Analysis of focal lucent bony lesion

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This lecture explains the approach to focal lucent bony lesion in plain radiograph with different examples to illustrate the steps of thinking.

This lecture explains the approach to focal lucent bony lesion in plain radiograph with different examples to illustrate the steps of thinking.

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  • 1. Analysis of focal lucent bony lesion Dr/Ahmed Bahnassy-M.B.CH.B.- M.D. Radiodiagnosis- Alexandria .FRCR-London
  • 2.  Study of lucent bony lesion depends on:1.structural modification. 2.periosteal reaction. 3.tumour matrix. 4.tumoural extension.
  • 3. Structural modification The bone reacts to any form of aggression by either : 1.stimulation of osteoclasts ..leading to osteolysis. 2.stimulation of osteoblasts..leading to sclerosis.
  • 4.  Hence bony reaction to aggression can be : Lytic … Sclerotic.. Or mixed.
  • 5. Osteolysis Analysis is based upon LODWICK criteria: Type I :Geographical lesion . Type II :moth eaten lesion .. Type Iii :peremeative bony lesion.
  • 6. :Different types of osteolysis 
  • 7. Geographical bony lesion Focal lesion ,well defined, rounded, lobulated or polygonal Can be divided to 3 sub types : IA: sclerotic margins denoting slowly progressive lesion (bone cyst ,NOF ,Fibrous dysplasia) IB: well defined ,non sclerotic margins ,denoting more rapid ,but still benign lesion (GCT, Chondromyxoid fibroma). IC :ill defined border denoting rapidly evoluting lesion (Malignant or infectious)
  • 8. Moth eaten lesion Formed of small multiple bony lucencies destroying the cortex . Corresponds to either infectious or malignant lesion .
  • 9. Permeative lesion Corticaldestruction by multiple bony lucencies ,seen in tangential view . Denoting a very aggressive process .. Either malignant or infectious.
  • 10. Sclerosis Originates from : 1.Calcified tumor matrix. 2.Osseous necrosis( infarction ,aseptic necrosis,or sequestrum )
  • 11. Mixed processes Geographical osteolyis ,surrounded by dense sclerosis: Denotes slowly progressive lesion (osteoid osteoma,Osteoblastoma or chronic osteitis ) Complex ,disorganized lesion formed of lytic and sclerotic areas almost always with malignant or infectious pathologies
  • 12. Periosteal reaction Periosteal agression by a bony lesion (or less frequently soft tissue lesion )leads to osteogenesis from subperiosteal osteoblasts . Manifested 2-4 weeks after beginning of the process.
  • 13. :Types of periosteal reaction 1.Solid homogenous. 2.Remodelled reaction. 3.continuous-separate from the cortex(uni or multi-lamellar). 4.Spiculated reaction (sun ray..brush border) 5.discontinuous periosteal reaction.
  • 14. Periosteal reaction 
  • 15.  Periosteal reaction
  • 16. Analysis of tumour matrix 1.CT density . 2.Aspect. 3.Vascularity . 4.Locoregional extension. Osseous. Soft Tissue. Distant.
  • 17. :Types of tumor matrix Osseous matrix :geographic ,lytic ,CT =100-1000 HU,MRI =hypo in all sequences Cartilaginous matrix : lobulated with flocculant calcifications ring and C- shaped, hypo T1,hyper T2 in MRI. Others :Cystic, fatty,homogenous ,heterogenous .
  • 18.  Loco-regional extension
  • 19. Diagnostic orientation : 1.Age :after 40 years-infants. 2.Sex: 3.Clinical presentation:4.Location :long or flat bones-epi, meta or diaphyseal-central .or eccentric
  • 20.  Now some examples
  • 21. Eccentric metaphyseal lucent lesion- GCT
  • 22. Meta-epiphyseal eccentric lucency )with sclerotic margins (NOF
  • 23. Metaphyseal dense lesion- Enchondroma
  • 24. Chondroma
  • 25. Eccentric metaphyseal lucency withcortical destruction (Telangiectatic )osteosarcoma
  • 26. Epihyseal lucency with central )sclerosis (osteoid osteoma
  • 27. Expanded-sclerosed vertebra )(Paget disease
  • 28. Vertebral body lucency (mets-GCT- )Active Paget
  • 29. Meta-diaphyseal sclerosis +ST swelling +periosteal reaction =Ewing sarcoma
  • 30. Metaphyseal lesion withdensities and no cortical destruction !Still It was chondrosarcoma
  • 31. Ollier disease
  • 32. Chondroblastoma
  • 33. Osteochondroma
  • 34. Chondromyxoid fibroma
  • 35. Chondromyxoid fibroma
  • 36. Osteoblastoma
  • 37. Giant cell tumor
  • 38. Ewing Sarcoma
  • 39. Soft tissue swelling ..for MRI
  • 40. Ewing Sarcoma
  • 41. Osteosarcoma
  • 42. Chondro -sarcoma
  • 43. Multiple Myeloma
  • 44. Multiple Myeloma
  • 45. Chordoma
  • 46. Aneurysmal Bone cyst
  • 47. ABC- CT
  • 48. Eosinophilic Granuloma
  • 49. Eosinophilic granuloma
  • 50. Angiosracoma
  • 51. Thank you…