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

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 with
cortical 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 with
densities 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
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