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NYCC MSP > Tumor Imaging > Flashcards

Tumor Imaging Flashcards

1
Q

What factor should you always start with when analyzing lesions?

A

age

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2
Q

What features of a clinical presentation would increase concern for malignancy, warranting a radiograph?

A
  • unable to recreate pain on ortho. tests (non-mechanical pain)
  • night pain
  • deep boring bone pain
  • night sweats
  • unexplained weight loss
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3
Q

What 6 features should you consider when examining lesions on an x-ray?

A

L’PoDZ PMS:
- Location
- Pattern of Destruction
- Zone of transition
- Periosteal reaction
- Matrix pattern
- Soft tissue mass

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4
Q

What should you consider when describing the location of a lesion?

A
  • what bone(s) are involved
  • where in the bone
  • central/eccentric
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5
Q

What should you consider when describing what bones are involved in radiographic lesions?

A
  • how many bones
  • what areas of the body
  • endochondral vs intramembranous ossification
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6
Q

When examining radiographic lesions, what should you consider when describing what part of the bone is affected?

A
  • epiphysis/apophysis (secondary oss.)
  • metaphysis
  • diaphysis
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7
Q

Tuberosities, trochanters, and epicondyles are examples of what part of a bone?

A

apophysis

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8
Q

Carpals and tarsals are considered ____ equivalents

A

epiphyseal

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9
Q

Carpals and tarsals undergo ____ ossification

A

endochondral

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10
Q

Lesions that prefer ____ will also affect the carpals and tarsals

A

epiphyses and apophyses

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11
Q

A lesion located in the middle of the medullary canal is termed ____

A

central

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12
Q

A lesion that is cortically-based is termed ____

A

eccentric

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13
Q

What is the basic science term for “central” (which Warshel claims we will not use)?

A

eucentric

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14
Q

What are the 2 general categories for pattern of destruction in bone?

A

osteolytic
osteoblastic

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15
Q

Osteolytic lesions appear ____ radiographically

A

radiolucent

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16
Q

Osteoblastic lesions appear ____ radiographically

A

radiopaque

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17
Q

What are the osteolytic patterns of destruction?

A
  • permeative
  • motheaten
  • geographic
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18
Q

What are the osteoblastic patterns of destruction?

A
  • focal
  • multifocal
  • diffuse
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19
Q

TRUE/FALSE:
The terms “benign” and “malignant” can be used when describing lesions radiographically

A

FALSE
need biopsy to use these terms

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20
Q

Which osteolytic pattern(s) of destruction are considered aggressive?

A
  • permeative
  • motheaten
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21
Q

Which osteolytic pattern(s) of destruction are considered non-aggressive?

A

geographic (generally)

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22
Q

What osteolytic pattern of destruction is described by a “dipped in acid” appearance?

A

permeative

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23
Q

What does a permeative pattern of destruction look like?

A
  • individual holes <1mm diameter (can conglomerate and appear larger)
  • “dipped in acid” appearance
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24
Q

What does a motheaten pattern of destruction look like?

A

individual holes >1mm diameter (can conglomerate and appear larger)

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25
Q

____ and ____ destruction are a continuum of eachother

A

permeative & motheaten

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26
Q

What pattern of destruction is described as an “island of disease”?

A

geographic lytic

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27
Q

As a general rule, are blastic patterns of destruction aggressive or non-aggressive?

A

more aggressive

28
Q

What does a focal pattern of destruction look like?

A

one lump of (blastic) disease

29
Q

What does a multifocal pattern of destruction look like?

A

multiple individual/focal (blastic) lesions

30
Q

What does a diffuse pattern of destruction look like?

A

^opacity involving larger portions of skeletal structure

31
Q

What pattern of destruction is involved in osteopetrosis?

A

diffuse

32
Q

What is a zone of transition?

A

interface between normal bone and diseased bone

33
Q

A zone of transition can be ____ or ____

A

long (wide) or short (narrow)

34
Q

A ____ zone of transition is considered aggressive

A

long/wide

35
Q

A ____ zone of transition is generally considered non-aggressive

A

short/narrow

36
Q

Permeative and motheaten destruction typically have a ____ zone of transition

A

long/wide

37
Q

Geographic destruction typically has a ____ zone of transition

A

short/narrow

38
Q

What is a long/wide zone of transition?

A

No sharp demarcation between healthy and diseased bone

39
Q

What is a short/narrow zone of transition?

A

Sharp demarcation between healthy & diseased bone (can tell exactly where it stops)

40
Q

What is referred to as the “skin” of bone?

A

periosteum

41
Q

What is reactive bone formation?

A

intramembranous bone formed in response to stress (lifting of periosteum) on bone or soft tissue

42
Q

Reactive bone formation is also called _____

A

periosteal reaction

43
Q

What are the types of periosteal reaction?

A
  • solid
  • laminated
  • spiculated
  • codman’s triangle
44
Q

Which type of periosteal reaction is the least aggressive?

A

solid

45
Q

A ____ periosteal reaction is described as a focal, cortical thickening

A

solid

46
Q

What is a solid periosteal reaction?

A

as periosteum is lifted slowly, it has time to fill in completely

47
Q

What are potential causes of solid periosteal reaction?

A
  • bone hemorrhage (eg. fatigue Fx)
  • benign bone tumors (eg. osteoid osteoma)
48
Q

A ____ periosteal reaction is described as an “onion skin” appearance

A

laminated

49
Q

What is a laminated periosteal reaction?

A
  • lifts periosteum, stops, repeats
  • lays down bone during rest phase
50
Q

A ____ periosteal reaction is described as a “hair on end” or “sunburst” appearance

A

spiculated

51
Q

What is a spiculated periosteal reaction?

A

periosteum is lifted rapidly, and bone growth occurs along Sharpey fibers

52
Q

What is a Codman’s triangle periosteal reaction?

A

process extending beyond bone rapidly, stripping periosteum away from adjacent uninvolved bone, creating a “triangle” appearance

53
Q

What do aggressive types of periosteal reaction have in common?

A

there is a soft tissue mass extending beyond the bone

54
Q

What are the patterns of matrix calcifcation?

A
  • no calcification
  • target calcification
  • stippled calcification
  • blastic lesion
  • ground glass
55
Q

What does matrix calcification tell us about a tissue?

A

what it’s made of

56
Q

What type of matrix calcification occurs in purely lytic lesions?

A

none (can’t tell matrix)

57
Q

What type of matrix calcification occurs in fatty tissue?

A

target calcification

58
Q

What type of matrix calcification occurs in cartilaginous tissue?

A

stippled calcification

59
Q

What type of matrix calcification occurs in osseous tissue?

A

blastic lesion

60
Q

What type of matrix calcification occurs in fibrous tissue?

A

ground glass

61
Q

What is target calcification?

A

central calcification of fat

62
Q

What is stippled calcification?

A

macrocalcification of cartilage appearing as individual white dots

63
Q

What is ground glass appearance?

A

microcalcification of fibrous tissue creating an opaque “frosted glass” appearance

64
Q

What 2 factors indicate a soft tissue mass extending beyond the bone?

A
  • aggressive periosteal Rxn
  • displacement of fascial planes
65
Q

Soft tissue mass is typically only seen in ____ bone tumors

A

primary
(not metastatic)

66
Q

If a tumor metastasizes to bone, will there be a soft tissue mass extending beyond the bone?

A

NO (rarely)

NYCC MSP (22 decks)

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