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RADIOLOGIAL APPROACH TO BONE TUMORS
DR. C. K.VASU, M.D
THERAPEUTIC GOALS
DO NOT OVERTREAT A BENIGN TUMOR
DO NOT UNDERTREAT A MALIGNANT TUMOR
DO NOT MISDIRECT BIOPSY
RADIOLOGIST CAN SEE THE THREE DIMENSIONAL GROSS PATHOLOGY
IF RADIOLOGIC FINDINGS ARE NOT CORRELATING WITH THE PATHOLOGY FINDINGS:SPECIAL STAINS, ADDITIONAL IMAGES WILL HELP
TUMOR MAY HAVE VARYING HISTOLOGY AND REPRESENTATIVE SAMPLE FROM EPICENTRE OF THE LESION HAS TO BE TAKEN
ROLE OF PLAIN RADIOGRAPH
INITIAL EXAMINATION –STARTS THE DIAGNOSTIC ALGORITHM
SCREENING, DETECTION,DIAGNOSIS,FOLLOWUP
IN THIS COST-CONSCIOUS ERA
SYSTEMATIC APPROACH
AGE
SITE
ZONE OF TRANSITION
MATRIX
CORTEX
PERIOSTEAL REACTION
SOFT TISSUE COMPONENT
SINGLE - MULTIPLE
AGE AT PRESENTATION
DIFFERENTIAL DIAGNOSIS CAN BE NARROWED
1 ST DECADE : NEUROBLASTOMA,LEUKEMIA2 ND DECADE : OSTEOSARCOMA, EWINGS SARCOMA3RD DECADE: GIANT CELL TUMORELDERLY : METASTASIS, CHONDROSARCOMA
CLUE TO AGE : FROM EPIPHYSEAL FUSION
OSTEOSARCOMA@
CHONDRO BLASTOMA
GCT@
LOCATION
EPIPHYSEAL :
CHONDROBLASTOMA, GIANT CELL TUMOUR
METAPHYSEAL :
OSTEOSARCOMA, ANEURYSMAL BONE CYST
DIAPHYSEAL :
EWINGS SARCOMA
CHONDRO BLASTOMA@
GCT / ABC
EWINGS SARCOMA
EWINGS SARCOMA
ZONE OF TRANSITION IT IS AN ASSESSMENT OF THE
BIOLOGICAL ACTIVITY GEOGRAPHIC OR TYPE 1 (LODWIG) 1A----WITH SCLEROSIS: BONE DEPOSITION
TO REDIRECT TRANSMITTED FORCES IN TYPE 1A LESIONS IDEAL POSTOP
RADIOGRAPH SHOULD SHOW COMPLETE REMOVAL OF NOT ONLY SCLEROTIC RIM BUT ALSO SEVERAL MMS “NORMAL BONE”
IF SCLEROTIC RIM REMAINS HIGHER RECURRENCE CHANCE
EX: CHONDROBLASTOMA, BONE CYST
TYPE 1B:
BIOLOGIC ACTIVITY IS SLIGHTLY MORE: NO SCLEROTIC RIM
EX: GIANT CELL TUMOR
TYPE 1C LESION
LYTIC LESION WITH ILL DEFINED MARGIN: THEY ARE MALIGNANT UNLESS PROVED OTHERWISE:
EX: CHONDROSARCOMA,
FIBROSARCOMA
MULTIPLE CLUSTERED SMALL HOLES(<5MM)
(TYPE 3) PERMEATIVE PATTERN
LUCENT LINEAR STREAKS DD IS SIMILAR: OSTEOSARCOMA,
EWINGS SARCOMA
(TYPE 2)MOTH EATEN
LYTIC LESION WITH SCLEROTIC RING
GCT
CHONDROSARCOMA RADIUS
OSTEOGENIC SARCOMA
PERMEATIVE PATTERN
CORTICAL BREAK
MALIGNANT LESIONS
:OSTEOSARCOMA,EWINGS SARCOMA
BENIGN LESIONS: NO CORTICAL BREAK USUALLY:
EX: GCT,ABC
GIANT CELL TUMOUR PATELLA
DESMOPLAS-TIC FIBROMA
OSTEOCHONDROMA@
OSTEOCHONDROMA
PERIOSTEAL REACTION
OUTER FIBROUS LAYER AND INNER CELLULAR LAYER.
