7. ENCHONDROMA
Intramedullary neoplasm comprising lobules of benign
hyaline cartilage.
Enchondromas typically affect the tubular bones of hand and
feet.
The lesions are metaphyseal or diaphyseal.
12. CHONDROMYXOID FIBROMA
Extremely rare, benign cartilaginous neoplasm.
Occurring in 2nd to 3rd decade of life.
Pathologically comprises of variable combination of
chondroid, myxoid and fibrous tissue component
organized in psudolobulated architecture.
14. OSTEOID OSTEOMA
CT demonstrates the classical features of a
round or oval soft tissue density nidus, which
commonly shows central dense
mineralization.
‘vascular grove sign’ which is manifested by
thin, serpentine channel in the thickened
bone surrounded by nidus.
15. MRI demonstrate heterogeneously low-
intermediate signal intensities on T1WI and
T2WI and enhancing strongly on
administration of intravenous contrast
media
17. OSTEOBLASTOMA
Possesses histological similarities with osteoid osteoma and
is differentiated primarily by its size, being greater than 1.5
cm in diameter.
Humerus is the commonest location in appendicular skeleton
and lesion arises in medullary cavity.
20. FIBROUS CORTICAL DEFECT
It as incidental finding, appearing as cortical based lytic lesion
commonly with a thin sclerotic margins.
Most commonly identified in the distal femur and proximal
tibial metaphysis.
Lesion typically fade with the time.
22. NON OSSIFYING FIBROMA
-The lesions are metaphyseal or diametaphyseal and
essentially intracortical
-Lobular appearance is classical with the lesion usually
enlarging into medullary cavity.
-The tumor is oval with its long axis in the line of bone
23. Axial PD FSE and coronal T2WI MR images showing a
lobular lesion containing prominent areas of
hypointensity due to its fibrous nature.
25. GIANT CELL TUMOR
it is an aggressive benign neoplasm accounting for
approximately 20% benign bone tumors.
Approximately 80% cases occurs between 18 and 45 years
of age with male : female ratio of 2:3
The tumor nearly always occurs in subarticular or subcortical
region(adjacent to fused apophysis of long bone)
Knee is the common site for tumor
26. On MRI lesion is iso-hypointense on T1WI and
shows heterogenous hyperintensity on STIR
Areas of hyperintensity on T1WI indicate the
presence of subacute hemorrhage
28. SIMPLE BONE CYST/ UNICAMERAL BONE CYST
Usually present between the age of 5 to 15 years.
The proximal humerus is most common site.
Initially SBC’s are located in the proximal metaphysis and
progress towards diaphysis.
30. ANEURYSMAL BONE CYST
Primary ABC present in second decade of life
Long bones and spine is most commonly involved.
Secondary ABC can be developed in variety of benign or
maliganent lesions, including NOF, GCT, FD, osteoblastoma,
osteosarcoma.
33. GENERAL CHARACTERISTICS OF BONE TUMOURS
Age at presentation
Primary bone tumors are rare below the age of 5 years and
over the age of 40 years
Metastasis are commonest lesion over the age of 40 years.
34. RADIOLOGICAL ASSEMENT OF BONE TUMOURS
Location
The location of lesion within skeleton(appendicular, axial) and
within the individual bone(epiphysis, metaphysis ,
diaphysis;intramedullary, intracortical, surface ) must be
considered since it has a influence on differential diagnosis
35. Rate of growth
Lesion margin is important feature of rate of growth
In benign neoplasm margin is sharp(Geographical ; Type 1)
Type 1A has rim of sclerosis between lesion and host bone
36. Type 1B is very well defined lytic lesion but with no marginal
sclerosis
37. Type 1C has less sharp and non-sclerotic margin
38. Periosteal Reaction
Helps to indicate aggressiveness of lesion
(A)Solid periosteal reaction- well formed periosteal reaction
- indicate slow rate of growth
65. OSTEOGENIC TUMOURS
Osteoid Osteoma
-Small benign vascular osteoblastic tumor
-most patients present in 2nd and 3rd decade of life and
male:female ratio is 2-3:1
-it is most common in appendicular skeleton with over
50% located in diaphysis or metaphysis of tibia or femur
66. Radiological features
-Characteristic feature is nidus which may appear lytic,
sclerotic or most commonly of mix density depending
upon degree of central mineralization.
-nidus is commonly surrounded by region of reactive
medullary sclerosis and solid periosteal reaction
-
67. CT demonstrates the classical features of a round or
oval soft tissue density nidus, which commonly shows
central dense mineralization.
‘vascular grove sign’ which is manifested by thin,
serpentine channel in the thickened bone surrounded
by nidus.
