Radiographic Signs:Patterns Of Bone Destuction

Question 1

What are the various features of geographic lesions?

Answer 1

Centric or Eccentric
Expansile or Non expansile
Compartment or non-compartment 
Speckled or radiolucent or 
Isodense
well or ill-defined
Thin or thick sclerotic margin
Benign or malignant

Question 2

Category of geographic lesion:

Well defined margin w/ sclerotic rim

Short zone of transition

Benign

Answer 2

1A

Question 3

Bone lesion:

Slow growing and benign (can spread)

Larger > 1cm in size

Zone of transition is an indicator of its aggressiveness

Base lesion is radiolucent area lesion

Answer 3

Geographic

Question 4

Category of Geographic lesion:

Well defined margin w/o sclerotic rim

More aggressive lesions > 1A

Wider transitional zone at the margin >1A

Benign

Answer 4

1B

Question 5

Prime example cause of 1B geographic lesion

Answer 5

Osteomyelitis

Question 6

Category of geographic lesion:

Ill-defined margin

Wide zone of transition

Aggressive, often malignant`

Answer 6

1C

Question 7

When examining the x-ray above, need to know ALAS “a foxism”

Answer 7

Age

Location
Appearance

Symptom

Question 8

When internal matrix has the same density as the medullary cavity

Answer 8

Isodense

Question 9

Causes of Lesions:

Benign or malignant, are common causes of Geographic Lesion

Can destroy right up to the articular margin, but will not touch the joint
- subarticular

Answer 9

Tumors

Question 10

Causes of Lesions:

(can be very dangerous)- full of plasma fluid (as opposed to cells)

Can destroy right up to the articular margin, but will not touch the joint
- subarticular

Answer 10

Tumor-like lesions

Question 11

Causes of Lesions:

No respect for anything (ie. Joints) unlike tumors

Does not stop at subchondral bone, would continue into joints

Answer 11

Osteomyelitis-Bone infection

Question 12

What are the main destroyers of bone?

Answer 12

Infection and tumor

Question 13

What ways do destructive bone lesions occur?

Answer 13

Replacement of bone with tissue or fluid

Removed by lytic enzymes

Question 14

T/F: Infections can replace bone with tissue or fluid and remove bone by lytic enzyme activity.

Answer 14

True

Question 15

What is the minimum loss of bone required to see on plain film?

Answer 15

30%

50% in the spine

Question 16

What is the minimum loss required to see on MRI?

Answer 16

1-2%

Question 17

Bone lesion:

Individual lesions <1cm

Well defined with NO sclerotic margin (usually considered 1B)

Usually in flat bones, especially in cranial fault. (can be in spine)

Answer 17

Punched-out

Question 18

What is the classic cause of punched out lesion?

Answer 18

Multiple Myeloma

Question 19

Appearance of punched-out lesions in the skull?

Answer 19

Scattered

usually of uniform size

Question 20

T/F: Punched-out lesions are usually part of myeltomatosis, which is wide spread loss of bone density

Answer 20

True

Question 21

Bone Lesion:

Holes 2-5mm

Malignant-rapid growth

Ragged border/wide zone of transition

May be benign (Osteomyelitis) or malignant (Osteosarcoma)

Freq. coexist w/ permeative

Answer 21

Moth eaten

Question 22

Cause of Moth eaten

Answer 22

Multiple Myeloma
Metastasis
Lymphoma
Ewing's sarcoma
Osteomyelitis
Osterolytic sarcoma

Question 23

Most common 1* bone malignancy

Answer 23

Multiple myeloma

Question 24

Primary lymph malignancy that spreads to bone but rarely starts in
bone.

Answer 24

Lymphoma

Question 25

Primary bone malignancy classified as a round cell malignancy

4th most common primary bone malignancy

Primarily in children – 1st most common in first decade

Usually permeative lesion

Answer 25

Ewing’s sarcoma

Question 26

Moth eaten and permeative bone lesion has to affect the cortex to be seen on film.

How will the cortex appear?

Answer 26

The cortex will be thinned and radiolucent

Question 27

Bone Lesion:
<1mm in size

Ill-defined

Worm holes small, tiny holes

Wide zone of transition with fine margins

Localized bone pain

Occurs in diaphysis

Answer 27

Permeative Osteolysis

Question 28

In which category of bone lesion will the pt have bone pain?

Answer 28

Moth eaten

Permeative

Question 29

Causes of permeative lesions

Answer 29

Lymphoma

Ewing’s**

Multiple Myeloma

Osteomyelitis

Neuroblastoma(Metastatic

Osteolytic sarcoma

Question 30

This cause of moth eaten and permeative lesions, comes from the adrenal glands, occurs 80% in children under 5 with a strong tendency to metastasize to bone

Answer 30

Neuroblastoma (METs)

Question 31

What disease does neuroblastoma come second to in children under 5?

Answer 31

Wilm’s tumor