrix – cloud like, poorly defined
Cartilage matrix – dots, rings, arcs of calcification <2mm

Question 7

Osteosarcoma MRI

Answer 7

Joint-to-joint
Assessment of growth plate – 75-88% cross growth plate to epiphysis

Question 8

Osteosarcoma NM

Answer 8

Bone scan: 3-phase positive, extent of osseous diffusion, level of bone resection
FDG: high grade intense uptake – tumor-to-background ratio cutoff 3.0 for malignant lesion
Tl, MIBI, Fluoride
SUV <2 after therapy – good response
SUV >5 – poor response

Question 9

Osteosarcoma therapy

Answer 9

Effective neoadjuvant – less amputation – active ossification mimics therapy failure – SUV <2.5 post therapy predicts tumor necrosis
Enlarge on posttherapy image

Question 10

Osteoid osteoma

Answer 10

Benign
Pain at night
Cortex of long bones (50% femur or tibia)
Intracortical <2cm nidus + mineralization, cortical thickening, reactive sclerosis

Question 11

Osteoblastoma

Answer 11

Benign
Posterior element of spine (cervical)
Nidus >2cm
Greater potential for growth, bone destruction, malignant transformation, recurs

Question 12

OO NM

Answer 12

Bone scan: lucent nidus surrounded by sclerosis – very hot spot + surrounding diffuse mildly increased uptake
SPECT - “one stop shop”
FDG – response to treatment

Question 13

Ewing Sarcoma

Answer 13

4-15 years
Pretreatment high SUV – high grade
SUV >5.8 – poor prognosis
Post-neoadjuvant SUV <2.5 – good response (90% necrosis)

Question 14

Ewing sarcoma Prognostic factor

Answer 14

size of lesion and distant MTS

Question 15

Ewing Sarcoma NM

Answer 15

diaphysis of long bone (femur)
Bone scan: nonspecific increased uptake
FDG: >MRI in skip lesions, MTS LN
< chest CT

Question 16

Chondroma

Answer 16

Benign, 30-80 years
Compose of mature hyaline cartilage – limited growth potential, not aggressive

Question 17

Enchondroma

Answer 17

occur in medullary canal
melting sore at pressure
20-30 years
>6cm – high risk for chondrosarcoma

Question 18

Risk for chondrosarcoma

Answer 18

Ollier disease
Mafucci disease
Exostosis
Most likely to seed biopsy track

Question 19

Chondroma CT

Answer 19

Cartilaginous matrix, endosteal scalloping
Thickness of cap >2cm – malignant

Question 20

Chondroma NM

Answer 20

Bone scan: cartilage matrix with increased uptake – malignant
FDG: low SUV for benign
SUV >2 threshold for malignant
No radio, no chemo

Question 21

Answer 21

Osteoid osteoma

Question 22

Answer 22

Osteosarcoma

Question 23

Answer 23

Chondrosarcoma

Question 24

Answer 24

Ewing sarcoma

Question 25

Answer 25

Enchondroma

Question 26

Answer 26

Chondroma

Question 27

Answer 27

Osteosarcoma

Question 28

Answer 28

Chondrosarcoma

Question 29

Answer 29

Fibrous dysplasia

Question 30

Answer 30

MTS superscan

Question 31

Answer 31

Hypertrophic pulmonary osteoarthropathy

Question 32

Answer 32

Spondylodiscitis

Question 33

Answer 33

Honda sign
Sacral insufficiency fracture

Question 34

Answer 34

Chicken bone
Osteomalacia

Question 35

Answer 35

Uptake in lung and stomach
Hyperpara

Question 36

Answer 36

Metabolic superscan

Question 37

Answer 37

Grenadier soldier
Hyperpara

Question 38

Answer 38

Rosary beads
Hyperpara

Question 39

Answer 39

Brown tumor in Hyperpara

Question 40

Answer 40

Shin splints

Question 41

Answer 41

Stress fracture

Question 42

Answer 42

AVN

Question 43

Answer 43

CRPS

Question 44

Answer 44

Paget