Tumor Imaging Flashcards
What factor should you always start with when analyzing lesions?
age
What features of a clinical presentation would increase concern for malignancy, warranting a radiograph?
- unable to recreate pain on ortho. tests (non-mechanical pain)
- night pain
- deep boring bone pain
- night sweats
- unexplained weight loss
What 6 features should you consider when examining lesions on an x-ray?
L’PoDZ PMS:
- Location
- Pattern of Destruction
- Zone of transition
- Periosteal reaction
- Matrix pattern
- Soft tissue mass
What should you consider when describing the location of a lesion?
- what bone(s) are involved
- where in the bone
- central/eccentric
What should you consider when describing what bones are involved in radiographic lesions?
- how many bones
- what areas of the body
- endochondral vs intramembranous ossification
When examining radiographic lesions, what should you consider when describing what part of the bone is affected?
- epiphysis/apophysis (secondary oss.)
- metaphysis
- diaphysis
- central/medullary
- eccentric/cortical
Tuberosities, trochanters, and epicondyles are examples of what part of a bone?
apophysis
Carpals and tarsals are considered ____ equivalents
epiphyseal
Carpals and tarsals undergo ____ ossification
endochondral
Lesions that prefer ____ will also affect the carpals and tarsals
epiphyses and apophyses
A lesion located in the middle of the medullary canal is termed ____
central
A lesion that is cortically-based is termed ____
eccentric
What is the basic science term for “central” (which Warshel claims we will not use)?
eucentric
What are the 2 general categories for pattern of destruction in bone?
osteolytic
osteoblastic
Osteolytic lesions appear ____ radiographically
radiolucent
Osteoblastic lesions appear ____ radiographically
radiopaque
What are the osteolytic patterns of destruction?
- permeative
- motheaten
- geographic
What are the osteoblastic patterns of destruction?
- focal/localized
- multifocal
- diffuse
TRUE/FALSE:
The terms “benign” and “malignant” can be used when describing lesions radiographically
FALSE
need biopsy to use these terms
Which osteolytic pattern(s) of destruction are considered aggressive?
- permeative
- motheaten
Which osteolytic pattern(s) of destruction are considered non-aggressive?
geographic (generally)
What osteolytic pattern of destruction is described by a “dipped in acid” appearance?
permeative
What does a permeative pattern of destruction look like?
- individual pinhole lesions <1mm diameter (can conglomerate and appear larger)
- ill-defined border
- “dipped in acid” appearance
What does a motheaten pattern of destruction look like?
individual holes >1mm diameter (can conglomerate and appear larger)
____ and ____ destruction are a continuum of eachother
permeative & motheaten
What pattern of destruction is described as an “island of disease”?
geographic lytic
As a general rule, are blastic patterns of destruction aggressive or non-aggressive?
more aggressive
What does a focal pattern of destruction look like?
one lump of (blastic) disease
What does a multifocal pattern of destruction look like?
multiple individual/focal (blastic) lesions
What does a diffuse pattern of destruction look like?
^opacity involving larger portions of skeletal structure
What pattern of destruction is involved in osteopetrosis?
diffuse
What is a zone of transition?
interface between normal bone and diseased bone
A zone of transition can be ____ or ____
long (wide) or short (narrow)
A ____ zone of transition is considered aggressive
long/wide
A ____ zone of transition is generally considered non-aggressive
short/narrow
Permeative and motheaten destruction typically have a ____ zone of transition
long/wide
Geographic lytic destruction typically has a ____ zone of transition
short/narrow
What is a long/wide zone of transition?
No sharp demarcation between healthy and diseased bone
What is a short/narrow zone of transition?
Sharp demarcation between healthy & diseased bone (can tell exactly where it stops)
What is referred to as the “skin” of bone?
periosteum
What is reactive bone formation?
intramembranous bone formed in response to stress (lifting of periosteum) on bone or soft tissue
Reactive bone formation is also called _____
periosteal reaction
What are the types of periosteal reaction?
- solid
- laminated
- spiculated
- codman’s triangle
Which type of periosteal reaction is the least aggressive?
solid
A ____ periosteal reaction is described as a focal, cortical thickening
solid
What is a solid periosteal reaction?
as periosteum is lifted slowly, it has time to fill in completely
What are potential causes of solid periosteal reaction?
- bone hemorrhage (eg. fatigue Fx)
- benign bone tumors (eg. osteoid osteoma)
A ____ periosteal reaction is described as an “onion skin” appearance
laminated
What is a laminated periosteal reaction?
- lifts periosteum, stops, repeats
- lays down bone during rest phase
A ____ periosteal reaction is described as a “hair on end” or “sunburst” appearance
spiculated
What is a spiculated periosteal reaction?
periosteum is lifted rapidly, and bone growth occurs along Sharpey fibers
What is a Codman’s triangle periosteal reaction?
process extending beyond bone rapidly, stripping periosteum away from adjacent uninvolved bone, creating a “triangle” appearance
What do aggressive types of periosteal reaction have in common?
there is a soft tissue mass extending beyond the bone
What are the patterns of matrix calcifcation?
- no calcification
- target calcification
- stippled calcification
- blastic lesion
- ground glass
What does matrix calcification tell us about a tumor?
what it’s made of
What type of matrix calcification occurs in purely lytic lesions?
none (can’t tell matrix)
What type of matrix calcification occurs with fatty tissue?
target calcification/sequestrum
What type of matrix calcification occurs with cartilaginous tissue?
stippled calcification
What type of matrix calcification occurs with osseous tissue?
blastic lesion
What type of matrix calcification occurs with fibrous tissue?
ground glass
What is target calcification/sequestrum?
central calcification of fat in bone
What is stippled calcification?
macrocalcification of cartilage appearing as individual white dots (looks like ice cube)
What is ground glass appearance?
microcalcification of fibrous tissue creating an opaque “frosted glass” appearance
What 2 factors indicate a soft tissue mass extending beyond the bone?
- aggressive periosteal Rxn
- displacement of fascial planes
Soft tissue mass is typically only seen in ____ bone tumors
primary
(not metastatic)
If a tumor metastasizes to bone, will there be a soft tissue mass extending beyond the bone?
NO (rarely)
