Radiographic Signs:Patterns Of Bone Destuction Flashcards
What are the various features of geographic lesions?
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
Category of geographic lesion:
Well defined margin w/ sclerotic rim
Short zone of transition
Benign
1A
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
Geographic
Category of Geographic lesion:
Well defined margin w/o sclerotic rim
More aggressive lesions > 1A
Wider transitional zone at the margin >1A
Benign
1B
Prime example cause of 1B geographic lesion
Osteomyelitis
Category of geographic lesion:
Ill-defined margin
Wide zone of transition
Aggressive, often malignant`
1C
When examining the x-ray above, need to know ALAS “a foxism”
Age
Location
Appearance
Symptom
When internal matrix has the same density as the medullary cavity
Isodense
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
Tumors
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
Tumor-like lesions
Causes of Lesions:
No respect for anything (ie. Joints) unlike tumors
Does not stop at subchondral bone, would continue into joints
Osteomyelitis-Bone infection
What are the main destroyers of bone?
Infection and tumor
What ways do destructive bone lesions occur?
Replacement of bone with tissue or fluid
Removed by lytic enzymes
T/F: Infections can replace bone with tissue or fluid and remove bone by lytic enzyme activity.
True
What is the minimum loss of bone required to see on plain film?
30%
50% in the spine
What is the minimum loss required to see on MRI?
1-2%
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)
Punched-out
What is the classic cause of punched out lesion?
Multiple Myeloma
Appearance of punched-out lesions in the skull?
Scattered
usually of uniform size
T/F: Punched-out lesions are usually part of myeltomatosis, which is wide spread loss of bone density
True
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
Moth eaten
Cause of Moth eaten
Multiple Myeloma Metastasis Lymphoma Ewing's sarcoma Osteomyelitis Osterolytic sarcoma
Most common 1* bone malignancy
Multiple myeloma
Primary lymph malignancy that spreads to bone but rarely starts in
bone.
Lymphoma
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
Ewing’s sarcoma
Moth eaten and permeative bone lesion has to affect the cortex to be seen on film.
How will the cortex appear?
The cortex will be thinned and radiolucent
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
Permeative Osteolysis
In which category of bone lesion will the pt have bone pain?
Moth eaten
Permeative
Causes of permeative lesions
Lymphoma
Ewing’s**
Multiple Myeloma
Osteomyelitis
Neuroblastoma(Metastatic
Osteolytic sarcoma
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
Neuroblastoma (METs)
What disease does neuroblastoma come second to in children under 5?
Wilm’s tumor
