The document discusses various radiographic clues that can help determine the nature of bone lesions. It describes clues provided by the appearance of lesions, including patterns of bone destruction (geographic, moth-eaten, permeative) and periosteal reactions. Certain appearances provide clues about benign versus malignant lesions. Location of lesions and lesion density also provide clues. Characteristic locations are described for several lesions. Sclerotic, lytic and blastic lesions have different potential underlying causes in children versus adults. Soft tissue extension is also a potential clue.

1. By
Dr.Muhammad Ben Zulfiqar(PGR-1)

2. Clues by Appearance of Lesion
Clues by Location of Lesion
Clues by Density of Lesion
Other Clues

3. Clues by Appearance of Lesion
Patterns of Bone Destruction
Periosteal Reactions
Tumor Matrix
Expansile Lesions of Bone

4. Clues by Appearance of Lesion
Patterns of Bone Destruction
Geographic
Moth-eaten
Permeative

5. Geographic Bone Destruction
Destructive lesion with sharply defined border
Implies a less-aggressive, more slow-growing, benign
process
Narrow transition zone

6. Patterns of Bone Destruction
Geographic
Moth-eaten
Permeative
Non-ossifying fibroma

7. Examples:
• Non-ossifying fibroma
• Chondromyxoid fibroma
• Eosinophilic granuloma

8. Moth-eaten Bone Destruction
Areas of destruction with ragged borders
Implies more rapid growth

Probably a malignancy

9. Patterns of Bone Destruction
Geographic
Moth-eaten
Permeative
Multiple Myeloma

10. Moth-eaten Bone Destruction
Examples:
Myeloma
Metastases
Lymphoma
Ewing’s sarcoma

11. Permeative Bone Destruction
Ill-defined lesion with multiple “worm-holes”
Spreads through marrow space
Wide transition zone
Implies an aggressive malignancy

Round-cell lesions

12. Patterns of Bone Destruction
Geographic
Moth-eaten
Permeative
Leukemia

13. Permeative Bone Destruction
Examples:
Lymphoma, leukemia
Ewing’s Sarcoma
Myeloma
Osteomyelitis
Neuroblastoma

14. Patterns of Bone Destruction
Geographic
Less malignant
Moth-eaten
Permeative
More malignant

15. Periosteal Reactions
Benign
None
Solid
More aggressive or malignant
Lamellated or onion peel
Sunburst
Codman’s triangle

16. Periosteal Reactions
• Benign
– None
– Solid
• Aggressive/malignant
– onion-peel
– Sunburst
– Codman’s triangle
Non-ossifying fibroma

17. Periosteal Reactions
• Benign
– None
– Solid
• Aggressive/malignant
– onion-peel
– Sunburst
– Codman’s triangle
Chronic osteomyelitis

18. Periosteal Reactions
• Benign
– None
– Solid
• Aggressive/malignant
– onion-peel
– Sunburst
– Codman’s triangle
Ewing sarcoma

19. Periosteal Reactions
• Benign
– None
– Solid
• Aggressive/malignant
– onion-peel
– Sunburst
– Codman’s triangle
Osteo-sarcoma

20. Periosteal Reactions
• Benign
– None
– Solid
• Aggressive/malignant
– onion-peel
– Sunburst
– Codman’s triangle

21. Periosteal Reactions
Solid
Sunburst
Less malignant
onion-peel
More malignant
Codman’s
triangle

22. Tumor Matrix
Osteoblastic
Fluffy, cotton-like or cloud-like densities
Osteosarcoma
 Cartilaginous
 Comma-shaped, punctate, annular, popcorn-like
 Enchondroma, chondrosarcoma, chondromyxoid fibroma

23. Tumor Matrix
Osteoblastic
 Cartilaginous

24. Tumor Matrix
 Osteoblastic
 Fluffy, cotton-like or cloud-like densities
as Osteosarcoma
Cartilaginous
Comma-shaped, punctate, annular, popcorn-like
as Enchondroma, chondrosarcoma,
chondromyxoid fibroma

25. Tumor Matrix
Osteoblastic
Cartilaginous
Chondrosarcoma

26. Expansile Lesions of Bone
•
•
•
•
•
•
Multiple myeloma
Mets
Brown tumor
Enchondroma
Aneurysmal bone cyst
Fibrous dysplasia

27. Expansile Lesions of Bone
Multiple
myeloma
Mets
Brown tumor
Enchondroma
Aneurysmal bone cyst
Fibrous dysplasia

28. Expansile Lesions of Bone
Multiple myeloma
Mets
Brown tumor
Enchondroma
Aneurysmal bone
cyst
Fibrous dysplasia
Renal cell carcinoma