68. MRI demonstrate heterogeneously low- intermediate signal
intensities on T1WI and T2WI and enhancing strongly on
administration of intravenous contrast media
69. OSTEOBLASTOMA
- Histologically similar to osteoid osteoma and is differentiated
by its size, being typically grater than 1.5 cm in diameter
- It shows more aggressive growth pattern with potential for
extra osseous extension
- Over 80% patients are under the age of 30 years.
- Humerus is the commonest location in appendicular skeleton
and the lesion arises in the medullary cavity.
70. Radiological features
-The lesion is predominantly lytic, measuring over 2cm in
diameter, with largest lesion showing greater degree of
matrix mineralization.
-CT reveal occult calcification, which can be punctate,
nodular or generalized
-larger lesion may result in bone expansion with or without
surrounding shell of reactive bone.
71. FIBROHISTIOCYTIC TUMOURS
Fibrous cortical defect
-It as incidental finding, appearing as cortical based lytic lesion
commonly with a thin sclerotic margins.
-Most commonly identified in the distal femur and proximal
tibial metaphysis.
-Lesion typically fade with the time.
72. Non ossifying fibroma
Benign neoplasm which is commonly identified
incidentally or may present with pathological fracture
-patients usually presents in second decade of life and
slight male preponderance is recorded
-majority(90%) involve lower limb,particularly tibia and
distal end of femur
73. Radiological features
-The lesions are metaphyseal or diametaphyseal and
essentially intracortical
- Lobular appearance is classical with the lesion usually
enlarging into medullary cavity.
- The tumor is oval with its long axis in the line of bone
74. On MRI NOF shows low-intermediate SI on T2WI
On T1WI lesion is hypointense ,but marginal with
marginal or septal hyperintensity and the remainder are
hypointense
75. GIANT CELL TUMOUR
Giant cell tumor
it is an aggressive benign neoplasm accounting for
approximately 20% benign bone tumors.
Approximately 80% cases occurs between 18 and 45 years
of age with male : female ratio of 2:3
The tumor nearly always occurs in subarticular or subcortical
region(adjacent to fused apophysis of long bone)
Knee is the common site for tumor
76. Radiological features
GCT is classically a subarticular ,eccentric, lytic lesion
with geographic, nonsclerotic margin
Poorly defined margin indicates more aggressive lesion
77. On MRI is iso-hypointense on T1WI and shows
heterogenous hyperintensity on STIR
Areas of hyperintensity on T1WI indicate the presence
of subacute hemorrhage
78. VASCULAR TUMOURS
Haemangioma
-Congenital vascular malformation
-May present as isolated bone lesion
-classified histologically as capillary, cavernous, arteriovenous
or venous.
-osseous capillary hemangioma most commonly affect
vertebral body and osseous cavernous hemangioma affect the
skull vault
79. Radiological features
-In vertebral lesions fine or coarse vertical trabeculation
is seen.
-hemangioma involving the epiphyses or metaphyses
linear striation running along the axis of long bone
CT demonstrates the thickened trabeculae as dense
“dot” with in fatty matrix
88. Fibrous Dysplasia
May either momostotic or polyostotic
75% cases present before age of 30 years
Radiological feature
-Geographic lesion that may cause bone expansion
and deformity with diffuse ground glass matrix
mineralization
-Thick sclerotic margin “rind sign” is characteristic
-Metadiaphyseal region is typically affected
89. CT
Demonstrates the ground glass matrix
MRI
On T1WI lesions are isointense but may shows areas of
mild hyperintensity due to hemorrhage.
On T2WI lesions may be isointense or hyperintense
lateral radiograph of distal femur showing pedunculated osteochondroma. Noted in metaphyseal region projecting away from epiphysis.
Radiograph of finger showing expansile lesion with typical chondral matrix calcification. Narrow zone of transition .
Eccentric, lytic, lobulated ,radiolucent lesion with well defined sclerotic margins parallel to long axis of bone.
d/d chondromyxoid fibroma, ABC, GCT,NOF.
Lateral radiograph of tibia showing thickening of cortex within which there is small calcified nidus,
AP radiograph of left proximal humerus showing a large mixed lytic and sclerotic lesion in medullary cavity
AP radiograph of proximal tibia showing a small elongated lytic lesion in medial proximal tibial metaphysis with thin sclerotic margins.
AP radiograph of the ankle showing lobular lesion expanding distal fibular metadiaphysis.
AP radiograph of wrist showing a distal radial subarticular ,eccentric, lytic lesion with internal trabeculation.
AP radiograph of left proximal humerus showing sharply demarcated radiolucent lesion, expands bone with thining of overlying bone.
Fallen fragment sign is seen which is dependent bony fragment with in lesion
AP radiograph of proximal tibia lesion with thin sclerotic margin located eccentrically within proximal tibial metaphysis.
