Analysis of focal lucent bony lesion

2,481 views

Published on

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

Published in: Health & Medicine

Analysis of focal lucent bony lesion

  1. 1. Analysis of focal lucent bony lesion Dr/Ahmed Bahnassy-M.B.CH.B.- M.D. Radiodiagnosis- Alexandria .FRCR-London
  2. 2.  Study of lucent bony lesion depends on:1.structural modification. 2.periosteal reaction. 3.tumour matrix. 4.tumoural extension.
  3. 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. 4.  Hence bony reaction to aggression can be : Lytic … Sclerotic.. Or mixed.
  5. 5. Osteolysis Analysis is based upon LODWICK criteria: Type I :Geographical lesion . Type II :moth eaten lesion .. Type Iii :peremeative bony lesion.
  6. 6. :Different types of osteolysis 
  7. 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. 8. Moth eaten lesion Formed of small multiple bony lucencies destroying the cortex . Corresponds to either infectious or malignant lesion .
  9. 9. Permeative lesion Corticaldestruction by multiple bony lucencies ,seen in tangential view . Denoting a very aggressive process .. Either malignant or infectious.
  10. 10. Sclerosis Originates from : 1.Calcified tumor matrix. 2.Osseous necrosis( infarction ,aseptic necrosis,or sequestrum )
  11. 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. 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. 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. 14. Periosteal reaction 
  15. 15.  Periosteal reaction
  16. 16. Analysis of tumour matrix 1.CT density . 2.Aspect. 3.Vascularity . 4.Locoregional extension. Osseous. Soft Tissue. Distant.
  17. 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. 18.  Loco-regional extension
  19. 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. 20.  Now some examples
  21. 21. Eccentric metaphyseal lucent lesion- GCT
  22. 22. Meta-epiphyseal eccentric lucency )with sclerotic margins (NOF
  23. 23. Metaphyseal dense lesion- Enchondroma
  24. 24. Chondroma
  25. 25. Eccentric metaphyseal lucency withcortical destruction (Telangiectatic )osteosarcoma
  26. 26. Epihyseal lucency with central )sclerosis (osteoid osteoma
  27. 27. Expanded-sclerosed vertebra )(Paget disease
  28. 28. Vertebral body lucency (mets-GCT- )Active Paget
  29. 29. Meta-diaphyseal sclerosis +ST swelling +periosteal reaction =Ewing sarcoma
  30. 30. Metaphyseal lesion withdensities and no cortical destruction !Still It was chondrosarcoma
  31. 31. Ollier disease
  32. 32. Chondroblastoma
  33. 33. Osteochondroma
  34. 34. Chondromyxoid fibroma
  35. 35. Chondromyxoid fibroma
  36. 36. Osteoblastoma
  37. 37. Giant cell tumor
  38. 38. Ewing Sarcoma
  39. 39. Soft tissue swelling ..for MRI
  40. 40. Ewing Sarcoma
  41. 41. Osteosarcoma
  42. 42. Chondro -sarcoma
  43. 43. Multiple Myeloma
  44. 44. Multiple Myeloma
  45. 45. Chordoma
  46. 46. Aneurysmal Bone cyst
  47. 47. ABC- CT
  48. 48. Eosinophilic Granuloma
  49. 49. Eosinophilic granuloma
  50. 50. Angiosracoma
  51. 51. Thank you…

×