29. Expansile Lesions of Bone
Multiple myeloma
Mets
Brown tumor
Enchondroma
Aneurysmal bone
cyst
Fibrous dysplasia

30. Expansile Lesions of Bone
Multiple myeloma
Mets
Brown tumor
Enchondroma
Aneurysmal bone
cyst
Fibrous dysplasia

31. Expansile Lesions of Bone
Multiple myeloma
Mets
Brown tumor
Enchondroma
Aneurysmal bone
cyst
Fibrous dysplasia

32. Expansile Lesions of Bone
Multiple myeloma
Mets
Brown tumor
Enchondroma
Aneurysmal bone
cyst
Fibrous dysplasia

33. Clues by Location of Lesion
•
•
•
•
In the Transverse Plane
In the Longitudinal Plane
Characteristic Locations by tumors
Characteristic Tumors by Body Site
– Pelvic Lesions
– Expansile Rib Lesions
– Lesions of the Spine

34. In the Transverse Plane
.
.
.

35. In the longitudinal Plane
Epiphyseal
GCT, chondroblastoma
Metaphyseal
Osteomyelitis, osteo-and chondrosarcoma
Diaphyseal
Round cell lesions, ABC, enchondroma

36. Characteristic Locations
Simple bone cyst
Proximal humerus
 Chondroblastoma
Epiphyses
 Giant Cell tumor
Epiphyses
 Adamantinoma
Tibia
 Chordoma
Sacrum, clivus
 Osteoblastoma
Spine, posterior

37. Characteristic Locations
 Simple bone cyst
Proximal humerus
Chondroblastoma
Epiphyses
 Giant Cell tumor
Epiphyses
 Adamantinoma
Tibia
 Chordoma
Sacrum, clivus
 Osteoblastoma
Spine, posterior

38. Characteristic Locations
 Simple bone cyst
Proximal humerus
 Chondroblastoma
Epiphyses
Giant Cell tumor
Epiphyses
 Adamantinoma
Tibia
 Chordoma
Sacrum, clivus
 Osteoblastoma
Spine, posterior

39. Characteristic Locations
 Simple bone cyst
Proximal humerus
 Chondroblastoma
Epiphyses
 Giant Cell tumor
Epiphyses
Adamantinoma
Tibia
 Chordoma
Sacrum, clivus
 Osteoblastoma
Spine, posterior

40. Characteristic Locations
 Simple bone cyst
Proximal humerus
 Chondroblastoma
Epiphyses
 Giant Cell tumor
Epiphyses
 Adamantinoma
Tibia
Chordoma
Sacrum, clivus
 Osteoblastoma
Spine, posterior

41. Characteristic Locations
 Simple bone cyst




Proximal humerus
Chondroblastoma
Epiphyses
Giant Cell tumor
Epiphyses
Adamantinoma
Tibia
Chordoma
Sacrum, clivus
Osteoblastoma
Spine, posterior

42. Clues by Density of Lesion
Sclerotic Cortical Lesions
Lytic Lesions in Children
Lytic Lesions in Adults
Blastic Lesions in Children
Blastic Lesions in Adults

43. Sclerotic Cortical Lesions
Osteoid osteoma
 Brodie’s abscess

44. Sclerotic Cortical Lesions
 Osteoid osteoma
Brodie’s abscess

45. Lytic Lesions in Children
Eosinophilic
granuloma
 Leukemia

46. Lytic Lesions in Children
 Eosinophilic granuloma
Leukemia

47. Lytic Lesions in Adults
Metastatic lesions
Lung
Renal
Thyroid
 Multiple myeloma
 Primary bone tumor
Metastatic thyroid carcinoma

48. Lytic Lesions in Adults
 Metastatic lesions
 Lung
 Renal
 Thyroid
Multiple myeloma
 Primary bone tumor

49. Lytic Lesions in Adults
 Metastatic lesions
 Lung
 Renal
 Thyroid
 Multiple myeloma
Primary bone tumor
Chondrosarcoma

50. Blastic Lesions in Children
Lymphoma

51. Blastic Lesions in Adults
Metastatic disease
Breast
–female
Prostate –male
 Lymphoma
 Paget’s disease
 Fluorosis
Prostatic Ca.

52. Blastic Lesions in Adults
 Metastatic disease
Breast –female
 Prostate –male

Lymphoma
 Paget’s disease
 Fluorosis

53. Blastic Lesions in Adults
 Metastatic disease
Breast –female
 Prostate –male
 Lymphoma

Paget’s disease
 Fluorosis

54. Blastic Lesions in Adults
 Metastatic disease
Breast –female
 Prostate –male
 Lymphoma
 Paget’s disease

Fluorosis

55. Other Clues
Soft Tissue Extension
Benign vs. Malignant

56. Soft Tissue Extension
Usually implies malignancy

More likely to form discrete soft tissue mass
Benign conditions with soft tissue extension

Osteomyelitis
 Usually infiltration of fat

57. Soft Tissue Extension
Lymphoma
Osteosarcoma

58. Benign vs. Malignant

59. Thank You