Tumor Imaging & Cystic Lesions of Bone Flashcards
When analyzing lesions, one must consider:
- Age
- Clinical presentation
- Radiographic characteristics
L’PoDZ PMS
What are five radiographic characteristics to analyze a lesion?
- Location
- Pattern of destruction
- Zone of transition
- Periosteal reaction
- Soft tissue mass
What are some descriptions for where in the bone a lesion has occurred?
- Epiphysis/apophysis, metaphysis, diaphysis
- Central (eucentric)/eccentric
What are the osteolytic patterns of destruction?
- Permeative
- Moth-eaten
- Geographic
What are the osteoblastic patterns of destruction?
- Focal
- Multifocal
- Diffuse
What is a permeative pattern of destruction?
Multiple endosteal radiolucent small lesions with a poor zone of transition
(osteolytic)
What is a moth-eaten pattern of destruction?
Multiple moderately sized endosteal radiolucent lesions with a poor zone of transition
(osteolytic)
What is a geographic pattern of destruction?
Lesion with sharply defined border and narrow zone of transition between normal and pathologic bone
(osteolytic)
What is a focal pattern of destruction?
Increased osteoblastic activity in one location appearing radiopaque
What is a multifocal pattern of destruction?
Multiple/many locations of increased osteoblastic activity appearing roadiopaque
What is a diffuse pattern of destruction?
Multiple bones (ie. spine, pelvis) increase in bone density (sclerotic) (without pinpoint locations of lesions)
(osteoblastic)
What is the zone of transition?
Interface between normal bone and diseased bone
How might the zone of transition be described?
Long or short; wide or narrow
If prostate cancer has caused the spine and pelvis to increase bone densities, what pattern of destruction has occurred?
Diffuse osteoblastic destruction
reactive bone formation
Intramembranous bone is formed in response to ___
stress on bone or soft tissue
reactive bone formation
Once stimulus lifts the periosteum, what is the result?
Intramembranous bone formation
reactive bone formation
If the periosteum has lifted, which types of bone will be made during intramembranous bone formation?
Woven or lamellar
What is the term for the process of lifting the periosteum and intramembranous bone formation?
Periosteal reaction
What are the types of periosteal reaction?
- Solid
- Laminated
- Spiculated
- Codman’s triangle
Can the periosteal reaction involve the endosteum?
Yes
How does a solid periosteal reaction progress?
- Slow growing
- Typically non-aggressive
- Periosteum is lifted slowly and fills completely
A patient has experienced a fatigue fracture causing bone hemorrhage. Their radiographs now display a periosteal reaction that has filled completely.
What type of periosteal reaction has occurred?
Solid periosteal reaction
A patient is known to have osteoid osteoma, a benign bone tumor. Their radiographs display a slow growing, filled in periosteal reaction.
What type of periosteal reaction has occurred?
Solid periosteal reaction
What are some causes of solid periosteal reaction?
- Bone hemorrhage (ie. fatigue fractures)
- Benign bone tumors (ie. osteoid osteoma)
Which periosteal reaction is an aggressive process of lifting, stopping, and lifting the periosteum again?
Laminated periosteal reaction
What is a laminated periosteal reaction?
- Aggressive process
- Lifts periosteum, stops, lifts again, etc.
- Lays down bone during rest phase
Which periosteal reaction is an aggressive process where periosteum is lifted rapidly?
Spiculated periosteal reaction
A patient’s radiograph evidences bone growth along Sharpey fibers with a “hair on end”/”sunburst” appearance
What type of periosteal reaction has occurred?
Spiculated periosteal reaction
How does a spiculated periosteal reaction appear on a radiograph?
- Bone growth along the Sharpey fibers
- “Hair on end”/”sunburst” appearance
Which periosteal reaction is an aggressive process extending beyond bone (into unaffected bone) rapidly?
Codman triangle periosteal reaction
What is Codman triangle periosteal reaction?
- Aggressive pattern
- Extends beyond bone rapidly
- Strips periosteum away from adjacent uninvolved bone
What are five patterns of matrix calcification?
- No calcification (can’t tell on purely lytic lesions)
- Target calcification
- Stippled calcification
- Blastic lesion
- Ground glass
Which matrix calcification occurs in fat?
Target calcification
Which matrix calcification occurs in cartilage?
Stippled calcification
Which matrix calcification occurs in osseous tissue?
Blastic lesion
Which matrix calcification occurs in fibrous tissue?
Ground glass
matrix calcification
Where does target calcification occur?
Fat
matrix calcification
Where does stippled calcification occur?
Cartilage
matrix calcification
Where does a blastic lesion occur?
Osseous structures
matrix calcification
Where does ground glass calcification occur?
Fibrous tissues
If there is an aggressive periosteal reaction, will there be a mass extending beyond bone into soft tissue?
Yes
If you can see displacement of facial planes, will there be a mass extending beyond bone into soft tissue?
Yes