10-21DAYS : SEEN EARLIER IN YOUNGER PATIENTS
INDICATION OF BIOLOGICAL ACTIVITY
TYPES OF PERIOSTEAL REACTION
CONTINUOUS: LAMELLATED (ONION –PEEL)
DISCONTINUOUS : CODMAN ANGLES COMPLEX: LAMELLATED + CODMAN MORE EXTENSIVE AND COMPLEX
THE PERIOSTEAL REACTION GREATER BIOLOGICAL ACTIVITY
EWINGS SARCOMA@
LAMELLAR APPEARENCE
SUN RAY
OSTEOSARCOMA
PAROSTEAL OSTEOSARCOMA
EWINS SARCOMA
MATRIX OSSEUS MATRIX: OSTEOMA,OSTEOID
OSTEOMA---CLOUD LIKE RELATIVELY HOMOGENOUS AREA OF BLASTIC CHANGE
CARTILAGE MATRIX: STIPLLED, CURVILINEAR CALCIFICATION(RINGS AND ARCS)---ENCHONDROMA,CHONDROSARCOMA
NON-MINERALIZED MATRIX: GIANT CELL TUMOR, OSTEOLYTIC OSTEOSARCOMA
OSTEOID OSTEOMA
D/D:GARRE’S OSTEOMYELITIS
OSTEOSARCOMA@
CHONDRO SARCOMA@
MEDULLARY NECROSIS
NO MATRIX--FIBROSARCOMA
SOFT TISSUE COMPONENT
DETECTED ON PLAIN XRAY-DISPLACED FAT PLANE
ROLE OF CT AND MRI
FIBROSARCOMA@
EWINGS SARCOMA
LESION MULTIPLICITY
KEY DIAGNOSTIC SIGN
PRIMARY BONE TUMORS USUALLY SINGLE
PRIMARY : SECONDARY --1: 500
MULTIPLE EXOSTOSIS
OLLIERS DISEASE
METASTASIS-from bronchus@
QUIZ
OSTEOCHONDROMA
OSTEOCHONDROMA
METAPHYSEAL
GROWS AWAY FROM THE JOINT
ANY AGE
NO CORTICAL BREAK
NORMAL CORTEX WITH WHICH IT IS CONTINUOUS
CHONDRO BLASTOMA@
CHONDROBLASTOMACARTILAGINOUS
MATRIXBEFORE EPIPHYSEAL
FUSIONNARROW ZONE OF
TRANSITIONEPIPHYSEAL
GCT
GIANT CELL TUMOUR
EPIPHYSEAL20-45 YEARSMATRIX NOT
MINERALIZEDNARROW ZONE OF
TRANSITION
OSTEOSARCOMA
OSTEOSARCOMA
15-25 YEARS2 ND PEAK AT 40+METAPHYSEALOSTEOID MATRIXCODMAN,SUNBURSTZONE OF TRANSITION
CHONDROSARCOMA
CHONDROSARCOMA 40 + AGE GROUP
MATRIX CALCIFIED
DISPROPORTIONATE SOFT TISSUE
ENDOSTEAL SCALLOPING
EWINGS SARCOMA AGE GROUP—5-30 YEARS ONION PEEL PERIOSTEAL
REACTION DD OSTEOMYELITIS WIDE ZONE OF TRANSITION DIAPHYSEAL
NO MATRIX--FIBROSARCOMA
FIBROSARCOMA
NO MINERALIZED MATRIX
LARGE SOFT TISSUE
DIAPHYSEAL
CORTICAL BREAK
OSTEOID OSTEOMA
OSTEOID OSTEOMA
SCLEROTIC
NIDUS
WELL DEFINED
NO CORTICAL BREAK
HEMANGIOMA SPINE
EWING’S SARCOMA
HEMANGIOMA
IVORY VERTEBRA
OSTEOCHONDROMA
OSTEOCHONDROMA